Full Text Available Background. The Latin American region is undergoing a demographic and epidemiological transition, which is leading to an increase in chronic and degenerative diseases. Osteoporosis (OP and fragility fractures (FF are emerging as main causes of disease burden with great impact on health institutions. Purpose. This review article provides an updated overview of trends in the epidemiology and economic impact of OP and FF, as well as in diagnosis and available treatments in Latin America, including calcium, vitamin D and prevention programs. Methods. Expert panel. Conclusions. According to this review, there is a lack of epidemiological and economic information in the region. It is desirable to obtain information regarding quality of life in OP and FF as well as to highlight prevention as a tool to reduce FF.
Williams, Gary M; Berry, Colin; Burns, Michele; de Camargo, Joao Lauro Viana; Greim, Helmut
Glyphosate has been rigorously and extensively tested for carcinogenicity by administration to mice (five studies) and to rats (nine studies). Most authorities have concluded that the evidence does not indicate a cancer risk to humans. The International Agency for Research on Cancer (IARC), however, evaluated some of the available data and concluded that glyphosate probably is carcinogenic to humans. The expert panel convened by Intertek assessed the findings used by IARC, as well as the full body of evidence and found the following: (1) the renal neoplastic effects in males of one mouse study are not associated with glyphosate exposure, because they lack statistical significance, strength, consistency, specificity, lack a dose-response pattern, plausibility, and coherence; (2) the strength of association of liver hemangiosarcomas in a different mouse study is absent, lacking consistency, and a dose-response effect and having in high dose males only a significant incidence increase which is within the historical control range; (3) pancreatic islet-cell adenomas (non-significant incidence increase), in two studies of male SD rats did not progress to carcinomas and lacked a dose-response pattern (the highest incidence is in the low dose followed by the high dose); (4) in one of two studies, a non-significant positive trend in the incidence of hepatocellular adenomas in male rats did not lead to progression to carcinomas; (5) in one of two studies, the non-significant positive trend in the incidence of thyroid C-cell adenomas in female rats was not present and there was no progression of adenomas to carcinomas at the end of the study. Application of criteria for causality considerations to the above mentioned tumor types and given the overall weight-of-evidence (WoE), the expert panel concluded that glyphosate is not a carcinogen in laboratory animals.
Hora, Stephen; Jensen, Mikael (eds.)
The Swedish Radiation Protection Authority, the Swedish Nuclear Power Inspectorate and the Swedish Nuclear Fuel and Waste Management Company have jointly carried out a project on expert panel elicitation on the issue of glacial induced Swedish earthquakes. Following a broad nomination procedure, 5 experts were chosen by a selection committee of 4 professors within Earth sciences disciplines. The 5 experts presented judgments about the frequency of earthquakes greater the magnitude 6 within 10 km for two Swedish sites, Oskarshamn and Forsmark, in connection with a glaciation cycle. The experts' median value vas 0,1 earthquakes for one glaciation cycle.
Louis, G.M. Buck; Jr, L.E. Gray; Marcus, M.
Serono Symposia International convened an expert panel to review the impact of environmental influences on the regulation of pubertal onset and progression while identifying critical data gaps and future research priorities. An expert panel reviewed the literature on endocrine-disrupting chemicals...... initiatives include (1) etiologic research that focus on environmentally relevant levels of endocrine-disrupting chemicals and body size in relation to normal puberty as well as its variants, (2) exposure assessment of relevant endocrine-disrupting chemicals during critical windows of human development......-onset disease Udgivelsesdato: 2008/2...
When members were first canvassed for participation in the Vadose Zone Expert Panel the stated purpose for convening the Panel was to review a controversial draft report, the SX Tank Farm Report. This report was produced by a DOE Grand Junction Project Office (GJPO) contractor, RUST Geotech, now MACTEC-ERS, for the DOE Richland Office (DOERL). Three meetings were planned for June, July and August, 1995 to review the draft report and to complete a Panel report by mid-September. The Expert Panel has found its efforts confounded by various non-technical issues. The Expert Panel has chosen to address some of the non-technical issues in this Preface rather than to dilute the technical discussion that follows in the body of this independent expert panel status report (Panel Report). Rather than performing a straightforward manuscript review, the Panel was asked to resolve conflicting interpretations of gamma-ray logging measurements performed in vadose zone boreholes (drywells) surrounding the high-level radioactive wastes of the SX tank farm. There are numerous and complex technical issues that must be evaluated before the vertical and radial extent of contaminant migration at the SX tank farm can be accurately assessed. When the Panel first met in early June, 1996, it quickly became apparent that the scientific and technical issues were obscured by policy and institutional affairs which have polarized discussion among various segments of the Hanford organization. This situation reflects the kinds of institutional problems described separately in reports by the National Research Council of the National Academy of Sciences (NAS/NRC), The Hanford Tanks Environmental Impacts and Policy Choices and BmTiers to Science: Technical Management of the Department of Energy Environmental Remediation Program. The Vadose Zone Characterization Program, appears to be caught between conflicting pressures and organizational mandates, some imposed from outside DOE-RL and some self
Hayat, Matthew J; Eckardt, Patricia; Higgins, Melinda; Kim, MyoungJin; Schmiege, Sarah J
Statistics education is a necessary element of nursing education, and its inclusion is recommended in the American Association of Colleges of Nursing guidelines for nurse training at all levels. This article presents a cohesive summary of an expert panel discussion, "Teaching Statistics to Nursing Students," held at the 2012 Joint Statistical Meetings. All panelists were statistics experts, had extensive teaching and consulting experience, and held faculty appointments in a U.S.-based nursing college or school. The panel discussed degree-specific curriculum requirements, course content, how to ensure nursing students understand the relevance of statistics, approaches to integrating statistics consulting knowledge, experience with classroom instruction, use of knowledge from the statistics education research field to make improvements in statistics education for nursing students, and classroom pedagogy and instruction on the use of statistical software. Panelists also discussed the need for evidence to make data-informed decisions about statistics education and training for nurses. Copyright 2013, SLACK Incorporated.
Hyrkäs, Kristiina; Appelqvist-Schmidlechner, Kaija; Oksa, Lea
Use of research instruments standardised in English-speaking countries is commonplace in non-English speaking countries. This article describes technical, linguistic and conceptual issued raised in the translation and validation of an acceptable country-specific instrument. The Manchester Clinical Supervision Scale was validated for use in clinical supervision in Finland using quantitative and qualitative methods. The approach applied was triangulation. The focus of this paper, is to describe the item validation process of the scale using an expert panel (n=11) by means of the content validity index and panel interview. The process resulted in a country-specific 33-item instrument. The study indicated that content validity index and panel discussion are easy, but reliable ways of demonstrating the instrument's content validity.
Kuntz, K M; Tsevat, J; Weinstein, M C; Goldman, L
Expert panels and decision-analytic techniques are increasingly used to determine the appropriateness of medical interventions, but these 2 approaches use different methods to process evidence. To compare expert panel appropriateness ratings of coronary angiography after myocardial infarction (from the time of hospital discharge to 12 weeks after infarction) with the health gains and cost-effectiveness predicted by a decision-analytic model. Comparison of the degree of importance of the clinical variables considered in expert panel appropriateness ratings vs a previously published decision-analytic model. Identification of 36 clinical scenarios from the expert panel that could be simulated by the decision-analytic model. Appropriateness score and appropriateness classification (expert panel) vs gain in quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (decision-analytic model). The most important clinical variables were similar in the 2 approaches, with the exercise tolerance test result exerting the greatest leverage on strength of recommendation for angiography. Among the expert panel clinical scenarios considered to be appropriate for coronary angiography that could be simulated in the decision-analysis model, the median (interquartile range) health gain and incremental cost-effectiveness ratio were 0.59 (0.41-0.76) QALYs and $27000 ($23000-$35000) per QALY gained, respectively. Among the clinical scenarios that expert panels considered inappropriate, the corresponding medians (interquartile ranges) were 0.24 (0.19-0.34) QALYs and $54000 ($36000-$58000) per QALY gained. The Spearman rank correlation between appropriateness score and QALY gain was 0.58 (Pappropriateness score and estimated incremental cost-effectiveness ratios was -0.66 (Pappropriateness score and both the health gain and the incremental cost-effectiveness ratio of coronary angiography compared with no angiography in the convalescent phase of acute myocardial infarction
Hermans, M H E; Cutting, K
To investigate the similarities and differences between Hydration Response Technology (HRT) and negative pressure wound therapy (NPWT) with regard to wound bed preparation, and to devise a set of recommendations for their use on the basis of the opinion of two panels. An expert panel that analysed in vitro and clinical data as well as the similarities and differences between the two modalities was established. This culminated in a series of recommendations on which modality to use for which indication. These recommendations were presented to a Delphi panel, consisting of users of both NPWT and HRT-dressing. The panel was then asked to produce its own recommendations. The outcomes and recommendations of both panels were reported. NPWT is the preferred treatment modality for abdominal dehisced wounds, and to a lesser extent, for surgical wound healing by secondary intention. For all other indications, the treatment modalities are at least equal, with HRT-dressing often being the superior mode to treat wounds such as venous leg ulcers, arterial ulcers and vasculitis. In the opinion of the expert panel and the Delphi panel, both modalities share a number of clinical and non-clinical properties. However, because of the numerous advantages of HRT technology, HRT dressing has the potential to replace NPWT in a number of indications, where the patient, health-care providers and institutions may benefit. This study was sponsored by Sorbion GmbH & Co, Senden, Germany. Authors M. Hermans and K. Cutting are consultants to Sorbion GmbH & Co, Senden, Germany.
Dufour, B; Plée, L; Moutou, F; Boisseleau, D; Chartier, C; Durand, B; Ganière, J P; Guillotin, J; Lancelot, R; Saegerman, C; Thébault, A; Hattenberger, A M; Toma, B
Risk assessment can be either quantitative, i.e. providing a numeric estimate of the probability of risk and the magnitude of the consequences, or qualitative, using a descriptive approach. The French Agency for Food, Environmental and Occupational Health and Safety (ANSES), formerly the French Food Safety Agency (AFSSA), bases its assessments on the opinions of scientific panels, such as the ANSES Animal Health Scientific Panel (AH-SP). Owing to the lack of relevant data and the very short period of time usually allowed to assess animal health risks on particular topics, this panel has been using a qualitative risk method for evaluating animal health risks or crises for the past few years. Some experts have drawn attention to the limitations of this method, such as the need to extend the range of adjectives used for the lower probabilities and to develop a way to assess consequences. The aim of this paper is to describe the improved method now established by the AH-SP, taking into account the limitations of the first version. The authors describe a new set of levels for probabilities, as well as the items considered when addressing either animal or human health consequences.
Tempero, M A; Berlin, J; Ducreux, M; Haller, D; Harper, P; Khayat, D; Schmoll, H-J; Sobrero, A; Van Cutsem, E
Pancreatic cancer has proven extremely challenging to treat. A collaborative effort is needed to advance research and improve treatment. An expert conference was conducted to elicit perspectives regarding the current treatment and future research of pancreatic cancer. The conference comprised an international panel of experts representing five European countries and the United States. Adjuvant radiotherapy is used more frequently in the United States than in Europe. In locally advanced disease, there is now more emphasis on early chemotherapy in both Europe and the United States. In metastatic disease, combination chemotherapy is commonly used in Europe and the United States. This varies by country. Advancing pancreatic research will require improving biorepositories and developing a roadmap to prioritize therapeutic targets in different models. Small randomized phase II trials of both non-selected and enriched patient populations will help identify activity of new agents. Phase III trials should only be initiated in appropriate patients based on strong clinical and biological signals. Developing drugs in the adjuvant setting may be preferable to eliminate some of the challenges of drug development in the advanced disease setting. Progress in research combined with encouraging improvements from the past offer hope for the future of pancreatic cancer patients.
Brusick, David; Aardema, Marilyn; Kier, Larry; Kirkland, David; Williams, Gary
In 2015, the International Agency for Research on Cancer (IARC) published a monograph concluding there was strong evidence for genotoxicity of glyphosate and glyphosate formulations and moderate evidence for genotoxicity of the metabolite aminomethylphosphonic acid (AMPA). These conclusions contradicted earlier extensive reviews supporting the lack of genotoxicity of glyphosate and glyphosate formulations. The IARC Monograph concluded there was strong evidence of induction of oxidative stress by glyphosate, glyphosate formulations, and AMPA. The Expert Panel reviewed the genotoxicity and oxidative stress data considered in the IARC Monograph, together with other available data not considered by IARC. The Expert Panel defined and used a weight of evidence (WoE) approach that included ranking of studies and endpoints by the strength of their linkage to events associated with carcinogenic mechanisms. Importantly, the Expert Panel concluded that there was sufficient information available from a very large number of regulatory genotoxicity studies that should have been considered by IARC. The WoE approach, the inclusion of all relevant regulatory studies, and some differences in interpretation of individual studies led to significantly different conclusions by the Expert Panel compared with the IARC Monograph. The Expert Panel concluded that glyphosate, glyphosate formulations, and AMPA do not pose a genotoxic hazard and the data do not support the IARC Monograph genotoxicity evaluation. With respect to carcinogenicity classification and mechanism, the Expert Panel concluded that evidence relating to an oxidative stress mechanism of carcinogenicity was largely unconvincing and that the data profiles were not consistent with the characteristics of genotoxic carcinogens.
O'Donovan, A; Mohile, S G; Leech, M
Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. © 2015 John Wiley & Sons Ltd.
O'Donovan, A.; Mohile, S.G.; Leech, M.
Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457
The National Toxicology Program Center for the Evaluation of Risks to Human Reproduction (NTP-CERHR) convened an expert panel in May 2004 to evaluate acrylamide. The report of the expert panel, prepared in accordance with CERHR Guidelines, provides a detailed summary of all publi...
Barros, Pedro Pita
The European Commission created the Expert Panel on Effective Ways of Investing in Health (EXPH) in 2012. The EXPH started its activities in July 2013 and ended its first term in May 2016. A personal review of the Expert Panel contributions in its first term is provided.
Inmaculada López Martín
Full Text Available The implementation of a quality Tutorial Action Plan (TAP, in which the integral formation of students is the main objective, is a topical issue in the Spanish university environment . This paper aims to identify the actions contemplated in the TAPs of different Spanish universities and catalog the different types of activities performed by the teachers-tutors in the context of tutorial action. To achieve this, the authors conducted a qualitative analysis based on expert panels. As a result, three main vectors were extracted: Standard elements in a college TAP, critical aspects from tutors and managers of tutorial actions, and tutorial actions with a seal of quality. From the analysis it was concluded that quality tutorial action is the basis for academic excellence. Its achievement requires to clarify and recognize the role of the tutor, adjust appropriately the ratio of students allocated per tutor, and promote the development of transversal skills in students. For this, the authors propose a cross-coordination among teachers, as well as counseling and support; tutor training and professionalism; and the application of working methods that allow proper guidance and monitoring of students. ----------------------------- Estudio Cualitativo sobre Tutoría Universitaria a Través del Método de Panel de Expertos Resumen La implantación de un plan de acción tutorial (PAT de calidad, en el cual la formación integral del alumnado sea lo principal, es un tema de actualidad en el entorno universitario español. El presente trabajo persigue identificar las acciones contempladas en los PAT de diferentes universidades españolas, así como catalogar los diferentes tipos de actividades realizadas por los profesores-tutores en el contexto de la acción tutorial. Para ello se realizó un análisis cualitativo basado en paneles de expertos. Como resultado, se extrajeron tres vectores principales: Elementos habituales en un PAT universitario; Aspectos cr
Sharifi, Hooman; Hessami, Zahra; Masjedi, Mohammad Reza
Iran signed the Framework Convention on Tobacco Control on June 16, 2003 and it was ratified by the parliament and the House of Representatives on November 6, 2005. Finally, it came into force on February 4, 2006. In this study, we aimed to evaluate health experts' opinion about tobacco control activities in Iran. This was a qualitative case study. We used a series of open-ended questionnaires to assess important information regarding Iranian National Tobacco Control law and FCTC implementation. The study population comprised of health experts. Use of this method ensured the validity of questionnaires' contents. The first round of the questionnaire had been pre-tested in a pilot study. The final structure and lay out of questionnaires consisted of three main parts. The first part was designed with 7 multiple choice questions. Participants were able to rank answers from five (the most important) to one (the least important). The second part comprised four questions mainly on National Tobacco Control Program (NTCP) and the final part was about FCTC. Data collection was carried out between May 2010 and May 2011. In the analysis process each interview was considered as a separate case and then compared to other cases to ascertain variations in answers. All 40 members (100%) of the panel completed the entire process. All the participants had a consensus on tobacco control program in Iran. They believed the prevention programs to be important priorities in this regard. Tobacco Company as a governmental organization is believed to be the main barrier against tobacco control activities in Iran, and banning sales of tobacco to minors and controlling its smuggling are important factors for decreasing the supply of tobacco products. It is essential to implement comprehensive tobacco control law in Iran. It is essential to implement comprehensive tobacco control law in Iran that covers all the priorities mentioned above. Considering the chronological aspect of law
of Biphasic Insulin Aspart 30 treatment has been published recently, these types of guidelines cannot always respond to all of the local requirements. Therefore, it is aimed to prepare a guideline to facilitate the use of Biphasic Insulin Aspart 30 in the right patient, at the right time and in the right manner, as well as to help the physicians. A guideline, aiming to contain current evidences and to meet local requirements, was developed in May and June 2010 by an expert panel composed of experienced endocrinologists working at different parts of Turkey. The guideline includes initial treatment, optimization of initiation dose, and intensification of Biphasic Insulin Aspart 30 during the disease progression. Although previously published global guidelines about initiation, intensification, dose division, dose addition and combination of Biphasic Insulin Aspart 30 with OADs is in applicable situation in general, the content is enlarged by adding some special conditions. Administration information presented in this article forms simply a suggestion rather than a strict recommendation. Since the treatment of every diabetic patient should be individualized, suggestions of this guideline do not have any obligatory power on physicians. Turk Jem 2011; 15: 65-70
The Expert Panel Oversight Committee (EPOC) has been overseeing the implementation of selected parts of Recommendation III of the final report, Expert Panel workshop for Hanford Site Double-Shell Tank Waste Chemistry Optimization, RPP-RPT-22126. Recommendation III provided four specific requirements necessary for Panel approval of a proposal to revise the chemistry control limits for the Double-Shell Tanks (DSTs). One of the more significant requirements was successful performance of an accelerated stress corrosion cracking (SCC) experimental program. This testing program has evaluated the optimization of the chemistry controls to prevent corrosion in the interstitial liquid and supernatant regions of the DSTs.
van der Plas Annicka G M
Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.
Beatty, Mark E.; Beutels, Philippe; Meltzer, Martin I.; Shepard, Donald S.; Hombach, Joachim; Hutubessy, Raymond; Dessis, Damien; Coudeville, Laurent; Dervaux, Benoit; Wichmann, Ole; Margolis, Harold S.; Kuritsky, Joel N.
Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease. PMID:21363989
Hayat, Matthew J; Higgins, Melinda; Schwartz, Todd A; Staggs, Vincent S
This article summarizes an expert panel discussion, "Statistical Challenges in Nursing Research," conducted at the 2013 Joint Statistical Meetings. The panel consisted of doctorally prepared statisticians with faculty appointments in United States-based academic nursing programs. The discussion centered on challenges concerning the use of statistics in nursing education and research. Five domains were identified, including perceptions about statistics, statisticians' roles and responsibilities, interdisciplinary collaboration between statisticians and nurse investigators, statistics education, and the use of statistics in the nursing literature.
Viral hemorrhagic septicemia virus (VHSV) is an OIE-listed pathogen of fish, recently expanding in known host and geographic range in North America. Through a group process designed for subjective probability assessment, an international panel of fish health experts identified and weighted risk factors perceived important to the emergence and spread of the viral genotype, VHSV IVb, within and from the Great Lakes region of the US and Canada. Identified factors included the presence of known VHSV-susceptible species, water temperatures conducive for disease, hydrologic connectivity and proximity to known VHSV-positive areas, untested shipments of live or frozen fish from known positive regions, insufficient regulatory infrastructure for fish health oversight, and uncontrolled exposure to fomites associated with boat and equipment or fish wastes from known VHSV-positive areas. Results provide qualitative insights for use in VHSV surveillance and risk-management planning, and quantitative estimates of contextual risk for use in a Bayesian model combining multiple evidence streams for joint probability assessment of disease freedom status. Consistency checks suggest that the compiled factors positively reflect expert judgment of watershed risk for acquiring VHSV IVb. External validation is recommended as the availability of empirical data permits.
Plas, A.G. van der; Onwuteaka-Philipsen, B.D.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Deliens, L.
ABSTRACT: BACKGROUND: Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel
van der Plas, A.G.M.; Onwuteaka-Philipsen, B.D.; van de Watering, M.; Jansen, W.J.J.; Vissers, K.C.; Deliens, L.
Background: Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure
A manuscript describes the results of an expert panel meeting of the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR). The purpose CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects ...
Deprez, P H; Bergman, J J; Meisner, S
Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes...... of cases, no description of training programs, and few published reports. In 2008, a panel of experts gathered in Rotterdam to discuss indications, training, and the wider use of ESD. The panel of experts and participants reached a consensus on five general statements: 1) ESD aims at treating mucosal...... level, and should include information on indication (Paris classification of lesion, location, and histological results prior to treatment), technique used (e.¿g. type of knife), results (en bloc and R0 resection), complications, and follow-up. The panel also agreed on minimal institutional requirements...
Martin, Judith A.; Campbell, Anthony; Killip, Thomas; Kotz, Margaret; Krantz, Mori J.; Kreek, Mary Jeanne; McCarroll, Brian A.; Mehta, Davendra; Payte, J. Thomas; Stimmel, Barry; Taylor, Trusandra; Wilford, Bonnie B.
In an effort to enhance patient safety in Opioid Treatment Programs (OTPs), the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone. Panel members reviewed the literature, regulatory actions, professional guidances, and OTPs’ experiences regarding adverse cardiac events associated with methadone. The Panel concluded that, to the extent possible, every OTP should have a universal Cardiac Risk Management Plan (incorporating clinical assessment, ECG assessment, risk stratification, and prevention of drug interactions) for all patients, and should strongly consider patient-specific risk minimization strategies (such as careful patient monitoring, obtaining ECGs as indicated by a particular patient’s risk profile, and adjusting the methadone dose as needed) for patients with identified risk factors for adverse cardiac events. The Panel also suggested specific modifications to informed consent documents, patient education, staff education, and methadone protocols. PMID:22026519
Erlangsen, Annette; Nordentoft, Merete; Conwell, Yeates
BACKGROUND: The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide....... AIMS: To disseminate key considerations for interventions addressing senior suicidal behavior. METHODS: An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. RESULTS...
What happens to the body when we are near cell phones, base stations and wireless networks are questions that are much debated in the media. A panel of experts appointed by the Health and transport authorities have reviewed research results, test results and management in this field and concludes that the large number of studies that are considered, not provide evidence that these devices can cause adverse health effects. This information leaflet shows the main conclusions from the review. (eb)
Hohmann, Erik; Brand, Jefferson C; Rossi, Michael J; Lubowitz, James H
Our current trend and focus on evidence-based medicine is biased in favor of randomized controlled trials, which are ranked highest in the hierarchy of evidence while devaluing expert opinion, which is ranked lowest in the hierarchy. However, randomized controlled trials have weaknesses as well as strengths, and no research method is flawless. Moreover, stringent application of scientific research techniques, such as the Delphi Panel methodology, allows survey of experts in a high quality and scientific manner. Level V evidence (expert opinion) remains a necessary component in the armamentarium used to determine the answer to a clinical question. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Full Text Available The article analyses the importance of language culture for transport experts. The analysis has been conducted on a questionnaire basis. Pursuant to the questionnaire, the obtained data were aimed at establishing if the use of a correct language might increase employment possibilities, if service suppliers talking correctly were stronger preferred, what sources designated for language culture were used in order to revise the accuracy of the employed terminol- ogy (or word, etc. The questionnaire also presents terms more relevant to transport staff and investigates the frequency of the used terminology both correct and incorrect. The researched data have been systemized and presented in the form of charts.
Torre-Alonso, Juan Carlos; Carmona, Loreto; Moreno, Mireia; Galíndez, Eva; Babío, Jesús; Zarco, Pedro; Linares, Luis; Collantes-Estevez, Eduardo; Barrial, Manuel Fernández; Hermosa, Juan Carlos; Coto, Pablo; Suárez, Carmen; Almodóvar, Raquel; Luelmo, Jesús; Castañeda, Santos; Gratacós, Jordi
The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.
Baldini, Elizabeth H., E-mail: email@example.com [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)
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
... hydrologic connectivity of waters; (b) ecologists with expertise in stream ecology or wetland ecology... individuals in the areas of expertise described above for possible service on this expert panel. Nominations...
James, Andra H.; Kouides, Peter A.; Abdul-Kadir, Rezan; Dietrich, Jennifer E.; Edlund, Mans; Federici, Augusto B.; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A.; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle
Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology
...) perform its mission. These programs together conducted an expert panel workshop on August 6-7, 2001 to evaluate the needs for research and development in the general area of chlorinated solvent site cleanup...
Lockport Dolomite SERDP & ESTCP Expert Panel Workshop on Reducing the C-16 Uncertainty of DNAPL Source Zone Remediation The Problem DNAPL...TCA, CT, CHCl3 Peroxide, New Fenton’s PCE, TCE, DCE, VC, CB DCA, CH2Cl2 TCA, CT, CHCl3 Calcium Peroxide PCE,TCE, DCE, VC, CB TCA, CH2Cl2...Benzene 11,084 ND Carbon Tetrachloride 17,152 ND Trichloroethene 7,500 ND Toluene 9,321 ND 1,1,2-Trichloroethane 26,386 ND Tetrachloroethene 3,036 ND
Association of American Medical Colleges, Washington, DC.
The Association of American Medical Colleges (AAMC) convened a multidisciplinary group of experts to share their insights about the learning objectives and educational experiences that they would recommend for the training of future physicians about bioterrorism. The expert panel broadened the scope of their discussion beyond bioterrorism to…
Park, Sungha; Buranakitjaroen, Peera; Chen, Chen-Huan; Chia, Yook-Chin; Divinagracia, Romeo; Hoshide, Satoshi; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Zhang, Yuqing; Kario, Kazuomi
Hypertension is the leading cause of mortality throughout Asia. Home blood pressure monitoring has the potential to improve hypertension control and is a useful adjunct to conventional office blood pressure measurements due to its diagnostic accuracy and prognostic value in predicting cardiovascular outcomes. At present, there are no region-specific guidelines addressing the use of home blood pressure monitoring in Asia. Therefore, an expert panel was convened to address the use of home blood pressure monitoring and develop key recommendations to help guide clinical practice throughout the Asia region. The resulting recommendations support the use of home blood pressure monitoring with a validated device as an accurate adjunct for diagnosing hypertension and predicting cardiovascular outcome. Diagnosis and treatment of hypertension should still be guided by conventional office/clinic blood pressure measurements. The expert panel encourages the incorporation of home blood pressure monitoring into local clinical guidelines and offers practical recommendations to ensure continuity of care where a validated home blood pressure device is not available.
Murrell, Dedee F; Peña, Sandra; Joly, Pascal; Marinovic, Branka; Hashimoto, Takashi; Diaz, Luis A; Sinha, Animesh A; Payne, Aimee S; Daneshpazhooh, Maryam; Eming, Rüdiger; Jonkman, Marcel F; Mimouni, Daniel; Borradori, Luca; Kim, Soo-Chan; Yamagami, Jun; Lehman, Julia S; Saleh, Marwah Adly; Culton, Donna A; Czernik, Annette; Zone, John J; Fivenson, David; Ujiie, Hideyuki; Wozniak, Katarzyna; Akman-Karakaş, Ayşe; Bernard, Philippe; Korman, Neil J; Caux, Frédéric; Drenovska, Kossara; Prost-Squarcioni, Catherine; Vassileva, Snejina; Feldman, Ron J; Cardones, Adela Rambi; Bauer, Johann; Ioannides, Dimitrios; Jedlickova, Hana; Palisson, Francis; Patsatsi, Aikaterini; Uzun, Soner; Yayli, Savas; Zillikens, Detlef; Amagai, Masayuki; Hertl, Michael; Schmidt, Enno; Aoki, Valeria; Grando, Sergei A; Shimizu, Hiroshi; Baum, Sharon; Cianchini, Guiseppe; Feliciani, Claudio; Iranzo, Pilar; Mascaró, Jose M; Kowalewski, Cezary; Hall, Russell; Groves, Richard; Harman, Karen E; Marinkovich, M Peter; Maverakis, Emanual; Werth, Victoria P
Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management, OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of recommendations. A preliminary survey, based on the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV) guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology (AAD) conference. A second survey was sent following the meeting to more experts to achieve greater international consensus. The 39 experts participated in the first round of the Delphi-survey while 54 from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II based on Delphi results and meeting discussion. Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first line therapy option for moderate to severe pemphigus. Copyright © 2018. Published by Elsevier Inc.
Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers?
Teitelbaum, Susan L; Belpoggi, Fiorella; Reinlib, Les
Breast cancer incidence continues to increase in the US and Europe, a reflection of the growing influence of environment factors that interact with personal genetics. The US Environmental Protection Agency estimates that there are approximately 10,000 endocrine disrupting chemicals among the common daily exposures that could affect the risk of disease. The daunting tasks of identifying, characterizing, and elucidating the mechanisms of endocrine disrupting chemicals in breast cancer need to be addressed to produce a comprehensive model that will facilitate preventive strategies and public policy. An expert panel met to describe and bring attention to needs linking common environmental exposures, critical windows of exposure, and optimal times of assessment in investigating breast cancer risk. The group included investigators with extensive experience in the use of rodent models and in leading population studies and produced a set of recommendations for effective approaches to gaining insights into the environmental origins of breast cancer across the lifespan. Published by Elsevier Inc.
Estey, Elihu; Grimwade, David; Amadori, Sergio; Appelbaum, Frederick R.; Büchner, Thomas; Dombret, Hervé; Ebert, Benjamin L.; Fenaux, Pierre; Larson, Richard A.; Levine, Ross L.; Lo-Coco, Francesco; Naoe, Tomoki; Niederwieser, Dietger; Ossenkoppele, Gert J.; Sanz, Miguel; Sierra, Jorge; Tallman, Martin S.; Tien, Hwei-Fang; Wei, Andrew H.; Löwenberg, Bob; Bloomfield, Clara D.
The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease. PMID:27895058
Kelly, Melissa A; Caleshu, Colleen; Morales, Ana; Buchan, Jillian; Wolf, Zena; Harrison, Steven M; Cook, Stuart; Dillon, Mitchell W; Garcia, John; Haverfield, Eden; Jongbloed, Jan D H; Macaya, Daniela; Manrai, Arjun; Orland, Kate; Richard, Gabriele; Spoonamore, Katherine; Thomas, Matthew; Thomson, Kate; Vincent, Lisa M; Walsh, Roddy; Watkins, Hugh; Whiffin, Nicola; Ingles, Jodie; van Tintelen, J Peter; Semsarian, Christopher; Ware, James S; Hershberger, Ray; Funke, Birgit
PurposeIntegrating genomic sequencing in clinical care requires standardization of variant interpretation practices. The Clinical Genome Resource has established expert panels to adapt the American College of Medical Genetics and Genomics/Association for Molecular Pathology classification framework for specific genes and diseases. The Cardiomyopathy Expert Panel selected MYH7, a key contributor to inherited cardiomyopathies, as a pilot gene to develop a broadly applicable approach.MethodsExpert revisions were tested with 60 variants using a structured double review by pairs of clinical and diagnostic laboratory experts. Final consensus rules were established via iterative discussions.ResultsAdjustments represented disease-/gene-informed specifications (12) or strength adjustments of existing rules (5). Nine rules were deemed not applicable. Key specifications included quantitative frameworks for minor allele frequency thresholds, the use of segregation data, and a semiquantitative approach to counting multiple independent variant occurrences where fully controlled case-control studies are lacking. Initial inter-expert classification concordance was 93%. Internal data from participating diagnostic laboratories changed the classification of 20% of the variants (n = 12), highlighting the critical importance of data sharing.ConclusionThese adapted rules provide increased specificity for use in MYH7-associated disorders in combination with expert review and clinical judgment and serve as a stepping stone for genes and disorders with similar genetic and clinical characteristics.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.218.
Frederick, John T; Steinman, Lesley E; Prohaska, Thomas; Satariano, William A; Bruce, Martha; Bryant, Lucinda; Ciechanowski, Paul; Devellis, Brenda; Leith, Katherine; Leyden, Kevin M; Sharkey, Joseph; Simon, Gregory E; Wilson, Nancy; Unützer, Jurgen; Snowden, Mark
To present findings from an expert panel-informed literature review on community-based treatment of late-life depression. A systematic literature review was conducted to appraise publications on community-based interventions for depression in older adults. The search was conducted between March and October 2005. An expert panel of mental health, aging, health services, and epidemiology researchers guided the review and voted on quality and effectiveness of these interventions. A total of 3,543 articles were found with publication dates from 1967 to October 2005; of these, 116 were eligible for inclusion. Adequate data existed to determine effectiveness for the following interventions: depression care management, group and individual psychotherapy for depression, psychotherapy targeting mental health, psychotherapy for caregivers, education and skills training (to manage health problems besides depression; and for caregivers), geriatric health evaluation and management, exercise, and physical rehabilitation and occupational therapy. After reviewing the data, panelists rated the depression care management interventions as effective. Education and skills training, geriatric health evaluation and management, and physical rehabilitation and occupational therapy received ineffective ratings. Other interventions received mixed effectiveness ratings. Insufficient data availability and poor study quality prevented the panelists from rating several reviewed interventions. While several well-described interventions were found to treat depression effectively in community-dwelling older adults, significant gaps still exist. Interventions that did not target depression specifically may be of benefit to older adults, but they should not be presumed to treat depression by themselves. Treating depressed elders may require a multifaceted approach to ensure effectiveness. More research in this area is needed.
Wahyono, T Y M; Nealon, J; Beucher, S; Prayitno, A; Moureau, A; Nawawi, S; Thabrany, H; Nadjib, M
Routine, passive surveillance systems tend to underestimate the burden of communicable diseases such as dengue. When empirical methods are unavailable, complimentary opinion-based or extrapolative methods have been employed. Here, an expert Delphi panel estimated the proportion of dengue captured by the Indonesian surveillance system, and associated health system parameters. Following presentation of medical and epidemiological data and subsequent discussions, the panel made iterative estimates from which expansion factors (EF), the ratio of total:reported cases, were calculated. Panelists estimated that of all symptomatic Indonesian dengue episodes, 57·8% (95% confidence interval (CI) 46·6-59·8) enter healthcare facilities to seek treatment; 39·3% (95% CI 32·8-42·0) are diagnosed as dengue; and 20·3% (95% CI 16·1-24·3) are subsequently reported in the surveillance system. They estimated most hospitalizations occur in the public sector, while ~55% of ambulatory episodes are seen privately. These estimates gave an overall EF of 5·00; hospitalized EF of 1·66; and ambulatory EF of 34·01 which, when combined with passive surveillance data, equates to an annual average (2006-2015) of 612 005 dengue cases, and 183 297 hospitalizations. These estimates are lower than those published elsewhere, perhaps due to case definitions, local clinical perceptions and treatment-seeking behavior. These findings complement global burden estimates, support health economic analyses, and can be used to inform decision-making.
Vinokur, A; Burnstein, E; Sechrest, L; Wortman, P M
Decision-making processes and their outcomes were investigated in six consensus development conferences at the National Institutes of Health in which panels of experts evaluated new medical technologies. One hundred seventy-seven self-administered questionnaires were obtained from participants in these conferences. Questionnaire data were analyzed along with data derived from content analyses of the six consensus statements (CS) produced by the conferences. Results of these analyses provide considerable support for the hypotheses that the quality of the outcome (i.e., the CS) is determined by the existence of an interaction process, a decision procedure, and a chairperson, which facilitate the exchange of relevant information. Strong disagreements among the panelists appear to inhibit such exchange and harm the quality of the CS. Personal satisfaction appears to be more strongly related to the quality of the process and of the information disseminated than to the quality of the outcome. A clear relation was found between the panelists' status and expertise, their participation in the process, and their contribution to the CS. The pattern of these findings is quite similar to that obtained in laboratory studies. The role of preconference organizational factors, such as the selection of conference questions, panel, and speakers, and the characteristics of the technology are discussed.
Worthen, Maria R
The research from the Expert Panel on Electronic Media and Youth Violence makes a compelling case for why educators and education policymakers should care about the effects of media on youth behavior, and the growing phenomenon of Internet bullying and harassment. The ability of the U.S. education system to respond is limited not only by competing instructional priorities but also by the governance structure of the education system itself. The federal role is limited to a proportionally small amount of funding for states and schools, to raising public awareness, and to providing research and data. States can set priorities, make requirements, and direct funding. Districts and schools ultimately have the most control over prevention program selection and setting social and behavioral norms. Key implications of the panel's research for educators and education policymakers include: Internet bullying is correlated with school behavior problems; Internet bullying behavior may peak in middle school; Internet bullying shares common predictors with verbal and, to some extent, physical bullying; Media literacy programs may mitigate the negative effects of electronic media on youth. Specific recommendations based on these conclusions are discussed, and research priorities for the prevention and education fields are identified.
Vandevijvere, Stefanie; Dominick, Clare; Devi, Anandita; Swinburn, Boyd
To assess government actions to improve the healthiness of food environments in New Zealand, based on the healthy food environment policy index. A panel of 52 public health experts rated the extent of government implementation against international best practice for 42 indicators of food environment policy and infrastructure support. Their ratings were informed by documented evidence, validated by government officials and international benchmarks. There was a high level of implementation for some indicators: providing ingredient lists and nutrient declarations and regulating health claims on packaged foods; transparency in policy development; monitoring prevalence of noncommunicable diseases and monitoring risk factors for noncommunicable diseases. There was very little, if any implementation of the following indicators: restrictions on unhealthy food marketing to children; fiscal and food retail policies and protection of national food environments within trade agreements. Interrater reliability was 0.78 (95% confidence interval, CI: 0.76-0.79). Based on the implementation gaps, the experts recommended 34 actions, and prioritized seven of these. The healthy food environment policy index provides a useful set of indicators that can focus attention on where government action is needed. It is anticipated that this policy index will increase accountability of governments, stimulate government action and support civil society advocacy efforts.
Boyle, Emily; O'Keeffe, Dara A; Naughton, Peter A; Hill, Arnold D K; McDonnell, Ciaran O; Moneley, Daragh
Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers? Eighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15. A clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively). VR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Deer, Timothy; Krames, Elliot S; Hassenbusch, Samuel; Burton, Allen; Caraway, David; Dupen, Stuart; Eisenach, James; Erdek, Michael; Grigsby, Eric; Kim, Phillip; Levy, Robert; McDowell, Gladstone; Mekhail, Nagy; Panchal, Sunil; Prager, Joshua; Rauck, Richard; Saulino, Michael; Sitzman, Todd; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Dean Willis, K; Witt, William; Follett, Kenneth; Huntoon, Mark; Liem, Leong; Rathmell, James; Wallace, Mark; Buchser, Eric; Cousins, Michael; Ver Donck, Ann
Background. Expert panel of physicians and nonphysicians, all expert in intrathecal (IT) therapies, convened in the years 2000 and 2003 to make recommendations for the rational use of IT analgesics based on the preclinical and clinical literature known up to those times, presentations of the expert panel, discussions on current practice and standards, and the result of surveys of physicians using IT agents. An expert panel of physicians and convened in 2007 to review previous recommendations and to form recommendations for the rational use of IT agents as they pertain to new scientific and clinical information regarding the etiology, prevention and treatment for IT granuloma. Method. A review of preclinical and clinical literature from 2000 to 2006 was undertaken and disseminated to an expert panel of physicians. Focused discussions concerning the rational use of IT agents and its relationship to the etiology of, prevention of, and treatment of IT granuloma were held. Results. This report presents here new knowledge of the etiology of catheter tip granuloma and guidelines for its prevention and treatment. © 2008 International Neuromodulation Society.
Hegelund, L; Sørensen, J T
In the process of developing a generic Hazard Analysis and Critical Control Point (HACCP)-like system for securing animal health and welfare in organic egg production, an expert panel analysis was used to perform the initial hazard analysis. Eighteen advisers and researchers in organic egg production were included in the expert panel. In a series of four questionnaires, the expert panel first scored 34 health and welfare problems seen in Danish organic egg production. Based on scorings of severity and occurrence, 10 problems were selected for further analysis. The experts subsequently suggested and scored risk factors for those problems and finally suggested control points, alarm values indicating the need for corrective actions in order to control the risk factors and monitoring frequencies of these. The 10 selected problems were hunger, thirst, piling, crop impaction, blackhead, pasteurellosis, bone fractures, cannibalism, predators and red mites. A total of 154 different risk factors were suggested for these problems. The 41 risk factors which rated highest in a combined scoring of importance and occurrence were selected for further analysis. There was a high degree of consensus between experts when scoring both problems and risk factors. The level of consensus, as defined by an interquartile range 1, was 79% to 100% when scoring the health and welfare problems (scale 1-5) and 77% to 95% when scoring the risk factors (scale 1-4). On average, 5.8 control points were suggested for every risk factor. Alarm values were often not detailed enough to be of practical significance and further analysis is needed in order to define these. The experts were highly diverse in their suggested monitoring frequencies and establishment of monitoring schemes should be part of developing the farm specific systems. An expert panel analysis based on questionnaires was a useful tool during the first steps of developing a HACCP plan, conducting a hazard analysis and suggesting control
Chang, Anne B; Oppenheimer, John J; Weinberger, Miles; Grant, Cameron C; Rubin, Bruce K; Irwin, Richard S
There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? We used the CHEST Expert Cough Panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus. Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies. There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines. Copyright © 2017. Published by Elsevier Inc.
Rushlow, C. R.; Soderquist, B.; Cohn, T.; Eitel, K.
Science communication is often perceived by scientists as the flow of information from experts to non-experts, and institutions have responded by providing science communication training that focuses on best practices for disseminating information. This unidirectional approach neglects a key component of science communication: scientists must understand the needs and values of the stakeholders for whom they are producing information, whether the stakeholders are community members, resource managers, or policy makers. We designed an activity for graduate students enrolled in a science communication class at the McCall Outdoor Science School to both alert them to this misconception, and to give them an opportunity to rectify it. Over the course of 24-hours, we challenged students to have a conversation about climate change with someone they encountered in the community of McCall, ID. Using material from their conversations, students created a story in podcast or video form to share with the class. Through reflecting on this activity, students experienced a change in their perceptions of their identities as science communicators. Many students expressed an increased interest in listening to the stories of community members to learn more about the community's needs and values. We repeated the activity with early career scientists attending a climate workshop in McCall offered by the USGS Northwest Climate Science Center, focusing our evaluation around the science identity model of Carlone and Johnson (2007). Evaluations suggest that participants recognized their role as scientists in not only to providing information, but also in listening to the values and needs of the people for whom they are working. We believe this understanding is fundamental to being a good science communicator and ensuring that science remains relevant to communities.
Torlakovic, Emina E.; Francis, Glenn; Garratt, John; Gilks, Blake; Hyjek, Elizabeth; Ibrahim, Merdol; Miller, Rodney; Nielsen, Søren; Petcu, Eugen B.; Swanson, Paul E.; Taylor, Clive R.; Vyberg, Mogens
Standardization of controls, both positive and negative controls, is needed for diagnostic immunohistochemistry (dIHC). The use of IHC-negative controls, irrespective of type, although well established, is not standardized. As such, the relevance and applicability of negative controls continues to challenge both pathologists and laboratory budgets. Despite the clear theoretical notion that appropriate controls serve to demonstrate the sensitivity and specificity of the dIHC test, it remains unclear which types of positive and negative controls are applicable and/or useful in day-to-day clinical practice. There is a perceived need to provide “best practice recommendations” for the use of negative controls. This perception is driven not only by logistics and cost issues, but also by increased pressure for accurate IHC testing, especially when IHC is performed for predictive markers, the number of which is rising as personalized medicine continues to develop. Herein, an international ad hoc expert panel reviews classification of negative controls relevant to clinical practice, proposes standard terminology for negative controls, considers the total evidence of IHC specificity that is available to pathologists, and develops a set of recommendations for the use of negative controls in dIHC based on “fit-for-use” principles. PMID:24714041
Liebelt, E.L.; Balk, S.J.; Faber, W.; Fisher, J.W.; Hughes, C.L.; Lanzkron, S.M.; Lewis, K.M.; Marchetti, F.; Mehendale, H.M.; Rogers,J.M.; Shad, A.T.; Skalko, R.G.; Stanek, E.J.
The National Toxicology Program (NTP) and the National Institute of Environmental Health Sciences (NIEHS) established the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR) in June 1998. The purpose of CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects on reproduction and development caused by agents to which humans may be exposed. Hydroxyurea was selected for evaluation by a CERHR expert panel because of (1) its increasing use in the treatment of sickle cell disease in children and adults, (2) knowledge that it inhibits DNA synthesis and is cytotoxic, and (3) published evidence of its reproductive and developmental toxicity in rodents. Hydroxyurea is FDA-approved for reducing the frequency of painful crises and the need for blood transfusions in adults with sickle cell anemia who experience recurrent moderate-to-severe crises. Hydroxyurea is used in the treatment of cancer, sickle cell disease, and thalassemia. It is the only treatment for sickle cell disease aside from blood transfusion used in children. Hydroxyurea may be used in the treatment of children and adults with sickle cell disease for an extended period of time or for repeated cycles of therapy. Treatment with hydroxyurea may be associated with cytotoxic and myelosuppressive effects, and hydroxyurea is mutagenic.
Andrew J. Mann
Full Text Available The US Department of Labor (US DOL oversees the Agricultural Hazardous Occupations Orders (AgHOs, which identifies specific tasks that youth are prohibited from performing for hire on American farms and ranches. An educational exemption from this public policy is currently in place that allows youth, 14–15 years old, to complete a certification program prior to engaging in agricultural work involving tractors and machinery. However, limited guidance is provided in the legislation regarding the format or content of the tractor and machinery certification exemption. Four AgHOs (tractor and machinery studies were identified and included in this meta-analysis publication. The research goals of this analysis were to determine basic trends of learning outcomes, and identify educational content to be delivered as a result of these studies. Within each of the four studies, expert panels were used to identify educational learning outcomes. The analysis revealed that 48.0% (n = 184 of all learning outcome items fell within the Tractor-based (Tractor learning outcome category, 29.8% (n = 114 within General Safety and Health (General, and 22.2% (n = 85 of items in the Machinery-based (Machinery category. Ultimately, sound educational methods and understanding of fundamental student competence are essential components for any training program, including youth who complete AgHOs tractor and machinery certification programs.
Background Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. Methods To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. Conclusions In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields. PMID:23883346
Kales, Helen C; Gitlin, Laura N; Lyketsos, Constantine G
Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care. © Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.
Jacobs, David R; Haddad, Ella H; Lanou, Amy Joy; Messina, Mark J
We summarize conclusions drawn from a panel discussion at the "Fifth International Congress on Vegetarian Nutrition" about the roles of and emphasis on food, plant food, and vegetarianism in current and future US dietary guidelines. The most general recommendation of the panel was that future dietary guidelines, following the lead of the 2005 Dietary Guidelines Advisory Committee, should emphasize food-based recommendations and thinking to the full extent that evidence allows. Although nutrient-based thinking and Dietary Reference Intakes (DRIs) may help ensure an adequate diet in the sense that deficiency states are avoided, the emphasis on DRIs may not capture many important nutritional issues and may inhibit a focus on foods. More generally, in the context of the conference on vegetarian nutrition, this report focuses on the history and structure of the Dietary Guidelines Advisory Committee, on various plant food-oriented recommendations that are supported by literature evidence, and on mechanisms for participating in the process of forming dietary guidelines. Among recommendations that likely would improve health and the environment, some are oriented toward increased plant food consumption and some toward vegetarianism. The literature on health effects of individual foods and whole lifestyle diets is insufficient and justifies a call for future food-oriented research, including expanding the evidence base for plant-based and vegetarian diets. The Dietary Guidelines Advisory Committee's role should be carried forward to creation of a publicly accessible icon (eg, the current pyramid) and related materials to ensure that the science base is fully translated for the public.
Becker, S M
Within the domestic preparedness community, there is a growing recognition of the importance of psychosocial issues in weapons of mass destruction (WMD) incidents. Whereas social and behavioral issues were only infrequently considered just a few years ago, they are now coming to be seen as central to consequence management efforts. As a result, discussions in the domestic preparedness community are beginning to consider the extent to which psychosocial effects are addressed in the Federal Response Plan and the degree to which additional preparedness and response steps may be needed. To grapple with this crucial issue, an expert panel was brought together at the International Conference on the Operational Impact of Psychological Casualties from Weapons of Mass Destruction. The panel brought together a wide range of specialists from federal agencies, the armed services, and the academic community. This article summarizes the views and assessments of the panelists as well as their policy recommendations for enhancing preparedness.
van Dijk, M C R F; Aben, K K H; van Hees, F; Klaasen, A; Blokx, W A M; Kiemeney, L A L M; Ruiter, D J
To assess the type of problems encountered in diagnosing melanocytic lesions and to evaluate the contribution of expert review. Data from 1887 lesions submitted for consultation to one of the expert pathologists of the Dutch Melanoma Working Group Pathology Panel between 1991 and 2004 were analysed. Referring pathologists can voluntarily submit lesions which are difficult to classify to the panel. Most cutaneous melanocytic lesions (n = 1217) were submitted with a presumed diagnosis by the referring pathologists. Relevant underdiagnoses of melanoma (in situ) and overdiagnoses of naevi were prevented in 12% (144/1217) and 15% (178/1217) of cases, respectively. Problematic melanocytic lesions were (i) spitzoid and dysplastic lesions, (ii) lesions with histological features that hampered the diagnosis such as regression, lymphocytic infiltrate, or a combination with other melanocytic lesions, and (iii) lesions with unusual clinical features, e.g. childhood melanoma. Remarkably, the features of the lesions that were submitted and the types of over- and under-diagnosis remained consistent from 1991 to 2004. A second opinion from an expert pathologist on problem-prone melanocytic lesions improves patient care, in our series in 27% of cases.
Heerkens, Johannes M.G.; Norde, Christiaan; van der Heijden, Beatrice
Purpose – This paper aims to investigate differences between experts and laypersons concerning the way they assess the importance of each of the various decision attributes (cost, risk, feasibility) taken into consideration during decision processes in an organizational setting.
Kelly, Melissa A.; Caleshu, Colleen; Morales, Ana; Buchan, Jillian; Wolf, Zena; Harrison, Steven M.; Cook, Stuart; Dillon, Mitchell W.; Garcia, John; Haverfield, Eden; Jongbloed, Jan D. H.; Macaya, Daniela; Manrai, Arjun; Orland, Kate; Richard, Gabriele; Spoonamore, Katherine; Thomas, Matthew; Thomson, Kate; Vincent, Lisa M.; Walsh, Roddy; Watkins, Hugh; Whiffin, Nicola; Ingles, Jodie; van Tintelen, J. Peter; Semsarian, Christopher; Ware, James S.; Hershberger, Ray; Funke, Birgit
PurposeIntegrating genomic sequencing in clinical care requires standardization of variant interpretation practices. The Clinical Genome Resource has established expert panels to adapt the American College of Medical Genetics and Genomics/Association for Molecular Pathology classification framework
Jacobs, Jr, David R; Haddad, Ella H; Lanou, Amy Joy; Messina, Mark J
We summarize conclusions drawn from a panel discussion at the "Fifth International Congress on Vegetarian Nutrition" about the roles of and emphasis on food, plant food, and vegetarianism in current...
Kesäniemi, Antero; Riddoch, Chris J; Reeder, Bruce
ABSTRACT: The Canadian Society for Exercise Physiology, in partnership with the Public Health Agency of Canada, has initiated a review of their physical activity guidelines to promote healthy active living for Canadian children, youth, adults and older adults; previous guidelines were released...... in 2002, 2002, 1998 and 1999 respectively. Several background papers from this project were published recently and provide foundation evidence upon which to base new guidelines. Furthermore, comprehensive systematic reviews were completed to ensure a rigorous evaluation of evidence informing the revision...... of physical activity guidelines for asymptomatic populations. The overall guideline development process is being guided and assessed by the AGREE II instrument. A meeting of experts was convened to present the evidence complied to inform the guideline revisions. An independent expert panel was assembled...
Gridelli, Cesare; Aapro, Matti; Ardizzoni, Andrea; Balducci, Lodovico; De Marinis, Filippo; Kelly, Karen; Le Chevalier, Thierry; Manegold, Christian; Perrone, Francesco; Rosell, Rafael; Shepherd, Frances; De Petris, Luigi; Di Maio, Massimo; Langer, Corey
The best treatment for elderly patients with advanced non-small-cell lung cancer (NSCLC) is still debated. To guide clinical management of these patients and suggest the priorities for clinical research in this field, an International Expert Panel met in Naples, Italy, on April 19 to 20, 2004. Results and conclusions based on a review of evidence available in the literature to date are presented in this article. A comprehensive geriatric assessment is recommended to better define prognosis and to predict tolerance to treatment. In the first randomized study dedicated to elderly NSCLC patients, single-agent vinorelbine showed superiority over supportive care alone, both in terms of survival and quality of life. In a large randomized trial, gemcitabine plus vinorelbine failed to show any advantage over either agent alone. Subset analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with an acceptable increase in toxicity for elderly patients. These data should be interpreted cautiously because retrospective subgroup analyses are encumbered by selection bias; hence, randomized trials dedicated to platinum-based chemotherapy for nonselected elderly patients are warranted. Several promising biologic therapies are under investigation; however, with present data, target-based agents as first-line treatment for elderly NSCLC patients are not yet recommended. Clinical research, with trials specifically designed for elderly patients, is mandatory. With the current evidence, single-agent chemotherapy with a third-generation drug (vinorelbine, gemcitabine, a taxane) should be the recommended option for nonselected elderly patients with advanced NSCLC. Platinum-based chemotherapy is a viable option for fit patients with adequate organ function. Best supportive care remains important, in addition to chemotherapy or as the exclusive option for patients who are unsuitable for more aggressive treatment.
van Chantal Dijk; Karel Spee; Ad Breukel
This study focuses on the possible advantage of an aesthetic appeal on the adoption of photovoltaic (PV) cells and panels. Study deals with the importance of this perception of solar panels by potential buyers. It reports the relative importance of aesthetics compared with other attributes, namely
National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.
Studies have shown that high blood cholesterol levels play a role in the development of coronary heart disease in adults, and that the process leading to atherosclerosis begins in childhood. To address the problem of high cholesterol levels in children, the Panel on Blood Cholesterol Levels recommends complementary approaches for individuals and…
J.M. Fitzpatrick (John); J. Bellmunt (Joaquim); K. Fizazi (Karim); A. Heidenreich (Axel); C.N. Sternberg (Cora); B. Tombal (Bertrand); A. Alcaraz (Antonio); A. Bahl (Amit); S. Bracarda (Sergio); G. Di Lorenzo (Giuseppe); E. Efstathiou (Eleni); S.P. Finn (Stephen); S.D. Fossa (Sophie); S. Gillessen (Silke); P.-L. Kellokumpu-Lehtinen (Pirkko-Liisa); F.E. Lecouvet (Frédéric); S. Oudard (Stéphane); T.M. de Reijke (Theo); C.N. Robson (Craig); M. de Santis (Maria); B. Seruga (Bostjan); R. de Wit (Ronald)
textabstractThe exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of
Stewart, Charles W; Bush, Spencer H; Berman, Herbert Stanton; Czajkowski, Carl J; Divine, James R; Posakony, Gerald J; Johnson, A B; Elmore, Monte R; Reynolds, D A; Anantatmula, Ramamohan P; Sindelar, Robert L; Zapp, Philip E
Expert workshops were held in Richland in May 2001 to review the Hanford Double-Shell Tank Integrity Project and make recommendations to extend the life of Hanford's double-shell waste tanks. The workshop scope was limited to corrosion of the primary tank liner, and the main areas for review were waste chemistry control, tank inspection, and corrosion monitoring. Participants were corrosion experts from Hanford, Savannah River Site, Brookhaven National Lab., Pacific Northwest National Lab., and several consultants. This report describes the current state of the three areas of the program, the final recommendations of the workshop, and the rationale for their selection.
Orringer, Carl E; Jacobson, Terry A; Saseen, Joseph J; Brown, Alan S; Gotto, Antonio M; Ross, Joyce L; Underberg, James A
An Expert Panel convened by the National Lipid Association was charged with updating the recommendations on the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody therapy that were provided by the 2015 National Lipid Association Recommendations for the Patient-Centered Management of Dyslipidemia: Part 2. Recent studies have demonstrated the efficacy of these agents in reducing low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and have confirmed their excellent safety profile. A cardiovascular outcomes study has shown that these agents reduce incident atherosclerotic cardiovascular disease (ASCVD) events in patents with stable ASCVD and concomitant risk factors. The current update provides the Expert Panel's evidence-based recommendations on the clinical utility of PCSK9 inhibitors in patients with stable ASCVD, progressive ASCVD, LDL-C ≥ 190 mg/dL (including polygenic hypercholesterolemia, heterozygous familial hypercholesterolemia and the homozygous familial hypercholesterolemia phenotype) and very-high-risk patients with statin intolerance. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Scheuring, Richard A.; Hamilton, Doug; Jones, Jeffrey A.; Alexander, David
There are currently several physiological monitoring requirements for EVA in the Human-Systems Interface Requirements (HSIR) document. There are questions as to whether the capability to monitor heart rhythm in the lunar surface space suit is a necessary capability for lunar surface operations. Similarly, there are questions as to whether the capability to monitor heart rhythm during a cabin depressurization scenario in the launch/landing space suit is necessary. This presentation seeks to inform space medicine personnel of recommendations made by an expert panel of cardiovascular medicine specialists regarding in-suit ECG heart rhythm monitoring requirements during lunar surface operations. After a review of demographic information and clinical cases and panel discussion, the panel recommended that ECG monitoring capability as a clinical tool was not essential in the lunar space suit; ECG monitoring was not essential in the launch/landing space suit for contingency scenarios; the current hear rate monitoring capability requirement for both launch/landing and lunar space suits should be maintained; lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG for IVA medical assessments; and, exercise stress testing for astronaut selection and retention should be changed from the current 85% maximum heart rate limit to maximal, exhaustive 'symptom-limited' testing to maximize diagnostic utility as a screening tool for evaluating the functional capacity of astronauts and their cardiovascular health.
Gersak, Borut; Fischlein, Theodor; Folliguet, Thierry A; Meuris, Bart; Teoh, Kevin H T; Moten, Simon C; Solinas, Marco; Miceli, Antonio; Oberwalder, Peter J; Rambaldini, Manfredo; Bhatnagar, Gopal; Borger, Michael A; Bouchard, Denis; Bouchot, Olivier; Clark, Stephen C; Dapunt, Otto E; Ferrarini, Matteo; Laufer, Guenther; Mignosa, Carmelo; Millner, Russell; Noirhomme, Philippe; Pfeiffer, Steffen; Ruyra-Baliarda, Xavier; Shrestha, Malakh; Suri, Rakesh M; Troise, Giovanni; Diegeler, Anno; Laborde, Francois; Laskar, Marc; Najm, Hani K; Glauber, Mattia
After a panel process, recommendations on the use of sutureless and rapid deployment valves in aortic valve replacement were given with special respect as an alternative to stented valves. Thirty-one international experts in both sutureless, rapid deployment valves and stented bioprostheses constituted the panel. After a thorough literature review, evidence-based recommendations were rated in a three-step modified Delphi approach by the experts. Literature research could identify 67 clinical trials, 4 guidelines and 10 systematic reviews for detailed text analysis to obtain a total of 28 recommendations. After rating by the experts, 12 recommendations were identified and degree of consensus for each was determined. Proctoring and education are necessary for the introduction of sutureless valves on an institutional basis as well as for the individual training of surgeons. Sutureless and rapid deployment should be considered as the valve prosthesis of first choice for isolated procedures in patients with comorbidities, old age, delicate aortic wall conditions such as calcified root, porcelain aorta or prior implantation of aortic homograft and stentless valves as well as for concomitant procedures and small aortic roots to reduce cross-clamp time. Intraoperative transoesophageal echocardiography is highly recommended, and in case of right anterior thoracotomy, preoperative computer tomography is strongly recommended. Suitable annular sizes are 19-27 mm. There is a contraindication for bicuspid valves only for Type 0 and for annular abscess or destruction due to infective endocarditis. Careful but complete decalcification of the aortic root is recommended to avoid paravalvular leakage; extensive decalcification should be avoided not to create annular defects. Proximal anastomoses of concomitant coronary artery bypass grafting should be placed during a single aortic cross-clamp period or alternatively with careful side clamping. Available evidence suggests that the use
Vilallonga, Ramon; Moreno Villares, José Manuel; Yeste Fernández, Diego; Sánchez Santos, Raquel; Casanueva Freijo, Felipe; Santolaya Ochando, Francisco; Leal Hernando, Nuria; Lecube Torelló, Albert; Castaño González, Luis Antonio; Feliu, Albert; Lopez-Nava, Gontrand; Frutos, Dolores; Torres Garcia, Antonio J; Ruiz de Adana, Juan Carlos
In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain. The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed. The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.
Andersen, F Alan; Bergfeld, Wilma F; Belsito, Donald V; Hill, Ronald A; Klaassen, Curtis D; Liebler, Daniel C; Marks, James G; Shank, Ronald C; Slaga, Thomas J; Snyder, Paul W
Calendula officinalis extract, C officinalis flower, C officinalis flower extract, C officinalis flower oil, and C officinalis seed oil are cosmetic ingredients derived from C officinalis. These ingredients may contain minerals, carbohydrates, lipids, phenolic acids, flavonoids, tannins, coumarins, sterols and steroids, monoterpenes, sesquiterpenes, triterpenes, tocopherols, quinones, amino acids, and resins. These ingredients were not significantly toxic in single-dose oral studies using animals. The absence of reproductive/developmental toxicity was inferred from repeat-dose studies of coriander oil, with a similar composition. Overall, these ingredients were not genotoxic. They also were not irritating, sensitizing, or photosensitizing in animal or clinical tests but may be mild ocular irritants. The Cosmetic Ingredient Review (CIR) Expert Panel concluded that these ingredients are safe for use in cosmetics in the practices of use and concentration given in this amended safety assessment.
Diaby, Vakaramoko; Goeree, Ron; Hoch, Jeffrey; Siebert, Uwe
Multi-criteria decision analysis (MCDA), a decision-making tool, has received increasing attention in recent years, notably in the healthcare field. For Canada, it is unclear whether and how MCDA should be incorporated into the existing health technology assessment (HTA) decision-making process. To facilitate debate on improving HTA decision-making in Canada, a workshop was held in conjunction with the 8th World Congress on Health Economics of the International Health Economics Association in Toronto, Canada in July 2011. The objective of the workshop was to discuss the potential benefits and challenges related to the use of MCDA for HTA decision-making in Canada. This paper summarizes and discusses the recommendations of an expert panel convened at the workshop to discuss opportunities and concerns with reference to the implementation of MCDA in Canada.
James, Andra H; Kouides, Peter A; Abdul-Kadir, Rezan; Dietrich, Jennifer E; Edlund, Mans; Federici, Augusto B; Halimeh, Susan; Kamphuisen, Pieter Willem; Lee, Christine A; Martínez-Perez, Oscar; McLintock, Claire; Peyvandi, Flora; Philipp, Claire; Wilkinson, Jeffrey; Winikoff, Rochelle
Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute menorrhagia. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Peris, Ketty; Licitra, Lisa; Ascierto, Paolo A; Corvò, Renzo; Simonacci, Marco; Picciotto, Franco; Gualdi, Giulio; Pellacani, Giovanni; Santoro, Armando
Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Most occur on the head and neck, where cosmetic and functional outcomes are critical. BCC can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for the majority of high-risk lesions. Aggressive, recurrent or unresectable tumors can be difficult to manage. Until recently, no approved systemic therapy was available for locally advanced or metastatic BCC inappropriate for surgery or radiotherapy. Vismodegib provides a systemic treatment option. However, a consensus definition of advanced BCC is lacking. A multidisciplinary panel with expertise in oncology, dermatology, dermatologic surgery and radiation oncology proposes a consensus definition based on published evidence and clinical experience.
Cariou, Alain; Payen, Jean-François; Asehnoune, Karim; Audibert, Gerard; Botte, Astrid; Brissaud, Olivier; Debaty, Guillaume; Deltour, Sandrine; Deye, Nicolas; Engrand, Nicolas; Francony, Gilles; Legriel, Stéphane; Levy, Bruno; Meyer, Philippe; Orban, Jean-Christophe; Renolleau, Sylvain; Vigue, Bernard; De Saint Blanquat, Laure; Mathien, Cyrille; Velly, Lionel
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations
Hegelund, Lene; Sørensen, Jan Tind
In the process of developing a generic Hazard Analysis and Critical Control Point (HACCP)-like system for securing animal health and welfare in organic egg production, an expert panel analysis was used to perform the initial hazard analysis. Eighteen advisers and researchers in organic egg...... specific systems. An expert panel analysis based on questionnaires was a useful tool during the first steps of developing a HACCP plan, conducting a hazard analysis and suggesting control points. However, care should be taken regarding the panel's size and fields of expertise in order to assure...... that the panel fully covers the field of interest throughout the study. A further development of the hazard analysis into a farm-specific HACCP system would include assembling an on-farm HACCP team consisting of farmers and advisors for the practical application of control points, alarm values and monitoring...
Fox, Mary A., E-mail: firstname.lastname@example.org [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Nachman, Keeve E. [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Center for a Livable Future, Johns Hopkins University, 615 North Wolfe Street, Room W7010, Baltimore, MD 21205 (United States); Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 (United States); Anderson, Breeana [Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205 (United States); Lam, Juleen [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); University of California at San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, Mailstop 0132, 550 16th Street, 7th Floor, San Francisco, CA 94143 (United States); and others
Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on “Future and Emerging Issues for Private Wells” was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs. - Highlights: • About 43 million Americans use federally unregulated private wells for drinking water. • Private wells may be contaminated with naturally occurring and man-made chemicals. • Protecting well water requires an “infrastructure for stewardship”. • Recommendations to advance private well protection are offered.
Christine G. Parks
Full Text Available Autoimmune diseases include 80 or more complex disorders characterized by self-reactive, pathologic immune responses in which genetic susceptibility is largely insufficient to determine disease onset. In September 2010, the National Institute of Environmental Health Sciences (NIEHS organized an expert panel workshop to evaluate the role of environmental factors in autoimmune diseases, and the state of the science regarding relevant mechanisms, animal models, and human studies. The objective of the workshop was to analyze the existing data to identify conclusions that could be drawn regarding environmental exposures and autoimmunity and to identify critical knowledge gaps and areas of uncertainty for future study. This consensus document summarizes key findings from published workshop monographs on areas in which “confident” and “likely” assessments were made, with recommendations for further research. Transcribed notes and slides were reviewed to synthesize an overview on exposure assessment and questions addressed by interdisciplinary panels. Critical advances in the field of autoimmune disease research have been made in the past decade. Collaborative translational and interdisciplinary research is needed to elucidate the role of environmental factors in autoimmune diseases. A focus on exposure assessment methodology is needed to improve the effectiveness of human studies, and more experimental studies are needed to focus on causal mechanisms underlying observed associations of environmental factors with autoimmune disease in humans.
Parks, Christine G.; Miller, Frederick W.; Pollard, Kenneth Michael; Selmi, Carlo; Germolec, Dori; Joyce, Kelly; Rose, Noel R.; Humble, Michael C.
Autoimmune diseases include 80 or more complex disorders characterized by self-reactive, pathologic immune responses in which genetic susceptibility is largely insufficient to determine disease onset. In September 2010, the National Institute of Environmental Health Sciences (NIEHS) organized an expert panel workshop to evaluate the role of environmental factors in autoimmune diseases, and the state of the science regarding relevant mechanisms, animal models, and human studies. The objective of the workshop was to analyze the existing data to identify conclusions that could be drawn regarding environmental exposures and autoimmunity and to identify critical knowledge gaps and areas of uncertainty for future study. This consensus document summarizes key findings from published workshop monographs on areas in which “confident” and “likely” assessments were made, with recommendations for further research. Transcribed notes and slides were reviewed to synthesize an overview on exposure assessment and questions addressed by interdisciplinary panels. Critical advances in the field of autoimmune disease research have been made in the past decade. Collaborative translational and interdisciplinary research is needed to elucidate the role of environmental factors in autoimmune diseases. A focus on exposure assessment methodology is needed to improve the effectiveness of human studies, and more experimental studies are needed to focus on causal mechanisms underlying observed associations of environmental factors with autoimmune disease in humans. PMID:25196523
Williams, Gary M; Aardema, Marilyn; Acquavella, John; Berry, Sir Colin; Brusick, David; Burns, Michele M; de Camargo, Joao Lauro Viana; Garabrant, David; Greim, Helmut A; Kier, Larry D; Kirkland, David J; Marsh, Gary; Solomon, Keith R; Sorahan, Tom; Roberts, Ashley; Weed, Douglas L
The International Agency for Research on Cancer (IARC) published a monograph in 2015 concluding that glyphosate is "probably carcinogenic to humans" (Group 2A) based on limited evidence in humans and sufficient evidence in experimental animals. It was also concluded that there was strong evidence of genotoxicity and oxidative stress. Four Expert Panels have been convened for the purpose of conducting a detailed critique of the evidence in light of IARC's assessment and to review all relevant information pertaining to glyphosate exposure, animal carcinogenicity, genotoxicity, and epidemiologic studies. Two of the Panels (animal bioassay and genetic toxicology) also provided a critique of the IARC position with respect to conclusions made in these areas. The incidences of neoplasms in the animal bioassays were found not to be associated with glyphosate exposure on the basis that they lacked statistical strength, were inconsistent across studies, lacked dose-response relationships, were not associated with preneoplasia, and/or were not plausible from a mechanistic perspective. The overall weight of evidence from the genetic toxicology data supports a conclusion that glyphosate (including GBFs and AMPA) does not pose a genotoxic hazard and therefore, should not be considered support for the classification of glyphosate as a genotoxic carcinogen. The assessment of the epidemiological data found that the data do not support a causal relationship between glyphosate exposure and non-Hodgkin's lymphoma while the data were judged to be too sparse to assess a potential relationship between glyphosate exposure and multiple myeloma. As a result, following the review of the totality of the evidence, the Panels concluded that the data do not support IARC's conclusion that glyphosate is a "probable human carcinogen" and, consistent with previous regulatory assessments, further concluded that glyphosate is unlikely to pose a carcinogenic risk to humans.
Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.
The Columbia River basalts underlying the Hanford Site in Washington State are being considered as a possible location for a geologic repository for high-level nuclear waste. To investigate the feasibility of a repository at this site, the hydrologic parameters of the site must be evaluated. Among hydrologic parameters of particular interest are the effective porosity of the Cohassett basalt flow top and flow interior and the vertical-to-horizontal hydraulic conductivity, or anisotropy ratio, of the Cohassett basalt flow interior. The Cohassett basalt flow is the prime candidate horizon for repository studies. Site-specific data for these hydrologic parameters are currently inadequate for the purpose of preliminary assessment of candidate repository performance. To obtain credible, auditable, and independently derived estimates of the specified hydrologic parameters, a panel of five nationally recognized hydrologists was assembled. Their expert judgments were quantified during two rounds of Delphi process by means of a probability encoding method developed to estimate the probability distributions of the selected hydrologic variables. The results indicate significant differences of expert opinion for cumulative probabilities of less than 10% and greater than 90%, but relatively close agreement in the middle ranges of values. The principal causes of the diversity of opinion are believed to be the lack of site-specific data and the absence of a single, widely accepted, conceptual or theoretical basis for analyzing these variables.
Philipp-Dormston, Wolfgang G; Karrer, Sigrid; Petering, Holger; Ulrich, Claas; Dirschka, Thomas; Berking, Carola; Lonsdorf, Anke S; Gerber, Peter Arne; Radakovic, Sonja; Hunger, Robert E; Szeimies, Rolf-Markus
Photodynamic Therapy (PDT) is one of the standard treatment modalities for actinic keratoses (AKs). Daylight PDT (DL-PDT) with MAL cream is a rather recent development, which, instead of an artificial light source, uses daylight for the activation of the photosensitizer. The present review summarizes available data based on a selective literature search, highlights practical aspects, and reflects the authors' expert knowledge in using DL-PDT. With respect to efficacy, study data shows that DL-PDT is noninferior to conventional PDT (cPDT). However, given that DL-PDT is markedly less painful, it is significantly better tolerated than cPDT. In Europe, DL-PDT can be performed from March to October, on sunny as well as on cloudy days. UV protection of untreated areas of the body should be observed. Outside temperature should not fall below 10°C. On hot days, patients should be advised to stay in the shade if necessary. Representing a useful addition to current therapeutic options, DL-PDT with MAL cream is, among others, suitable for patients with field cancerization and/or those who have experienced severe pain associated with cPDT. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Bakakos, Petros; Toumbis, Michalis; Loukides, Stelios; Vassilakopoulos, Theodoros
Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns. Unit costs from official, published sources were subsequently assigned to resource use to estimate direct medical costs. Indirect costs were estimated as number of work loss days. Cost base year was 2015, and the perspective adopted was that of the National Organization of Health Care Services Provision, as well as the societal. Patients with asthma are mainly managed by pulmonologists (71.4%) and secondarily by general practitioners and internists (28.6%). The annual cost of managing exacerbations was estimated at €273.1, while maintenance costs were estimated at €1,100.2 per year. Total costs of managing asthma per patient per year were estimated at €2,281.8, 64.4% of which represented direct medical costs. Of the direct costs, pharmaceutical treatment was the key driver, accounting for 63.9 and 41.2% of direct and total costs, respectively. Direct non-medical costs (patient travel and waiting time) were estimated at €152.3. Indirect costs accounted for 28.9% of total costs. Asthma is a chronic condition, the management of which constrains the already limited Greek health care resources. The increasing prevalence of the disease raises concerns as it could translate per patient costs into a significant burden for the Greek health care system. Thus, the prevention, self-management, and improved quality of care for asthma should find a place in the health policy agenda in Greece.
Riddle, Mark S; Connor, Bradley A; Beeching, Nicholas J; DuPont, Herbert L; Hamer, Davidson H; Kozarsky, Phyllis; Libman, Michael; Steffen, Robert; Taylor, David; Tribble, David R; Vila, Jordi; Zanger, Philipp; Ericsson, Charles D
: Travelers' diarrhea causes significant morbidity including some sequelae, lost travel time and opportunity cost to both travelers and countries receiving travelers. Effective prevention and treatment are needed to reduce these negative impacts. : This critical appraisal of the literature and expert consensus guideline development effort asked several key questions related to antibiotic and non-antibiotic prophylaxis and treatment, utility of available diagnostics, impact of multi-drug resistant (MDR) colonization associated with travel and travelers' diarrhea, and how our understanding of the gastrointestinal microbiome should influence current practice and future research. Studies related to these key clinical areas were assessed for relevance and quality. Based on this critical appraisal, guidelines were developed and voted on using current standards for clinical guideline development methodology. : New definitions for severity of travelers' diarrhea were developed. A total of 20 graded recommendations on the topics of prophylaxis, diagnosis, therapy and follow-up were developed. In addition, three non-graded consensus-based statements were adopted. : Prevention and treatment of travelers' diarrhea requires action at the provider, traveler and research community levels. Strong evidence supports the effectiveness of antimicrobial therapy in most cases of moderate to severe travelers' diarrhea, while either increasing intake of fluids only or loperamide or bismuth subsalicylate may suffice for most cases of mild diarrhea. Further studies are needed to address knowledge gaps regarding optimal therapies, the individual, community and global health risks of MDR acquisition, manipulation of the microbiome in prevention and treatment and the utility of laboratory testing in returning travelers with persistent diarrhea.
Bobes-García, Julio; Saiz-Ruiz, Jerónimo; Bernardo-Arroyo, Miquel; Caballero-Martínez, Fernando; Gilaberte-Asín, Inmaculada; Ciudad-Herrera, Antonio
Available data from scientific literature show that patients with schizophrenia have higher rates of physical comorbidity and excess mortality due to other physical pathologies. The growing interest to investigate and improve the health of these patients has led a group of Spanish experts to publish in 2008 a "Consensus on physical health of patients with schizophrenia from the Spanish Societies of Psychiatry and Biological Psychiatry" (2008 Consensus). These recommendations imply a significant change to the present model of medical attention. To gauge the level of agreement of a group of expert psychiatrists on the clinical criteria and recommendations collected from the scientific literature and the 2008 Consensus on the physical health of patients with schizophrenia. The process involved four phases: 1) Scientific Committee established to manage the study and to define the 66-item questionnaire; 2) Panel of 15 experts in psychiatry is established; 3) Submission of questionnaire to the Expert Panel in two consecutive rounds, with an intermediate processing and sharing of results; 4) Evaluation of results, discussion and conclusions between Scientific Committee and Expert Panel. All items, as set by the Scientific Committee and aligned with the recommendations published in the 2008 Consensus, achieved consensus on agreement from the Expert Panel, except 5 items, for which most of the answers were placed in the indeterminate position rate. The expert criteria shown in this study indicate a global agreement with regard to clinical criteria on the physical health of patients with schizophrenia, as well as with the present recommendations to improve the health of patients having, or at risk to have, other concomitant pathologies. The need to incorporate new intervention guidelines that facilitate a better control and improvement of the physical health of patients with schizophrenia must be disseminated in the psychiatric providers' collectives.
National Institutes of Health (DHHS), Bethesda, MD.
This report describes effective approaches for enhancing maternal, infant, and family outcomes based on the scientific and systematic assessment of the content of prenatal care conducted by the Public Health Service's Expert Panel on the Content of Prenatal Care. The range of risks, both medical and psychosocial, that the prenatal care provider…
Bruce G. Marcot; Chris S. Allen; Steve Morey; Dan Shively; Rollie. White
The bull trout Salvelinus confluentus is an apex predator in native fish communities in the western USA and is listed as threatened under the U.S. Endangered Species Act (ESA). Restoration of this species has raised concerns over its potential predatory impacts on native fish fauna. We held a five-person expert panel to help determine potential...
Jeffs, Lianne; Kuluski, Kerry; Law, Madelyn; Saragosa, Marianne; Espin, Sherry; Ferris, Ella; Merkley, Jane; Dusek, Brenda; Kastner, Monika; Bell, Chaim M
Nursing plays a central role in facilitating care transitions for complex older adults, yet there is no consensus of the components of nurse-led care transitions interventions to facilitate high quality care transitions among complex older adults. A structured expert panel was established with the purpose of identifying effective nurse-led care transition interventions. A modified Delphi consensus technique based on the RAND method was employed. Panelists (n = 23) were asked to individually rate a series of statements derived from a realist synthesis of the literature for relevance, feasibility and likely impact. Statements receiving an aggregate score of ≥75% (7/9) were reviewed and revised at a face-to-face consensus meeting. A second round of rating following the same process as round one was used, followed by a final ranking of the statements. The five highest ranked intervention components and contextual factors were: (a) educating and coaching patients, their family members and caregivers about self-management skills; (b) ensuring patients, their family members and caregivers are aware of follow-up medical appointments and postdischarge care plan; (c) using standardized documentation tools and comprehensive communication strategies during care transitions; (d) optimizing nurses' roles and scopes of practice across the care transitions spectrum; and (e) having strong leadership, strategic alignment and accountability structures in organizations to enable quality care transitions for the complex older person population. Key insights on optimizing the nurses' roles and scope of practice during care transitions included having nurses provide "warm hand-offs" and serve as the "go-to person." The panel also identified current challenges to optimizing the nurses' roles and scope of practice across care transition points. Future research is required to determine effective nurse-led intervention components and in which context do they work or do not. © 2017 Sigma
Mulligan, Jo-Ann; Conteh, Lesong
As global research investment increases, attention inevitably turns to assessing and measuring the outcomes and impact from research programmes. Research can have many different outcomes such as producing advances in scientific knowledge, building research capacity and, ultimately, health and broader societal benefits. The aim of this study was to test the use of a Delphi methodology as a way of gathering views from malaria research experts on research priorities and eliciting relative valuations of the different types of health research impact. An international Delphi survey of 60 malaria research experts was used to understand views on research outcomes and priorities within malaria and across global health more widely. The study demonstrated the application of the Delphi technique to eliciting views on malaria specific research priorities, wider global health research priorities and the values assigned to different types of research impact. In terms of the most important past research successes, the development of new anti-malarial drugs and insecticide-treated bed nets were rated as the most important. When asked about research priorities for future funding, respondents ranked tackling emerging drug and insecticide resistance the highest. With respect to research impact, the panel valued research that focuses on health and health sector benefits and informing policy and product development. Contributions to scientific knowledge, although highly valued, came lower down the ranking, suggesting that efforts to move research discoveries to health products and services are valued more highly than pure advances in scientific knowledge. Although the Delphi technique has been used to elicit views on research questions in global health this was the first time it has been used to assess how a group of research experts value or rank different types of research impact. The results suggest it is feasible to inject the views of a key stakeholder group into the research
Ahemmed, Baiju; Sundarapandian, Vani; Gutgutia, Rohit; Balasubramanyam, Sathya; Jagtap, Richa; Biliangady, Reeta; Gupta, Priti; Jadhav, Sachin; Satwik, Ruma; Dewda, Pavitra Raj; Thakor, Priti; Esteves, Sandro C
Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should "freeze-all" policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10-15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt "freeze-all" policy. Further research is needed due to lack of data availability on progesterone threshold or index.
Hassenbusch, Samuel J; Portenoy, Russell K; Cousins, Michael; Buchser, Eric; Deer, Timothy R; Du Pen, Stuart L; Eisenach, James; Follett, Kenneth A; Hildebrand, Keith R; Krames, Elliot S; Levy, Robert M; Palmer, Pamela P; Rathmell, James P; Rauck, Richard L; Staats, Peter S; Stearns, Lisa; Willis, K Dean
Intraspinal drug infusion using fully implantable pump and catheter systems is a safe and effective therapy for selected patients with chronic pain. The options for this approach are increasing, as drugs that are commercially available for systemic administration are adapted to this use and other drugs that are in development specifically for intraspinal administration become available. In 2000 a Polyanalgesic Consensus Conference was organized to evaluate the existing literature and develop guidelines for drug selection. The major outcome of this effort, an algorithm for drug selection, was based on the best available evidence at the time. Rapid changes have occurred in the science and practice of intraspinal infusion and a Polyanalgesic Consensus Conference 2003 was organized to pursue the following goals: 1) to review the literature on intraspinal drug infusion since 1999, 2) to revise the 2000 drug-selection algorithm, 3) to develop guidelines for optimizing drug dosage and concentration, 4) to create a process for documenting minimum evidence supporting the use of a drug for intraspinal infusion, and 5) to clarify issues pertaining to compounding of drugs. Based on the best available evidence and expert opinion, consensus recommendations were developed in all these areas. The panel's conclusions may provide a foundation for clinical practice and a rational basis for new research.
Schaffartzik, Walter; Neu, Johann
The Gutachterkommissionen and Schlichtungsstellen in Germany (Expert Panels and Arbitration Boards for Medical Liability) were founded in the 1970s in order to serve as an institution other than the courts where suspected incidents of malpractice can be evaluated. The "Medical Error Reporting System" (MERS) was developed by the North German Schlichtungsstelle. The data it provides serve as the basis for the national statistics published by the Bundesärztekammer (German Medical Association). 7201 factual decisions were made. In 5074 proceedings no malpractice cases or risk disclosure problems were discovered, while in 2127 proceedings either of the two problems was noticed, and in 1,683 proceedings these problems were rated as being causative in the claimed harm and led to the recommendation to grant financial compensation to the patient. The MERS data reveal that most of the diagnoses which led patients to file a claim with the Gutachterkommissionen and Schlichtungsstellen referred to orthopaedics and traumatology and in the majority of cases reproaches were directed at surgical therapy. Doctors must strive to minimise malpractice and harm caused by medical treatment. With the help of the national statistics of the Bundesärztekammer derived from MERS the doctor can easily access information on cases of medical malpractice and harm in his or her discipline. This knowledge helps to foresee risks in a patient's treatment and to avoid errors.
Gosselin, P. [Inst. national de sante publique, Quebec, PQ (Canada); Hrudey, S.E. [Alberta Univ., Edmonton, AB (Canada). Faculty of Medicine and Dentistry, Div. of Analytical and Environmental Toxicology; Naeth, M.A. [Alberta Univ., Edmonton, AB (Canada). Faculty of Agricultural, Life, and Environmental Sciences; Plourde, A. [Alberta Univ., Edmonton, AB (Canada). Dept. of Economics; Therrien, R. [Natural Sciences and Engineering Research Council of Canada, Ottawa, ON (Canada); Laval Univ., Quebec City, PQ (Canada). Dept. of Geology and Geological Engineering; Van Der Kraak, G. [Guelph Univ., ON (Canada). Dept. of Integrative Biology; Guelph Univ., ON (Canada). College of Biological Science; Xu, Z. [Alberta Univ., Edmonton, AB (Canada). Faculty of Engineering
This expert panel report was commissioned by the Royal Society of Canada to provide a comprehensive evidence-based assessment of the environmental and health impacts of Canada's oil sands industry. The report evaluated the feasibility of land reclamation and the impacts of oil sands contaminants on downstream residents. Health impacts on residents living in the Regional Municipality of Wood Buffalo were assessed, and the impacts on regional water supplies were evaluated. Regional water and ground water quantities were examined, and issues related to tailing pond operations and reclamation were examined. Ambient air quality impacts were assessed, as well as potential impacts of the oil sands industry on greenhouse gas (GHG) emissions. The environmental regulatory performance of operators in the industry was also evaluated. A summary of economic and policy issues related to the industry was also provided. The study identified major gaps in the process of assessment, prevention, and mitigation of the health impacts of oil sands exploitation, as as major indirect health impacts linked to past exploitation activities. 672 refs., 11 tabs., 11 figs. 10 appendices.
Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng
To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method. Copyright © 2015 Elsevier Ltd. All rights reserved.
Chang, Anne B; Oppenheimer, John J; Weinberger, Miles M; Rubin, Bruce K; Weir, Kelly; Grant, Cameron C; Irwin, Richard S
Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed). Copyright © 2017 American College of Chest Physicians. All rights reserved.
Huesing, Joseph; Romeis, Jörg; Ellstrand, Norman; Raybould, Alan; Hellmich, Richard; Wolt, Jeff; Ehlers, Jeff; Dabiré, Clémentine; Fatokun, Christian; Hokanson, Karen; Ishiyaku, Mohammad F; Margam, Venu; Obokoh, Nompumelelo; Mignouna, Jacob; Nangayo, Francis; Ouedraogo, Jeremy; Pasquet, Rémy; Pittendrigh, Barry; Schaal, Barbara; Stein, Jeff; Tamò, Manuele; Murdock, Larry
Cowpea (Vigna unguiculata spp unguiculata) is adapted to the drier agro-ecological zones of West Africa where it is a major source of dietary protein and widely used as a fodder crop. Improving the productivity of cowpea can enhance food availability and security in West Africa. Insect predation--predominately from the legume pod borer (Maruca vitrata), flower thrips (Megalurothrips sjostedti) and a complex of pod-sucking bugs (e.g., Clavigralla spp)--is a major yield-limiting factor in West African cowpea production. Dramatic increases in yield are shown when M. vitrata is controlled with insecticides. However, availability, costs, and safety considerations limit pesticides as a viable option for boosting cowpea production. Development of Bt-cowpea through genetic modification (GM) to control the legume pod borer is a promising approach to cowpea improvement. Cowpea expressing the lepidopteran-active Cry1Ab protein from Bacillus thuringiensis is being developed as a first generation Bt-cowpea crop for West Africa. Appropriate stewardship of Bt-cowpea to assure its sustainability under West African conditions is critical to its successful development. A first step in this process is an environmental risk assessment to determine the likelihood and magnitude of adverse effects of the Cry1Ab protein on key environmental protection goals in West Africa. Here we describe the results of an expert panel convened in 2009 to develop the problem formulation phase for Bt-cowpea and to address specific issues around gene flow, non-target arthropods, and insect resistance management.
Ruxton, C H S
The increased availability of caffeinated drinks raises questions about the level of caffeine that is appropriate for children, as well as the benefits and risks associated with their consumption. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates evidence from randomised controlled trials investigating the effects of caffeine on cognition, behaviour, mood and exercise performance in children. Observational studies and expert panel guidelines are also discussed. One hundred and nine studies were found, with 11 randomised controlled trials and 13 observational studies meeting the criteria. High caffeine intakes (e.g. >5 mg kg(-1) body weight day(-1)) were associated with an increased risk of anxiety and withdrawal symptoms. However, smaller amounts were not linked with such effects and may benefit cognitive function and sports performance based on adult studies. The evidence suggests that children and adolescents should limit daily caffeine consumption to 2.5 mg kg(-1) body weight day(-1), equating to one or two cups of tea or one small cup of coffee. Lower contributors of caffeine, such as tea, may be more appropriate for children because they contribute to daily fluid intakes and provide flavonoids. By contrast, caffeinated soft drinks may be less suitable options for children as a result of their acidity, higher caffeine content, presence of added sugar (in some cases) and absence of bioactive compounds. More studies are needed to determine the intakes that represent a risk and whether there may be benefits for alertness and sports performance with moderate intakes of caffeine. © 2013 The British Dietetic Association Ltd.
Deer, Timothy; Krames, Elliot S; Hassenbusch, Samuel J; Burton, Allen; Caraway, David; Dupen, Stuart; Eisenach, James; Erdek, Michael; Grigsby, Eric; Kim, Phillip; Levy, Robert; McDowell, Gladstone; Mekhail, Nagy; Panchal, Sunil; Prager, Joshua; Rauck, Richard; Saulino, Michael; Sitzman, Todd; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Willis, K Dean; Witt, William; Follett, Kenneth; Huntoon, Marc; Liem, Leong; Rathmell, James; Wallace, Mark; Buchser, Eric; Cousins, Michael; Ver Donck, Anne
Background. Expert panels of physicians and nonphysicians in the field of intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of intrathecal opioid and nonopioid agents. Methods. A review of preclinical and clinical published relevant studies from 2000 to 2006 was undertaken and disseminated to a convened expert panel of physicians and nonphysicians. Focused discussions were held on the rational use of intrathecal agents and a survey asking questions regarding intrathecal therapies management was given to the panelists. Results. The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one intrathecal drug.
Elmore, Kim; Flanagan, Barry; Jones, Nicholas F; Heitgerd, Janet L
In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC's Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC's strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal.
Oral contraception and menstrual bleeding during treatment of venous thromboembolism: Expert opinion versus current practice Combined results of a systematic review, expert panel opinion and an international survey
Klok, F. A.; Schreiber, K.; Stach, K.; Ageno, W.; Middeldorp, S.; Eichinger, S.; Delluc, A.; Blondon, M.; Ay, C.
Introduction: The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians.
In October 2011, the UN Committee on World Food Security (CFS) recommended a ''review of biofuels policies -- where applicable and if necessary -- according to balanced science-based assessments of the opportunities and challenges that they may represent for food security so that biofuels can be produced where it is socially, economically and environmentally feasible to do so''. In line with this, the CFS requested the HLPE (High Level Panel of Experts) to ''conduct a science-based comparative literature analysis taking into consideration the work produced by the FAO and Global Bioenergy Partnership (GBEP) of the positive and negative effects of biofuels on food security''. Recommendations from the report include the following. Food security policies and biofuel policies cannot be separated because they mutually interact. Food security and the right to food should be priority concerns in the design of any biofuel policy. Governments should adopt the principle: biofuels shall not compromise food security and therefore should be managed so that food access or the resources necessary for the production of food, principally land, biodiversity, water and labour are not put at risk. The CFS should undertake action to ensure that this principle is operable in the very varied contexts in which all countries find themselves. Given the trend to the emergence of a global biofuels market, and a context moving from policy-driven to market-driven biofuels, there is an urgent need for close and pro-active coordination of food security, biofuel/bioenergy policies and energy policies, at national and international levels, as well as rapid response mechanisms in case of crisis. There is also an urgent need to create an enabling, responsible climate for food and non-food investments compatible with food security. The HLPE recommends that governments adopt a coordinated food security and energy security strategy, which would require articulation
... the condition of whole ecosystems; (f) statisticians with expertise in analysis of environmental..., subcommittees and advisory panels; and (f) for the Panel as a whole, diversity of expertise and viewpoints. The... Environmental Protection Agency Science Advisory Board (EPA-SAB-EC-02-010), which is posted on the SAB Web site...
The purpose of this article is to make authors and readers master some writing and reading skills by elaborating the definition, characteristics, the comparison of style and writing technique of expert commentary. Expert commentary is journal editorial that is not only author's personal point of view, but also the collective opinions of Ophthalmology Branch of the Chinese Medical Association and editorial board of the magazine. Therefore, it should be view clear, clear-cut stand and having certain academic orientation. It is our common responsibility to promote the academic development of ophthalmology in China, by mobilizing various aspects strength, carefully written and read expert commentary.
Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V
There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Full Text Available Praveen J Patel,1 Helen Devonport,2 Sobha Sivaprasad,1 Adam H Ross,3 Gavin Walters,4 Richard P Gale,5 Andrew J Lotery,6 Sajjad Mahmood,7 James S Talks,8 Jackie Napier9 1National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 2The Ophthalmology Department, Bradford Royal Infirmary, Bradford, UK; 3The Ophthalmology Department, Bristol Eye Hospital, Bristol, UK; 4Department of Ophthalmology, Harrogate District Hospital, Harrogate, UK; 5The Ophthalmology Department, The York Hospital and Department of Health Sciences, University of York, York, UK; 6Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; 7Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; 8Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK; 9Medical Affairs, Bayer plc, Reading, Berkshire, UK Abstract: National recommendations on continued administration of aflibercept solution for injection after the first year of treatment for neovascular age-related macular degeneration (nAMD have been developed by an expert panel of UK retina specialists, based on clinician experience and treatment outcomes seen in year 2. The 2017 update reiterates that the treatment goal is to maintain or improve the macular structural and functional gains achieved in year 1 while attempting to reduce or minimize the treatment burden, recognizing the need for ongoing treatment. At the end of year 1 (ie, the decision visit at month 11, two treatment options should be considered: do not extend the treatment interval and maintain fixed 8-weekly dosing, or extend the treatment interval using a treat-and-extend regimen up to a maximum 12 weeks. Criteria for considering not extending the treatment interval are persistent macular fluid with stable
The Expert Panel Oversight Committee (EPOC) on Double-Shell Tank Corrosion Monitoring and Testing has been overseeing the Fiscal Year FY 2008 experimental program being performed at CC Technologies (CCT) to optimize the chemistry control for corrosion limits in Double-Shell Tanks (DSTs). The EPOC met at the M & D Professional Services Conference Facility on August 4 and 5, 2008 to discuss various aspects of that responsibility including FY 2009 planning. Formal presentations were made to update the EPOC on the these subjects.
Doull, J; Gaylor, D; Greim, H A; Lovell, D P; Lynch, B; Munro, I C
MON 863, a genetically engineered corn variety that contains the gene for modified Bacillus thuringiensis Cry3Bb1 protein to protect against corn rootworm, was tested in a 90-day toxicity study as part of the process to gain regulatory approval. This study was reanalyzed by Séralini et al. who contended that the study showed possible hepatorenal effects of MON 863. An Expert Panel was convened to assess the original study results as analyzed by the Monsanto Company and the reanalysis conducted by Séralini et al. The Expert Panel concludes that the Séralini et al. reanalysis provided no evidence to indicate that MON 863 was associated with adverse effects in the 90-day rat study. In each case, statistical findings reported by both Monsanto and Séralini et al. were considered to be unrelated to treatment or of no biological or clinical importance because they failed to demonstrate a dose-response relationship, reproducibility over time, association with other relevant changes (e.g., histopathology), occurrence in both sexes, difference outside the normal range of variation, or biological plausibility with respect to cause-and-effect. The Séralini et al. reanalysis does not advance any new scientific data to indicate that MON 863 caused adverse effects in the 90-day rat study.
Barber, Claire E H; Marshall, Deborah A; Alvarez, Nanette; Mancini, G B John; Lacaille, Diane; Keeling, Stephanie; Aviña-Zubieta, J Antonio; Khodyakov, Dmitry; Barnabe, Cheryl; Faris, Peter; Smith, Alexa; Noormohamed, Raheem; Hazlewood, Glen; Martin, Liam O; Esdaile, John M
Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics. A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs. Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.
Gaeta, Giovanni B; Puoti, Massimo; Coppola, Nicola; Santantonio, Teresa; Bruno, Raffaele; Chirianni, Antonio; Galli, Massimo
This paper is aimed at providing practical recommendations for the management of acute hepatitis C (AHC). This is an expert position paper based on the literature revision. Final recommendations were graded by level of evidence and strength of the recommendations. Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments. Early treatment with DAA should be offered when available.
Su, Chunxia; Meyer, Mathias; Pirker, Robert; Voigt, Wieland; Shi, Jingyun; Pilz, Lothar; Huber, Rudolf M; Wu, Yilong; Wang, Jinghong; He, Yonglan; Wang, Xuan; Zhang, Jian; Zhi, Xiuyi; Shi, Meiqi; Zhu, Bo; Schoenberg, Stefan S; Henzler, Thomas; Manegold, Christian; Zhou, Caicun; Roessner, Eric Dominic
The first Chinese-German Lung Cancer Expert Panel was held in November 2015 one day after the 7th Chinese-German Lung Cancer Forum, Shanghai. The intention of the meeting was to discuss strategies for the diagnosis and treatment of lung cancer within the context of lung cancer screening. Improved risk classification criteria and novel imaging approaches for screening populations are highly required as more than half of lung cancer cases are false positive during the initial screening round if the National Lung Screening Trial (NLST) demographic criteria [≥30 pack years (PY) of cigarettes, age ≥55 years] are applied. Moreover, if the NLST criteria are applied to the Chinese population a high number of lung cancer patients are not diagnosed due to non-smoking related risk factors in China. The primary goal in the evaluation of pulmonary nodules (PN) is to determine whether they are malignant or benign. Volumetric based screening concepts such as investigated in the Dutch-Belgian randomized lung cancer screening trial (NELSON) seem to achieve higher specificity. Chest CT is the best imaging technique to identify the origin and location of the nodule since 20% of suspected PN found on chest X-ray turn out to be non-pulmonary lesions. Moreover, novel state-of-the-art CT systems can reduce the radiation dose for lung cancer screening acquisitions down to a level of 0.1 mSv with improved image quality to novel reconstruction techniques and thus reduce concerns related to chest CT as the primary screening technology. The aim of the first part of this manuscript was to summarize the current status of novel diagnostic techniques used for lung cancer screening and minimally invasive treatment techniques for progressive PNs that were discussed during the first Chinese-German Lung Cancer. This part should serve as an educational part for the readership of the techniques that were discussed during the Expert Panel. The second part summarizes the consensus recommendations
Roger, Sebastian [RWE Innogy GmbH, Essen (Germany). Asset Management Hydro National; Kaefer, Sabine [Verbund Hydro Power AG, Villach (Austria); Ulrich, Jochen [EDH Energiedienst Holding AG, Laufenburg (Switzerland). Oekologie und Werkdienst; Zemanek, Friedrich [evn naturkraft Erzeugungsgesellschaft m.b.H., Maria Enzersdorf (Austria)
In recent years, ecological regulations and environmental demands have steadily increased on European, national, and on Federal State level. One key issue of Federal implementations of the European water framework directive is to achieve the environmental targets by establishing the passability for fish. In support of its member companies, VGB (TC 'Hydro Power Plants') set up a transnational expert group. This group was to analyse, compare, and evaluate different essential guidelines for fish passes and residual flows including the exchange of experience and the provision of practical examples. (orig.)
Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten; Ardern-Jones, Michael R; Barbarot, Sebastien; Deleuran, Mette; Bieber, Thomas; Vestergaard, Christian; Brown, Sara J; Cork, Michael J; Drucker, Aaron M; Eichenfield, Lawrence F; Foelster-Holst, Regina; Guttman-Yassky, Emma; Nosbaum, Audrey; Reynolds, Nick J; Silverberg, Jonathan I; Schmitt, Jochen; Seyger, Marieke M B; Spuls, Phyllis I; Stalder, Jean-Francois; Su, John C; Takaoka, Roberto; Traidl-Hoffmann, Claudia; Thyssen, Jacob P; van der Schaft, Jorien; Wollenberg, Andreas; Irvine, Alan D; Paller, Amy S
Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Our work is a consensus statement, not a systematic review. The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies. Copyright © 2017 American Academy of Dermatology, Inc. All rights reserved.
Joseph Francois; Julia Woerz
We develop a panel-based ICLS framework for estimating the export tax equivalent (ETE) of quotas where the ETEs vary over time. Working with a panel of bilateral data on textile and clothing trade, underlying bilateral tari?s, and the country-pair coverage of quotas under the WTOÕs Agreement on Textiles and Clothing (ATC), we use this framework to examine the evolution of market access conditions in the textile and clothing sectors. Our estimating framework takes advantage of the panel nature...
Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire
There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023
Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire
There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.
Burmester, Gerd; Lanas, Angel; Biasucci, Luigi; Hermann, Matthias; Lohmander, Stefan; Olivieri, Ignazio; Scarpignato, Carmelo; Smolen, Josef; Hawkey, Chris; Bajkowski, Adam; Berenbaum, Francis; Breedveld, Ferdinand; Dieleman, Peter; Dougados, Maxime; MacDonald, Thomas; Mola, Emilio Martin; Mets, Tony; Van den Noortgate, Nele; Stoevelaar, Herman
Given the safety issues of non-steroidal anti-inflammatory drugs (NSAID) and the robustness of guidelines, making treatment choices in daily clinical practice is increasingly difficult. This study aimed systematically to analyse the opinions of a multidisciplinary European expert panel on the appropriateness of different NSAID, with or without the use of a proton pump inhibitor (PPI), in individual patients with chronic rheumatic disease. /Using the Research and Development/University of California at Los Angeles appropriateness method, the appropriateness of five (non-)selective NSAID with or without a PPI was assessed for 144 hypothetical patient profiles, ie, unique combinations of cardiovascular and gastrointestinal risk factors. Appropriateness statements were calculated for all indications. All options without PPI were considered appropriate in patients with no gastrointestinal/cardiovascular risk factors. Cyclooxygenase-2 selective inhibitors (C2SI) alone and non-selective NSAID plus PPI were preferred for patients with elevated gastrointestinal risk and low cardiovascular risk. Naproxen plus PPI was favoured in patients with high cardiovascular risk. For the combination of high gastrointestinal/high cardiovascular risk the use of any NSAID was discouraged; if needed, naproxen plus PPI or a C2SI plus PPI could be considered. The panel results may support treatment considerations at the level of individual patients, according to their gastrointestinal/cardiovascular risk profile.
Hokanson, Karen E; Ellstrand, Norman C; Dixon, Alfred G O; Kulembeka, Heneriko P; Olsen, Kenneth M; Raybould, Alan
The probability and consequences of gene flow to wild relatives is typically considered in the environmental risk assessment of genetically engineered crops. This is a report from a discussion by a group of experts who used a problem formulation approach to consider existing information for risk assessment of gene flow from cassava (Manihot esculenta) genetically engineered for virus resistance to the 'wild' (naturalized) relative M. glaziovii in East Africa. Two environmental harms were considered in this case: (1) loss of genetic diversity in the germplasm pool, and (2) loss of valued species, ecosystem resources, or crop yield and quality due to weediness or invasiveness of wild relatives. Based on existing information, it was concluded that gene flow will occur, but it is not likely that this will reduce the genetic diversity in the germplasm pool. There is little existing information about the impact of the virus in natural populations that could be used to inform a prediction about whether virus resistance would lead to an increase in reproduction or survival, hence abundance of M. glaziovii. However, an increase in the abundance of M. glaziovii should be manageable, and would not necessarily lead to the identified environmental harms.
Cabrera, Maria Elena; Martinez, Virginia; Nathwani, Bharat N; Muller-Hermelink, H Konrad; Diebold, Jacques; Maclennan, Kenneth A; Armitage, James; Weisenburger, Dennis D
The distribution of subtypes of non-Hodgkin lymphoma (NHL) in Latin America is not well known. This Chilean study included 207 consecutive cases of NHL diagnosed at five cancer centers in the capital, Santiago, and one center in Viña del Mar. All cases were reviewed and classified independently by five expert hematopathologists according to the 2001 World Health Organization classification of NHL. A consensus diagnosis of NHL was reached in 195 of the 207 cases (94%). B-cell lymphomas constituted 88% of NHL, and diffuse large B-cell lymphoma (DLBCL, 38.5%) and follicular lymphoma (25.1%) were the most common subtypes. There was a high frequency of marginal zone B-cell lymphoma (10.3%), as well as of extranodal natural killer (NK)/T-cell lymphoma, nasal type (2.6%) and adult T-cell leukemia/lymphoma (0.5%). Extranodal presentation was seen in 74 of the 195 cases (38%) and the most common extranodal presentation was in the stomach (37.6%). The most common gastric lymphoma was DLBCL (54.5%) followed by mucosa-associated lymphoid tissue (MALT) lymphoma (41%). Overall, the frequency of NHL subtypes in Chile is between that reported in Western and Eastern countries, which is probably a reflection of the admixture of ethnicities as well as the environment and socioeconomic status of its population.
van den Akker, Edmée F M M; Van't Hul, Alex J; Birnie, Erwin; Chavannes, Niels H; Rutten-van Mölken, Maureen P M H; In't Veen, Johannes C C M
A comprehensive diagnostic assessment is needed to improve understanding of the health status of patients with chronic obstructive pulmonary disease (COPD) or asthma. Therefore, this study investigated which components and subsequent instruments should be part of a holistic assessment in secondary care. We also explored which data need to be exchanged for an adequate transfer of patients between primary and secondary care, and vice versa. A cross-sectional Web-based survey was conducted among Dutch healthcare professionals using a Delphi-like procedure; these included professionals working in primary or secondary care, medical advisors of health insurance companies and patients' representatives. The national guidelines were used as a starting point, resulting in a questionnaire addressing 55 components related to a comprehensive diagnostic assessment, covering the domains physiological impairments, symptoms, functional limitations and quality of life. Of the 151 experts and stakeholders invited, 92 (60.9%) completed the first round and 79 (52.3%) the second round; most respondents were pulmonologists. There was a high level of agreement between respondents from primary versus secondary care regarding which components should be measured during a comprehensive assessment of patients with asthma or COPD in secondary care and the instruments to measure these components. Regarding the exchange of information, upon referral, pulmonologists required little information from the general practitioners, whereas general practitioners required more extensive information after referral. An overview is provided of what should be part of a holistic assessment of health status in asthma and COPD. This information can be used as input for integrated care pathways.
Franceschini, M; Iocco, M; Molteni, F; Santamato, A; Smania, N
should be assessed at repeated follow-up visits. This expert panel survey can provide guidance for clinicians in the assessment of patients treated with BTX-A therapy.
controls. Neither Polyisobutene nor Hydrogenated Polyisobutene were ocular irritants, nor were they dermal irritants or sensitizers. Polyisobutene was not comedogenic in a rabbit ear study. Polyisobutene did not induce transformation in the Syrian hamster embryo (SHE) cell transformation assay, but did enhance 3-methylcholanthrene-induced transformation of C3H/10T1/2 cells. In a carcinogenicity study in mice, Polyisobutene was not carcinogenic, nor did it promote the carcinogenicity of 7,12-dimethylbenz(alpha)anthracene. Clinical patch tests uncovered no evidence of dermal irritation and repeat-insult patch tests with a product containing 4% Hydrogenated Polyisobutene or 1.44% Hydrogenated Polyisobutene found no reactions greater than slight erythema. These products also were not phototoxic or photoallergenic. The product containing 4% Hydrogenated Polyisobutene was not an ocular irritant in a clinical test. The Cosmetic Ingredient Review (CIR) Expert Panel recognized that there are data gaps regarding use and concentration of these ingredients. However, the overall information available on the types of products in which these ingredients are used and at what concentrations indicate a pattern of use, which was considered by the Expert Panel in assessing safety. Although there is an absence of dermal absorption data for Polyisobutene and Hydrogenated Polyisobutene, the available octanol water partition coefficient data and the low solubility in water suggest very slow absorption, so additional data are not needed. Gastrointestinal absorption is also not a major concern due to the low solubility of these chemicals. Although one in vitro study did report that Polyisobutene did promote cellular transformation, a mouse study did not find evidence of tumor promotion. Because lifetime exposure studies using rats and dogs exposed to Polybutene failed to demonstrate any carcinogenic or tumor promotion effect, and a three-generation reproductive/developmental toxicity study produced
“The disease often begins in childhood and sometimes lasts until old age. It may follow an attack of whooping cough. One of the most striking peculiarities is the bizarre and extraordinary variety of circumstances, which at times induce a paroxysm. Among these local conditions, climate or atmosphere is most important.”
Günzel-Jensen, Franziska; Robinson, Sarah; Neergaard, Helle
an “experience deficit” and why some novices rely on effectuation remains largely unanswered. Approach/Method: We use a multiple case study of 29 entrepreneurial teams in an undergraduate entrepreneurship classroom. Findings: We identify three phases in the effectuation process in the classroom i) an initiation...... through trial and error are experienced and reflection and confidence/trust in the team/process/outcome are important. At each of these phases some teams opt out when the context is perceived as hindering desired outcomes. Implications/Value: The contribution of this paper is threefold: (i) even...
Full Text Available Both the prevalence and incidence of type 2 diabetes are increasing worldwide and over 60% of people with T2DM develop cardiovascular disease. There are many data supporting the view that glycaemic control plays a role in reducing cardiovascular complications. The relationship between hyperglycaemia and cardiovascular disease is complex with evidence suggesting that an acute increase of glycaemia, particularly after a meal, may have a direct detrimental effect on cardiovascular disease. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing post meal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. New classes of therapies for managing post meal plasma glucose in people with diabetes (glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors have shown significant benefits in reducing post meal plasma glucose excursions andlowering HbA1c. The individual properties of the various GLP‑1 receptor agonists might enable incretin-based treatment of type 2 diabetes mellitus to be tailored to the needs of each patient.
Originality/value: The obtained values of the indicators of methane risk assessment and analysis of their changes showed that the proposed method can be an important element in the design and construction of a modern methane safety system in coal mines. It provides the possibility of controlling this risk and enables the minimization of its consequences in accordance with the criteria of their acceptance, adopted in this paper. The method does not replace the currently used methods of methane risk assessment, but complements them in a significant and modern way.
Performance of the FilmArray® blood culture identification panel utilized by non-expert staff compared with conventional microbial identification and antimicrobial resistance gene detection from positive blood cultures.
McCoy, Morgan H; Relich, Ryan F; Davis, Thomas E; Schmitt, Bryan H
Utilization of commercially available rapid platforms for microbial identification from positive blood cultures is useful during periods of, or in laboratories with, limited expert staffing. We compared the results of the FilmArray® BCID Panel performed by non-expert technologists to those of conventional methods for organism identification performed by skilled microbiologists. Within 8 h of signalling positive by a continuous monitoring blood culture system, positive bottles were analysed by the FilmArray BCID Panel. Data from these analyses were compared to standard-of-care testing, which included conventional and automated methods. To gauge the ease of use of the BCID Panel by non-expert staff, technologists unfamiliar with diagnostic bacteriology performed the testing without prior knowledge of the Gram stain results, or even whether organisms were detected. Identifications of 172/200 (86 %) positive blood cultures using the BCID Panel were consistent with identifications provided by standard-of-care methods. Standard-of-care testing identified organisms in 20 positive blood cultures, which were not represented on the BCID Panel. Seven (3.5 %) blood cultures demonstrated a discrepancy between the methods, which could not be attributed to either a lack of representation on the panel or unclear separate detection of organisms in a mixed blood culture of a shared genus or grouping of organisms, e.g. Staphylococcus or Enterobacteriaceae . One (0.5 %) blood culture yielded invalid results on two separate panels, so it was eliminated from the study. The easy-to-use FilmArray® technology shows good correlation with blood culture identification and antibiotic resistance detection performed by conventional methods. This technology may be particularly useful in laboratories with limited staffing or limited technical expertise.
Baldari, Sergio; Boni, Giuseppe; Bortolus, Roberto; Caffo, Orazio; Conti, Giario; De Vincentis, Giuseppe; Monari, Fabio; Procopio, Giuseppe; Santini, Daniele; Seregni, Ettore; Valdagni, Riccardo
Radium-223, a calcium mimetic bone-seeking radionuclide that selectively targets bone metastases with alpha particles, is approved for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC) and symptomatic bone metastases. In patients with mCRPC, treatment with radium-223 has been associated with survival benefit, regardless of prior docetaxel use, and also has a positive impact on symptomatic skeletal events and quality of life. Radium-223 is best suited for patients with symptomatic mCRPC and bone-predominant disease and no visceral metastases, and may lead to better outcomes when given early in the course of the disease. An expert multidisciplinary panel convened in Milan, Italy to review the current best-evidence literature on radium-223 and to convey their personal expertise with the use of radium-223 and identify possible strategies for best practice. This article summarizes the best available evidence for the use of radium-223, discusses the essential role of the multidisciplinary team in delivering effective treatment for mCRPC, clarifies pre- and post-treatment evaluation and monitoring, and outlines future scenarios for radium-223 in the treatment of men with MCRPC. Copyright © 2017. Published by Elsevier B.V.
Vertigan, Anne E; Murad, Mohammad H; Pringsheim, Tamara; Feinstein, Anthony; Chang, Anne B; Newcombe, Peter A; Rubin, Bruce K; McGarvey, Lorcan P; Weir, Kelly; Altman, Kenneth W; Weinberger, Miles; Irwin, Richard S; Adams, Todd M; Altman, Kenneth W; Barker, Alan F; Birring, Surinder S; Blackhall, Fiona; Bolser, Donald C; Boulet, Louis-Philippe; Braman, Sidney S; Brightling, Christopher; Callahan-Lyon, Priscilla; Canning, Brendan J; Chang, Anne B; Coeytaux, Remy; Cowley, Terrie; Davenport, Paul; Diekemper, Rebecca L; Ebihara, Satoru; El Solh, Ali A; Escalante, Patricio; Feinstein, Anthony; Field, Stephen K; Fisher, Dina; French, Cynthia T; Gibson, Peter; Gold, Philip; Gould, Michael K; Grant, Cameron; Harding, Susan M; Harnden, Anthony; Hill, Adam T; Irwin, Richard S; Kahrilas, Peter J; Keogh, Karina A; Lane, Andrew P; Lim, Kaiser; Malesker, Mark A; Mazzone, Peter; Mazzone, Stuart; McCrory, Douglas C; McGarvey, Lorcan; Molasiotis, Alex; Murad, M Hassan; Newcombe, Peter; Nguyen, Huong Q; Oppenheimer, John; Prezant, David; Pringsheim, Tamara; Restrepo, Marcos I; Rosen, Mark; Rubin, Bruce; Ryu, Jay H; Smith, Jaclyn; Tarlo, Susan M; Vertigan, Anne E; Wang, Gang; Weinberger, Miles; Weir, Kelly; Wiener, Renda Soylemez
We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.
Juan Arturo Rubio Arostegui
Full Text Available L’acreditació es defineix per les agències de qualitat de l’Espai Europeu d’Educació Superior com un element clau en la gestió de la qualitat i la millora contínua dels processos d’ensenyament-aprenentatge a la universitat. Aquesta pràctica institucional comença a desenvolupar-se en 2014 a Espanya. L’article il·lustra el cas de l’agència de qualitat del sistema universitari madrileny, com a anàlisi de cas, per mitjà de l’experiència del propi autor com a panelista en l’acreditació dels títols. Metodològicament es parteix de l’enfocament autoetnogràfic i de la teoria de l’interaccionisme simbòlic, per poder desvetlar i analitzar el procés i les cultures avaluatives. Per a fer-ho, es tracen dos eixos d’anàlisis: els resultats d’aprenentatge i el valor de la recerca en els recursos humans adscrits al títol, tots dos considerats per les agències de qualitat com a criteris crítics perquè l’informe final del títol siga favorable. A través d’aquests dos criteris es plantegen les interaccions que es donen en el panel d’experts en les diferents fases del procés d’acreditació.
Frye, Richard E; Rossignol, Daniel; Casanova, Manuel F; Brown, Gregory L; Martin, Victoria; Edelson, Stephen; Coben, Robert; Lewine, Jeffrey; Slattery, John C; Lau, Chrystal; Hardy, Paul; Fatemi, S Hossein; Folsom, Timothy D; Macfabe, Derrick; Adams, James B
Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals
Richard Eugene Frye
Full Text Available Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD, the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections and immunomodulation and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports L-carnitine, multivitamins and N-acetyl-L-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet and transcranial magnetic simulation. Zinc and L-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use these treatments. Additional studies concerning these treatments for controlling seizures in individuals with ASD
Pięta, Ewa; Proniewicz, Edyta; Szmelter-Fausek, Bożena; Olszewska-Świetlik, Justyna; Proniewicz, Leonard M
Samples were obtained from two world-famous 17th century panel paintings of the Gdańsk school of panting: 'Seven Acts of Charity' (1607, in St. Mary's Church in Gdańsk, Poland) by Anton Möller and 'Angelic Concert' (1611, in Diocesan Museum in Pelplin, Poland) by Hermann Han. Micro-Raman spectroscopy (MRS), optical microscopy (OM), and X-ray fluorescence (XRF) spectroscopy studies of the samples were performed to characterize the pigments present in the individual painting layers (a rich palette of white, black, blue, red, and yellow pigments) and the pictorial techniques used by the artists. Copyright © 2014 Elsevier B.V. All rights reserved.
Chen, Jinying; Zheng, Jiaping; Yu, Hong
Many health organizations allow patients to access their own electronic health record (EHR) notes through online patient portals as a way to enhance patient-centered care. However, EHR notes are typically long and contain abundant medical jargon that can be difficult for patients to understand. In addition, many medical terms in patients' notes are not directly related to their health care needs. One way to help patients better comprehend their own notes is to reduce information overload and help them focus on medical terms that matter most to them. Interventions can then be developed by giving them targeted education to improve their EHR comprehension and the quality of care. We aimed to develop a supervised natural language processing (NLP) system called Finding impOrtant medical Concepts most Useful to patientS (FOCUS) that automatically identifies and ranks medical terms in EHR notes based on their importance to the patients. First, we built an expert-annotated corpus. For each EHR note, 2 physicians independently identified medical terms important to the patient. Using the physicians' agreement as the gold standard, we developed and evaluated FOCUS. FOCUS first identifies candidate terms from each EHR note using MetaMap and then ranks the terms using a support vector machine-based learn-to-rank algorithm. We explored rich learning features, including distributed word representation, Unified Medical Language System semantic type, topic features, and features derived from consumer health vocabulary. We compared FOCUS with 2 strong baseline NLP systems. Physicians annotated 90 EHR notes and identified a mean of 9 (SD 5) important terms per note. The Cohen's kappa annotation agreement was .51. The 10-fold cross-validation results show that FOCUS achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.940 for ranking candidate terms from EHR notes to identify important terms. When including term identification, the performance of FOCUS for
Duits, Lucas C.; Phoa, K. Nadine; Curvers, Wouter L.; Ten Kate, Fiebo J W; Meijer, Gerrit A.; Seldenrijk, Cees A.; Offerhaus, G. Johan; Visser, Mike; Meijer, Sybren L.; Krishnadath, Kausilia K.; Tijssen, Jan G P; Mallant-Hent, Rosalie C.; Bergman, Jacques J G H M
Objective Reported malignant progression rates for low-grade dysplasia (LGD) in Barrett's oesophagus (BO) vary widely. Expert histological review of LGD is advised, but limited data are available on its clinical value. This retrospective cohort study aimed to determine the value of an expert
Mulligan, J; Conteh, L
Background As global research investment increases, attention inevitably turns to assessing and measuring the outcomes and impact from research programmes. Research can have many different outcomes such as producing advances in scientific knowledge, building research capacity and, ultimately, health and broader societal benefits. The aim of this study was to test the use of a Delphi methodology as a way of gathering views from malaria research experts on research priorities and eliciting rela...
Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.
The present study implemented a probability encoding method to estimate the probability distributions of selected hydrologic variables for the Cohassett basalt flow top and flow interior, and the anisotropy ratio of the interior of the Cohassett basalt flow beneath the Hanford Site. Site-speciic data for these hydrologic parameters are currently inadequate for the purpose of preliminary assessment of candidate repository performance. However, this information is required to complete preliminary performance assessment studies. Rockwell chose a probability encoding method developed by SRI International to generate credible and auditable estimates of the probability distributions of effective porosity and hydraulic conductivity anisotropy. The results indicate significant differences of opinion among the experts. This was especially true of the values of the effective porosity of the Cohassett basalt flow interior for which estimates differ by more than five orders of magnitude. The experts are in greater agreement about the values of effective porosity of the Cohassett basalt flow top; their estimates for this variable are generally within one to two orders of magnitiude of each other. For anisotropy ratio, the expert estimates are generally within two or three orders of magnitude of each other. Based on this study, the Rockwell hydrologists estimate the effective porosity of the Cohassett basalt flow top to be generally higher than do the independent experts. For the effective porosity of the Cohassett basalt flow top, the estimates of the Rockwell hydrologists indicate a smaller uncertainty than do the estimates of the independent experts. On the other hand, for the effective porosity and anisotropy ratio of the Cohassett basalt flow interior, the estimates of the Rockwell hydrologists indicate a larger uncertainty than do the estimates of the independent experts.
Experts on the Federal Insecticide, Fungicide, and Rodenticide Act Scientific Advisory Panel provide independent scientific advice to the EPA on a wide range of health and safety issues related to pesticides.
Herlihy, Barbara; Dufrene, Roxane L.
A Delphi study was conducted to ascertain the opinions of panel experts regarding the most important current and emerging ethical issues facing the counseling profession. Expert opinions on ethical issues in counselor preparation also were sought. Eighteen panelists responded to 3 rounds of data collection interspersed with feedback. Themes that…
Abbatangelo-Gray, Jodie; Cole, Galen E; Kennedy, May G
In May 2004, 12 experts in evaluating large-scale health communication programs came to the Centers for Disease Control and Prevention to participate in an electronic focus group discussion. They offered advice on topics ranging from the role of logic models to the best strategies for controlling for self-selection bias in surveys regarding outcomes of exposure to mass media health messages. The experts also highlighted health communication evaluation topics that have received too little scientific attention. Finally, they made strategic policy recommendations. Use of the state-of-the-art evaluation methods that they recommended could improve the communication of factual and persuasive health messages and help to guard the public health of the nation. Their advice may also advance evaluation practice in other substantive areas, especially where it is difficult or impossible to implement randomized designs.
Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel.
Freer, Phoebe E; Slanetz, Priscilla J; Haas, Jennifer S; Tung, Nadine M; Hughes, Kevin S; Armstrong, Katrina; Semine, A Alan; Troyan, Susan L; Birdwell, Robyn L
Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review, the Cochrane review, National Comprehensive Cancer Network guidelines, American Cancer Society recommendations, and American College of Radiology appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman.
Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels.
McCullough, Amanda R; Ryan, Cristín; O'Neill, Brenda; Bradley, Judy M; Elborn, J Stuart; Hughes, Carmel M
Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients' adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3). We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients' adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3). Eight TDF domains were perceived to influence patients' and HCPs' behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in
Fernández-Gómez, J M; Carballido-Rodríguez, J; Cozar-Olmo, J M; Palou-Redorta, J; Solsona-Narbón, E; Unda-Urzaiz, J M
Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. To present the work performed by said committee and the resulting recommendations. An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.
Verplanken, Kaat; Wauters, Jella; Vercruysse, Vicky; Aluwé, Marijke; Vanhaecke, Lynn
One of the main issues related to entire male pigs is the occurrence of boar taint, an off-odour, which compromises meat consumability. In this study, odour thresholds (indole: 24-65µgkg(-1), skatole: 44-89µgkg(-1), androstenone: 121-342µgkg(-1)) for the boar taint compounds were estimated in minced meat, dry fermented sausage and dry-cured ham. Afterwards, sensory evaluation of these products containing 10% tainted meat (minced meat and dry fermented sausage) or moderate boar taint compound levels (dry-cured ham) occurred. The beneficial effect of diluting tainted meat was demonstrated, as no significant difference in consumability was observed between gilts and 10% tainted meat by experts as well as consumers. Also dry-curing proved a promising technique for masking boar taint and preventing consumer dissatisfaction. The obtained results demonstrate the applicability of the estimated thresholds in meat as a tool for identifying masking and reducing strategies on the perception of boar taint. Copyright © 2017 Elsevier Ltd. All rights reserved.
Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel.
Akers, Amy; Al-Shahi Salman, Rustam; A Awad, Issam; Dahlem, Kristen; Flemming, Kelly; Hart, Blaine; Kim, Helen; Jusue-Torres, Ignacio; Kondziolka, Douglas; Lee, Cornelia; Morrison, Leslie; Rigamonti, Daniele; Rebeiz, Tania; Tournier-Lasserve, Elisabeth; Waggoner, Darrel; Whitehead, Kevin
Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. To develop guidelines for CCM management. The Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was
Nanni, Cristina; Rambaldi, Ilaria; Fanti, Stefano [AOU Policlinico S. Orsola-Malpighi, Nuclear Medicine, Bologna (Italy); Zamagni, Elena; Cavo, Michele [AOU Policlinico S. Orsola-Malpighi, Hematology, Bologna (Italy); Versari, Annibale [IRCSS, Nuclear Medicine, S. Maria Nuova Hospital, Reggio Emilia (Italy); Chauvie, Stephane [Santa Croce e Carle Hospital, Medical Physics Unit, Cuneo (Italy); Bianchi, Andrea [Santa Croce e Carle Hospital, Nuclear Medicine, Cuneo (Italy); Rensi, Marco [AOU S.Maria della Misericordia, Nuclear Medicine, Udine (Italy); Bello, Marilena [AO Citta della Salute e della Scienza, Nuclear Medicine, Torino (Italy); Gallamini, Andrea [A Lacassagne Cancer Center, Research and Innovation Department, Nice (France); Patriarca, Francesca [Udine University, Hematologic Clinic, Udine (Italy); Gay, Francesca [University of Torino, Myeloma Unit, Division of Hematology, Torino (Italy); Gamberi, Barbara [IRCCS, Hematology Unit, Azienda Ospedaliera ASMN, Reggio Emilia (Italy)
FDG PET/CT is able to detect active disease in patients with multiple myeloma (MM) and can be helpful for staging and assessing therapy response, but no standard interpretation criteria have been proposed for the evaluation of FDG PET/CT in MM. A group of Italian nuclear medicine physicians and haematologists met to propose new visual interpretation criteria to standardize FDG PET/CT evaluation in MM patients (Italian Myeloma criteria for PET USe; IMPeTUs) and the reproducibility of these criteria was tested. This Italian multicentre protocol was set up as a subprotocol of EMN02, an international prospective multicentre trial of the European Myeloma Network. The criteria were agreed at multidisciplinary consensus meetings. They include a description of the metabolic state of the bone marrow (BM), number and site of focal PET-positive lesions, the number of osteolytic lesions, and the presence and site of extramedullary disease, paramedullary disease and fractures. A visual degree of uptake was defined for the target lesion and extramedullary lesions according to modified Deauville criteria. MM patients who had undergone FDG PET/CT at baseline (PET-0), after induction (PET-AI) and at the end of treatment (PET-EoT) were enrolled. The patients had been prospectively enrolled in EMN02 and their PET scans were a posteriori reinterpreted in a blinded independent central review process managed by WIDEN registered. Five expert nuclear medicine physicians scored the scans according to the new criteria. A case was considered read when four out of the five reviewers completed the report. Concordance among reviewers on different metrics was calculated using Krippendorff's alpha coefficient. A total of 17 consecutive patients were enrolled. On PET-0, the alpha coefficients for the BM score, the score for the hottest focal lesion, the number of focal lesions and the number of lytic lesions were 0.33 and 0.47, 0.40 and 0.32, respectively. On PET-AI, the alpha coefficients
Análise crítica das recomendações formuladas por um painel de experts para o cuidado clínico de pacientes com Leucemia Mielóide Crônica Critical analysis of the recommendations from an expert panel on the management of patients with Chronic Myeloid Leukemia
Full Text Available As recomendações sobre Leucemia Mielóide Crônica feitas em 2006 por um painel de experts, em nome do "European Leukemia Network", foram adotadas internacionalmente como um roteiro para a monitoração e tratamento da doença. Passados 18 meses de sua publicação, fazemos aqui um sumário dessas recomendações e em seguida apontamos diversas áreas em que as recomendações poderão ser aperfeiçoadas e atualizadas. Aspectos específicos relacionados à aplicação das recomendações no Brasil são também considerados.The recommendations about chronic myeloid leukemia by a panel of experts in 2006 on behalf of the "European Leukemia Network" have been internationally accepted as a guide for monitoring and treatment of this disease. Eighteen months after its publication, we present here a summary of these recommendations, and point to areas in which they might be improved and updated. Specific aspects of the application of these recommendations in Brazil are also considered.
Strobbe, L.; Schans, S.A. van de; Heijker, S.M.; Meijer, J.W.R.; Mattijssen, E.J.; Mandigers, C.M.P.W.; Kievit, I.M. de; Raemaekers, J.M.M.; Hebeda, K.M.; Krieken, J.H. van
Abstract Correct histological classification of malignant lymphomas is important but has always been a difficult challenge. Since 2001 the World Health Organization (WHO) classification has been used, which should make it easier to define distinct disease entities. The purpose of this study was to
STRING 2008 hold at CERN -- the largest and most important conference on String Theory with the mostly active researchers in the field. The main purpose of the conference is to review the latest developments for experts.
STRING 2008 hold at CERN -- the largest and most important conference on String Theory with the mostly active researchers in the field. The main purpose of the conference is to review the latest developments for experts.
Prevalence of the metabolic syndrome using the Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) and the modified ATP III definitions for Japanese and Mongolians.
Enkhmaa, Byambaa; Shiwaku, Kuninori; Anuurad, Erdembileg; Nogi, Akiko; Kitajima, Keiko; Yamasaki, Masayuki; Oyunsuren, Tsendsuren; Yamane, Yosuke
A clustering of insulin resistance, hypertension, and dyslipidemia has been labeled as metabolic syndrome. Asians have a lower frequency of obesity than do Caucasians but have an increasing tendency toward metabolic syndrome. We conducted a cross-sectional study of individuals aged 30-60 years. We analyzed the health data of 596 Japanese and Mongolians for metabolic syndrome based on the Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) definition and the three modified ATP III definitions. The prevalence of metabolic syndrome using ATP III criteria was 6% for the Japanese and 12% for the Mongolians, a remarkable lower prevalence relative to the reported prevalence in the United States. With the exception of visceral obesity, the prevalences of individual metabolic abnormalities within each of the two Asian groups were similar to each other and to reported rates of prevalence in the United States. A universal metabolic syndrome definition is inappropriate for comparisons of metabolic syndrome among Asian ethnic groups. We believe that the ATP III index for visceral obesity should be adjusted for Asian populations.
Paillot, Romain; Rash, Nicola L; Garrett, Dion; Prowse-Davis, Leah; Montesso, Fernando; Cullinane, Ann; Lemaitre, Laurent; Thibault, Jean-Christophe; Wittreck, Sonia; Dancer, Agnes
Vaccination is highly effective to prevent, control, and limit the impact of equine influenza (EI), a major respiratory disease of horses. However, EI vaccines should contain relevant equine influenza virus (EIV) strains for optimal protection. The OIE expert surveillance panel annually reviews EIV evolution and, since 2010, the use of Florida clade 1 and 2 sub-lineages representative vaccine strains is recommended. This report summarises the development process of a fully- updated recombinant canarypox-based EI vaccine in order to meet the last OIE recommendations, including the vaccine mode of action, production steps and schedule. The EI vaccine ProteqFlu contains 2 recombinant canarypox viruses expressing the haemagglutinin of the A/equine/Ohio/03 and A/equine/Richmond/1/07 isolates (Florida clade 1 and 2 sub-lineages, respectively). The updated EI vaccine was tested for efficacy against the representative Florida clade 2 EIV strain A/equine/Richmond/1/07 in the Welsh mountain pony model. Protective antibody response, clinical signs of disease and virus shedding were compared with unvaccinated control ponies. Significant protection was measured in vaccinated ponies, which supports the vaccine registration. The recombinant canarypox-based EI vaccine was the first fully updated EI vaccine available in the EU, which will help to minimise the increasing risk of vaccine breakdown due to constant EIV evolution through antigenic drift.
Togias, Alkis; Cooper, Susan F; Acebal, Maria L; Assa'ad, Amal; Baker, James R; Beck, Lisa A; Block, Julie; Byrd-Bredbenner, Carol; Chan, Edmond S; Eichenfield, Lawrence F; Fleischer, David M; Fuchs, George J; Furuta, Glenn T; Greenhawt, Matthew J; Gupta, Ruchi S; Habich, Michele; Jones, Stacie M; Keaton, Kari; Muraro, Antonella; Plaut, Marshall; Rosenwasser, Lanny J; Rotrosen, Daniel; Sampson, Hugh A; Schneider, Lynda C; Sicherer, Scott H; Sidbury, Robert; Spergel, Jonathan; Stukus, David R; Venter, Carina; Boyce, Joshua A
Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy. Prompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy. The addendum provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation. Guidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy. Published by Elsevier Inc.
Evaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel.
Cuevas, Luis E; Browning, Renee; Bossuyt, Patrick; Casenghi, Martina; Cotton, Mark F; Cruz, Andrea T; Dodd, Lori E; Drobniewski, Francis; Gale, Marianne; Graham, Stephen M; Grzemska, Malgosia; Heinrich, Norbert; Hesseling, Anneke C; Huebner, Robin; Jean-Philippe, Patrick; Kabra, Sushil Kumar; Kampmann, Beate; Lewinsohn, Deborah; Li, Meijuan; Lienhardt, Christian; Mandalakas, Anna M; Marais, Ben J; Menzies, Heather J; Montepiedra, Grace; Mwansambo, Charles; Oberhelman, Richard; Palumbo, Paul; Russek-Cohen, Estelle; Shapiro, David E; Smith, Betsy; Soto-Castellares, Giselle; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire; Worrell, Carol
Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children. In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children.
discipline that permits them to testify to an opinion that will aid a judge or jury in resolving a question that is beyond the understanding or competence of laypersons. An expert witness is an expert who makes his or her knowledge available to a court (a tribunal or any other forum where formal rules of evidence apply) to help ...
Hildebrandt, Thomas Troels; Cattani, Gian Luca
An expert system is a computer system for inferring knowledge from a knowledge base, typically by using a set of inference rules. When the concept of expert systems was introduced at Stanford University in the early 1970s, the knowledge base was an unstructured set of facts. Today the knowledge...... base of expert systems is often given in terms of an ontology, extracted and built from various data sources by employing natural language-processing and statistics. To emphasize such capabilities, the term “expert” is now often replaced by “cognitive,” “knowledge,” “knowledge-based,” or “intelligent......” system. With very few exceptions, general-purpose expert systems have failed to emerge so far. However, expert systems are applied in specialized domains, particularly in healthcare. The increasing availability of large quantities of data to organizations today provides a valuable opportunity...
A metabolic panel is a group of tests that measures different chemicals in the blood. These tests are usually ... kidneys and liver. There are two types: basic metabolic panel (BMP) and comprehensive metabolic panel (CMP). The ...
Berman, Brian; Ablon, Glynis R; Bhatia, Neal D; Ceilley, Roger I; Goldberg, David J; Nestor, Mark S; Weinkle, Susan H
Dermatologists treat actinic keratosis (AK) primarily because these lesions have the potential to progress to invasive squamous cell carcinoma. Patients, on the other hand, generally seek treatment to remove the lesions and achieve an improved appearance of their skin following treatment. In selecting a treatment option for AK, dermatologists should consider post-treatment cosmesis, because cosmetic outcomes differ across AK treatments. To obtain expert opinion on the cosmetic sequelae related to chronically photodamaged skin and the treatment of AK, an expert panel meeting among dermatologists was conducted in February 2016. These experts reviewed current treatment options for photodamage, including AK, and discussed the relative merits of the various cosmetic assessments commonly used by investigators and patients in both clinical trial and dermatology practice settings. A main goal of the expert panel meeting was to propose assessment tools that could be specifically designed to characterize cosmesis results after treatment of AK. The panel agreed that existing tools for measurement of cosmetic outcomes following treatment of photodamage could also be used to evaluate cosmesis after treatment of AK. Digital photography is probably the best method used for this, with validation by other technologies. Better measurement tools specifically for assessing cosmesis after AK treatment are needed. Once they are developed and validated, regulatory agencies should be educated about the importance of including cosmetic outcomes as a component of product labeling. J Drugs Dermatol. 2017;16(3):260-265..
Lex van Teeffelen
The EU and national governments rely on expert panels and opinions for their policies (EU, 2003; EU, 2006a; EU, 2006b) on SME ownership transfers. Also entrepreneurs depend on expert opinions and advice. We know from expert studies that expert judgment may lead to confusion and conflicting results.
The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement.
Athyros, Vasilios G; Alexandrides, Theodore K; Bilianou, Helen; Cholongitas, Evangelos; Doumas, Michael; Ganotakis, Emmanuel S; Goudevenos, John; Elisaf, Moses S; Germanidis, Georgios; Giouleme, Olga; Karagiannis, Asterios; Karvounis, Charalambos; Katsiki, Niki; Kotsis, Vasilios; Kountouras, Jannis; Liberopoulos, Evangelos; Pitsavos, Christos; Polyzos, Stergios; Rallidis, Loukianos S; Richter, Dimitrios; Tsapas, Apostolos G; Tselepis, Alexandros D; Tsioufis, Konstantinos; Tziomalos, Konstantinos; Tzotzas, Themistoklis; Vasiliadis, Themistoklis G; Vlachopoulos, Charalambos; Mikhailidis, Dimitri P; Mantzoros, Christos
Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is characterized by accumulation of fat (>5% of the liver tissue), in the absence of alcohol abuse or other chronic liver diseases. It is closely related to the epidemic of obesity, metabolic syndrome or type 2 diabetes mellitus (T2DM). NAFLD can cause liver inflammation and progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis or hepatocellular cancer (HCC). Nevertheless, cardiovascular disease (CVD) is the most common cause of death in NAFLD/NASH patients. Current guidelines suggest the use of pioglitazone both in patients with T2DM and in those without. The use of statins, though considered safe by the guidelines, have very limited use; only 10% in high CVD risk patients are on statins by tertiary centers in the US. There are data from several animal studies, 5 post hoc analyses of prospective long-term survival studies, and 5 rather small biopsy proven NASH studies, one at baseline and on at the end of the study. All these studies provide data for biochemical and histological improvement of NAFLD/NASH with statins and in the clinical studies large reductions in CVD events in comparison with those also on statins and normal liver. Ezetimibe was also reported to improve NAFLD. Drugs currently in clinical trials seem to have potential for slowing down the evolution of NAFLD and for reducing liver- and CVD-related morbidity and mortality, but it will take time before they are ready to be used in everyday clinical practice. The suggestion of this Expert Panel is that, pending forthcoming randomized clinical trials, physicians should consider using a PPARgamma agonist, such as pioglitazone, or, statin use in those with NAFLD/NASH at high CVD or HCC risk, alone and/or preferably in combination with each other or with ezetimibe, for the primary or secondary prevention of CVD, and the avoidance of cirrhosis, liver transplantation or HCC, bearing in mind that CVD is the main cause
... FOR THE CERTIFICATION AND RE-CERTIFICATION OF THE WASTE ISOLATION PILOT PLANT'S COMPLIANCE WITH THE 40... judgment elicitation processes and the reasoning behind those results. Documentation of interviews used to... and technical views to expert panels as input to any expert elicitation process. ...
Iofcu, Tereza; Diederich, Joerg; Dolog, Peter
the GrowBag approach . The main assumption is that such user profiles can provide good hints about users' expertise. Such extended FOAF files (called ExpertFOAF) can be published on a user's home page, on web pages of institutions or conferences to characterize them. They can be crawled by distributed...
DuBois, James M; Kraus, Elena M; Gursahani, Kamal; Mikulec, Anthony; Bakanas, Erin
No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.
Brænder, Morten; Andersen, Lotte Bøgh
Based on our 2013-article, ”Does Deployment to War Affect Soldiers' Public Service Motivation – A Panel Study of Soldiers Before and After their Service in Afghanistan”, we present Panel Analysis as a methodological discipline. Panels consist of multiple units of analysis, observed at two or more...... in research settings where it is not possible to distribute units of analysis randomly or where the independent variables cannot be manipulated. The greatest disadvantage in regard to using panel studies is that data may be difficult to obtain. This is most clearly vivid in regard to the use of panel surveys...
Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists
Sidiropoulos, P.I.; Hatemi, G.; Song, I.H.
of enthesitis. The compiled agreement among experts ranged from 72% to 93%. CONCLUSION: Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group......OBJECTIVE: Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined...... with practising rheumatologists addressing specific questions relevant to clinical practice. METHODS: Ten countries participated in three rounds of discussions and votes concerning the management of AS. A set of nine questions was formulated in the domains of diagnosis, monitoring and treatment, after a Delphi...
Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative
Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S. R.; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D.; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J.; Landewé, Robert B.; Bijlsma, Johannes W.; Branco, Jaime C.; Burgos-Vargas, Rubén; Catrina, Anca I.; Elewaut, Dirk; Ferrari, Antonio J. L.; Kiely, Patrick; Leeb, Burkhard F.; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Ostergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M.
We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated
Shows how to implement software using them and indicating the potential pitfalls. This book covers: Core database structures and utilities; Performance tuning; Advanced SQL features; Extensibility using C, Java and OR features; Security; and Important supplied packages.
Thomas, Linda V; Jenkins, Gill; Belton, Julie; Clements, Suzie; Jacob, Ciara; Johnson, Naomi; Joy, Deirdre; Low, Jennifer; Munson, Eileen; Sheppard, Jessica
This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.
The Geothermal Technologies Program assembled a geothermal Blue Ribbon Panel on March 22-23, 2011 in Albuquerque, New Mexico for a guided discussion on the future of geothermal energy in the United States and the role of the DOE Program. The Geothermal Blue Ribbon Panel Report captures the discussions and recommendations of the experts. An addendum is available here: http://www.eere.energy.gov/geothermal/pdfs/gtp_blue_ribbon_panel_report_addendum10-2011.pdf
A unique industrial panel covering the challenges and needs of various industries and how being innovative is important. The session involves two invited industry speakers (24 minutes each) who will set the stage for the interactive round table panel session. The Panel, led by moderator Mark Bernius (Morgan Advanced Materials), consists of the two invited speakers plus an additional five industry panelists. The first thirty minutes of the panel session has the five additional panelists introducing themselves and their work/company. These introductions could include what they or their company does, sharing one or two technical highlights, listing some challenges or needs for physicists, and what innovation breakthroughs are needed in their industries. The final hour of the session will be highly interactive with questions to the panel coming from the moderator, the audience, and the panelists themselves. Questions that might be addressed include: how physicists are or could be critical in advancing innovation; how can AIP/APS/FIAP help industry get the physics help they need to be innovative (knowledge, the right staff, etc.); what role can students and post docs play in advancing industry's mission; etc. We invite you to participate in this interactive session and ask our industry experts your own interesting and challenging questions. The invited speakers are George Thompson, Intel, and Rick Watkins, Nike. The panel members also include Jason Cleveland, Asylum Research; Robert Doering, Texas Instruments; William Gallagher, IBM T.J. Watson Research Center; James Hollenhorst, Agilent Technologies; and Martin Poitzsch, Schlumberger-Doll Research.
... Analysis Kidney Stone Risk Panel KRAS Mutation Lactate Lactate Dehydrogenase (LD) Lactoferrin Lactose Tolerance Tests LDL Cholesterol LDL ... GGT) – another enzyme found mainly in liver cells Lactate dehydrogenase (LD) – an enzyme released with cell damage; found ...
... Links Patient Resources For Health Professionals Subscribe Search Liver Panel Send Us Your Feedback Choose Topic At ... Images View Sources Ask Us Also Known As Liver Profile Liver Function Tests LFTs Formal Name Hepatic ...
Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative.
Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Ostergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M
We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010-2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.
Commons, Michael Lamport; Miller, Patrice Marie; Gutheil, Thomas G
A pilot study of perceptions of different sources of expert bias, as well as of personal investment in case outcomes, was performed among attendees at a workshop at an annual meeting of the American Academy of Psychiatry and the Law. Participants were asked to rate hypothetical responses by experts to various case outcomes and the biasing potential of different kinds of situations for opposing or other experts. A factor analysis produced two factors. Factor 1 included questions about situations that were obviously biasing (such as working only for the defense). Factor 2 included questions assessing the potential of certain situations to cause bias in experts, or how likely experts thought other experts were to be biased. In general, experts identified only four areas to be overtly biasing. All occurred within situations in which experts worked only for one or the other side of civil or criminal cases. Experts otherwise thought other experts were reasonably bias free and well able to compensate for any bias when it occurred. The data suggest that experts may deal with bias by turning down cases that may cause them personal discomfort.
Amarra, Sofia; Chan, Pauline
The Infant and Early Childhood Nutrition Task Force, International Life Sciences Institute Southeast Asia (ILSI SEA) Region, organised the 1st and 2nd Expert Consultation and Planning Meeting on Infant and Early Childhood Nutrition in 2009 and 2011, respectively. The goal of the consultations was "to generate and promote relevant science-based information that will help improve nutritional status, growth and development of infants and young children in Southeast Asia." An Expert Panel Core Group was created whose role is to provide advice and recommendations through a review of current scientific knowledge regarding issues related to early childhood growth and nutrition. The Panel is composed of experts representing 7 countries (China, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam). In July 2012, the Panel convened the 3rd Expert Consultation and Planning Meeting on Infant and Young Child Nutrition in Singapore. This report presents the highlights of the meeting and recommendations made by the Panel on ways to improve infant and young child nutrition in Southeast Asia. The effective use of WHO indicators for assessing infant and young child feeding practices, mitigating the effects of maternal employment on breastfeeding, using behaviour change communication, updating the education of health personnel, and improving maternal health were considered important actions to be taken. Since current feeding practices in Southeast Asia fall short of WHO recommendations, studies are needed to develop strategies which take into consideration the diverse cultural settings that characterise the region.
Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).
Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
This short report represents a summary of the analysis conducted so far on the GfK Panel Data. The focus was on the main three types of raw meat: chicken, pork, beef, as well as three categories of processed food products: liver paste, cold cuts and sausages. The aim was to look at the market indicators for each one of the six sub-categories, out of which market share and penetration were considered to be the most important. Besides these two indicators, I also included some extra calculatio...
Goodall, Amanda H.
How much knowledge should leaders have of their organization's core business? This is an important question but not one that has been addressed in the management literature. In a new 'theory of expert leadership' (TEL), this paper blends conceptual work with recent empirical evidence. It suggests that organizations perform more effectively when led by individuals who have a deep understanding of the core business of their organization. Being a capable general manager is not sufficient. Expert...
Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative.
Whittle, Samuel L; Colebatch, Alexandra N; Buchbinder, Rachelle; Edwards, Christopher J; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L; Radner, Helga; Ramiro, Sofia; Richards, Bethan L; Tarner, Ingo H; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B; Müller-Ladner, Ulf; Bijlsma, Johannes W J; Branco, Jaime C; Bykerk, Vivian P; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Ostergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée
To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. A total of 49,242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.
Abu-Nasser, Bassem S.
International audience; There is an increase interest in the area of Artificial Intelligence in general and expert systems in particular. Expert systems are rapidly growing technology. Expert system is a branch of Artificial Intelligence which is having a great impact on many fields of human life. Expert systems use human expert knowledge to solve complex problems in many fields such as Health, science, engineering, business, and weather forecasting. Organizations employing the technology of ...
Fedorov, Alexander; Levitskaya, Anastasia; Camarero, Emma
The article analyzes the results of the international experts' survey regarding the curriculum of media literacy education, which was administrated by the authors in September-October 2015. The expert panel includes specialists actively involved in the real process of media literacy education in schools, universities and other educational…
Mcewan, J.A.; Hunter, E.A.; Gemert, L.J. van; Lea, P.
Proficiency testing in sensory analysis is an important step towards demonstrating that results from one sensory panel are consistent with the results of other sensory panels. The uniqueness of sensory analysis poses some specific problems for measuring the proficiency of the human instrument
The profession of an expert auditor is a public trust occupation with a distinctive feature of taking responsibility for actions in the public interest. The main responsibility of expert auditors is performing financial auditing; however, expert auditors are prepared to carry out different tasks which encompass a wide plethora of financial and auditing services for different kinds of institutions and companies. The aim of the article is first of all the description of expert auditors’ service...
In today's complex world, we have come to rely increasingly on those who have expertise in specific areas and can bring their knowledge to bear on crucial social, political and scientific questions. Taking the viewpoint that experts are consulted when there is something important at stake for an individual, a group, or society at large, Experts in Science and Society explores expertise as a relational concept. How do experts balance their commitment to science with that to society? How does a society actually determine that a person has expertise? What personal traits are valued in an expert? From where does the expert derive authority? What makes new forms of expertise emerge? These and related questions are addressed from a wide range of areas in order to be inclusive, as well as to demonstrate similarities across areas. Likewise, in order to be culturally comparative, this volume includes examples and discussions of experts in different countries and even in different time periods. The topics include the r...
Ucer, A. S.
One of the major activities of AGARD panels is to form working groups, which assemble experts who work on the particular subject for two or three years. As a result of the work, an advisory report is published, which complies the state-of-the-art knowledge on the chosen specific topic. This paper explains the philosophy and procedures adopted during the formation of working groups of the Propulsion and Energetics Panel. Working groups concerning gas turbine technologies are presented. The selected working groups aim to improve the computational and experimental knowledge that would lead to the design of advanced aero gas turbine engines. Objective, scope, procedure, and important results of each working group will be explained. Working groups that were active during the 1980s and which were presently active are covered.
Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone).
Pergolizzi, Joseph; Böger, Rainer H; Budd, Keith; Dahan, Albert; Erdine, Serdar; Hans, Guy; Kress, Hans-Georg; Langford, Richard; Likar, Rudolf; Raffa, Robert B; Sacerdote, Paola
status need to be taken carefully into account when addressing pain in the elderly. World Health Organization step III opioids are the mainstay of pain treatment for cancer patients and morphine has been the most commonly used for decades. In general, high level evidence data (Ib or IIb) exist, although many studies have included only few patients. Based on these studies, all opioids are considered effective in cancer pain management (although parts of cancer pain are not or only partially opioid sensitive), but no well-designed specific studies in the elderly cancer patient are available. Of the 2 opioids that are available in transdermal formulation--fentanyl and buprenorphine--fentanyl is the most investigated, but based on the published data both seem to be effective, with low toxicity and good tolerability profiles, especially at low doses. 2. The use of opioids in noncancer-related pain: Evidence is growing that opioids are efficacious in noncancer pain (treatment data mostly level Ib or IIb), but need individual dose titration and consideration of the respective tolerability profiles. Again no specific studies in the elderly have been performed, but it can be concluded that opioids have shown efficacy in noncancer pain, which is often due to diseases typical for an elderly population. When it is not clear which drugs and which regimes are superior in terms of maintaining analgesic efficacy, the appropriate drug should be chosen based on safety and tolerability considerations. Evidence-based medicine, which has been incorporated into best clinical practice guidelines, should serve as a foundation for the decision-making processes in patient care; however, in practice, the art of medicine is realized when we individualize care to the patient. This strikes a balance between the evidence-based medicine and anecdotal experience. Factual recommendations and expert opinion both have a value when applying guidelines in clinical practice. 3. The use of opioids in
Martinez i Coma, F.; van Ham, C.T.
Expert surveys have been used to measure a wide variety of phenomena in political science, ranging from party positions, to corruption, to the quality of democracy and elections. However, expert judgments raise important validity concerns, both about the object being measured as well as the experts.
Mark A Burgman
Full Text Available Expert judgements are essential when time and resources are stretched or we face novel dilemmas requiring fast solutions. Good advice can save lives and large sums of money. Typically, experts are defined by their qualifications, track record and experience. The social expectation hypothesis argues that more highly regarded and more experienced experts will give better advice. We asked experts to predict how they will perform, and how their peers will perform, on sets of questions. The results indicate that the way experts regard each other is consistent, but unfortunately, ranks are a poor guide to actual performance. Expert advice will be more accurate if technical decisions routinely use broadly-defined expert groups, structured question protocols and feedback.
Alonso, A. [Consejo de Seguridad Nuclear, Madrid (Spain)
Scientific knowledge and technological maturity are needed to establish regulatory requirements, what also needs talent and skills. Scientists are rarely interested in regulation and regulators not always are closely connected to scientific research. This has created gaps in regulations, mainly within qualified importers. A qualified importer, in the sense of this presentation, is a country who has acquired nuclear power plants from more technologically advanced exporters but with an increasing participation of its own industry and institutions in the design, construction, component manufacture and assembly of such nuclear power plants and is fully responsible for the operation of the nuclear units and the corresponding fuel cycle. These countries have also a long standing and independent nuclear regulatory organization and the corresponding technical body. Spain is a qualified importer. In the case of Spain, it originally adopted the codes and regulations of the UE which it was a member of, as well as the codes and standards of the country from which their reactors were produced. Since Spain added KWU plants they even went to German regulations. Plant operation rested with Spain. As problems began to appear in operating plants, local research projects were funded to study the problems, aimed at immediate solutions, but also providing training for local personnel in addition to information of use for regulators. Spain has participated in many joint research projects, which have trained people, and given confidence to Spaniards involved in science and regulations. Qualified importers, like Spain, participate in research, even though it may not translate itself into regulation. Such participation will always serve to give self-confidence and independence to regulators and licensees, to better understand the adopted regulations of the most advanced countries and to solve specific problems.
No Author Given
Panel discussion: summation and future projections. Introductory remarks by panelists followed by questions and comments from the floor. Panelists: Dr. Joseph Barnea (former director of Resources and Transport for the United Nations; energy consultant to the United Nations Institute for Training and Research (UNITAR)); the Honorable Clyde F. Bel, Jr. (member of the Louisiana House of Representatives representing District 90 and New Orleans); Dr. David Lombard (acting chief of the Advanced Systems Branch of the Division of Geothermal Energy Research and Technology, Energy Research and Development Administration (ERDA)); Fred C. Repper (vice-president of Central Power and Light Company in Corpus Christi, Texas); Dr. Hans Suter (environmental consultant in Corpus Christi, Texas; environmental columnist for the Corpus Christi Caller Times). Session chairman: Herbert Woodson.
Acampa, Wanda; Gaemperli, Oliver; Gimelli, Alessia; Knaapen, Paul; Schindler, Thomas H; Verberne, Hein J; Zellweger, Michael J
Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: email@example.com.
Commons, Michael Lamport; Miller, Patrice Marie; Li, Eva Yujia; Gutheil, Thomas Gordon
How do expert witnesses perceive the possible biases of their fellow expert witnesses? Participants, who were attendees at a workshop at the American Academy of Psychiatry and Law were asked to rate for their biasing potential a number of situations that might affect the behavior of an opposing expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different kinds of situations from the most biasing to the least biasing. Working for only one side in both civil and criminal cases had large scaled values and also were the first factor. In interesting contrast, a) an opposing expert also serving as the litigant's treater and b) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were two situations viewed as not very biasing. Order of Hierarchical Complexity also accounted for items from the 1st, 2nd and 3rd factors. The result suggests that the difficulty in understanding the conceptual basis of bias underlies the perception of how biased a behavior or a situation is. The more difficult to understand the questionnaire item, the less biasing its behavior or situation is perceived by participants. Copyright © 2012 Elsevier Ltd. All rights reserved.
... AGENCY Science Advisory Board Staff Office; Request for Nominations of Experts for the SAB.... SUMMARY: The EPA Science Advisory Board (SAB) Staff Office is requesting public nominations of experts to... hazards of PCBs. The SAB Staff Office will form an expert panel to review the PCBs assessment. The SAB (42...
Warburton, Robert E. (Inventor); Cuva, William J. (Inventor)
The present invention relates to a heat exchanger panel which has broad utility in high temperature environments. The heat exchanger panel has a first panel, a second panel, and at least one fluid containment device positioned intermediate the first and second panels. At least one of the first panel and the second panel have at least one feature on an interior surface to accommodate the at least one fluid containment device. In a preferred embodiment, each of the first and second panels is formed from a high conductivity, high temperature composite material. Also, in a preferred embodiment, the first and second panels are joined together by one or more composite fasteners.
Waterlander, Wilma E; Steenhuis, Ingrid H M; de Vet, Emely; Schuit, Albertine J; Seidell, Jacob C
Pricing strategies are an important component in the marketing mix and may also be useful in stimulating healthier food choices. However, due to competing interests and feasibility problems, the introduction of pricing strategies is complicated. For successfully introducing food pricing strategies, it is essential to explore incentives that are not only promising but also realizable and being approved by different sectors. We aimed to assemble a list of pricing strategies by exploring expert views using the Delphi method. Subjects included experts from academia, industry, retail, agriculture, policymakers, consumers and non-governmental organizations. Data were collected in three rounds. In round one, experts designed promising pricing strategies. Based on a time-budget model incorporating Sleep, Leisure, Occupation, Transportation and Home-based activities, these strategies were in the subsequent rounds judged on several criteria. Results were analysed using median and interquartile deviations scores. We found fair consensus levels among experts and a varied list of promising pricing strategies. The panel agreed on the potential success of offering small presents, providing price-cuts on healthy foods and discounting healthier foods more frequently. Also, it was found that experts gave higher rates to pricing strategies for which the implementation responsibilities could be placed elsewhere. The resulted list of promising monetary incentives is an essential first step for the future design of pricing strategies. Following this study, it is important to determine how to make solid agreements on responsibility and implementation issues. Also, consumer perceptions regarding the proposed pricing strategies should be studied.
targets a central debate in philosophy and psychology on whether reflection is conducive for, or detrimental to, skillful performance. My analyses show that the concepts assumed in the literature on this question are poorly defined and gloss over more important features of expertise. The second question...... and psychology of music. The dissertation is structured through the asking, analyzing and answering of three primary questions, namely: 1) What is it like to be an expert? 2) What is the general phenomenology of expert musicianship? 3) What happens to the self in deep musical absorption? The first question...
and psychology of music. The dissertation is structured through the asking, analyzing and answering of three primary questions, namely: 1) What is it like to be an expert? 2) What is the general phenomenology of expert musicianship? 3) What happens to the self in deep musical absorption? The first question...... targets a central debate in philosophy and psychology on whether reflection is conducive for, or detrimental to, skillful performance. My analyses show that the concepts assumed in the literature on this question are poorly defined and gloss over more important features of expertise. The second question...
Expert systems have become one of the most exciting applications within the domain of artificial intelligence. Further interest has been provoked by Japan's Fifth Generation Project, which identifies expert or knowledge-based systems as a key element in the computer systems of the future. This book presents an introduction to expert systems at a level suited to the undergraduate student and the interested layman. It surveys the three main techniques for knowledge representation - rules, frames and logic. and describes in detail the expert systems which employ them. Contents: Expert systems and artificial intelligence; Formalisms for knowledge representation; MYCIN; Medical diagnosis using rules. MYCIN derivatives; TEIRESIAS, EMYCIN, and GUIDON; RI: recognition as a problem-solving strategy; CENTAUR: a combination of frames metalevel inference and commonsense reasoning in MECHO; Tools for building expert systems; Summary and conclusions; Exercises.
This dissertation develops a phenomenology of expert musicianship through an interdisciplinary approach that integrates qualitative interviews with the Danish String Quartet with philosophical analyses drawing on ideas and theses found in phenomenology, philosophy of mind, cognitive science...... and psychology of music. The dissertation is structured through the asking, analyzing and answering of three primary questions, namely: 1) What is it like to be an expert? 2) What is the general phenomenology of expert musicianship? 3) What happens to the self in deep musical absorption? The first question...... targets a central debate in philosophy and psychology on whether reflection is conducive for, or detrimental to, skillful performance. My analyses show that the concepts assumed in the literature on this question are poorly defined and gloss over more important features of expertise. The second question...
Iglesias, Cynthia P; Thompson, Alexander; Rogowski, Wolf H; Payne, Katherine
Expert judgement has a role in model-based economic evaluations (EEs) of healthcare interventions. This study aimed to produce reporting criteria for two types of study design to use expert judgement in model-based EE: (i) an expert elicitation (quantitative) study; and (ii) a Delphi study to collate (qualitative) expert opinion. A two-round online Delphi process identified the degree of consensus for four core definitions (expert; expert parameter values; expert elicitation study; expert opinion) and two sets of reporting criteria in a purposive sample of experts. The initial set of reporting criteria comprised 17 statements for reporting a study to elicit parameter values and/or distributions and 11 statements for reporting a Delphi survey to obtain expert opinion. Fifty experts were invited to become members of the Delphi process panel by e-mail. Data analysis summarised the extent of agreement (using a pre-defined 75 % 'consensus' threshold) on the definitions and suggested reporting criteria. Free-text comments were analysed using thematic analysis. The final panel comprised 12 experts. Consensus was achieved for the definitions of expert (88 %); expert parameter values (83 %); and expert elicitation study (83 %). The panel recommended criteria to use when reporting an expert elicitation study (16 criteria) and a Delphi study to collate expert opinion (11 criteria). This study has produced guidelines for reporting two types of study design to use expert judgement in model-based EE: (i) an expert elicitation study requiring 16 reporting criteria; and (ii) a Delphi study to collate expert opinion requiring 11 reporting criteria.
Waserman, S; Chad, Z; Francoeur, M J; Small, P; Stark, D; Vander Leek, T K; Kaplan, A; Kastner, M
Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts. The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management of anaphylaxis in primary care. Physician-specific gaps from our systematic review were prioritized by consensus meeting participants in two rounds, which involved the rating, discussion, and re-rating of gaps. Using current anaphylaxis guidelines, recommendations were then developed for each category of gaps that were identified by the panel as clinically important. Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and when and how to use epinephrine auto-injectors as clinically important knowledge gaps; and rated infrequent or delayed epinephrine administration, low rate of auto-injector prescription, and infrequent or no referrals to allergy specialists after a reaction as important practice behavior gaps. Evidence from four guidelines was used to support the consensus recommendation statements for three resulting categories of gap themes: anaphylaxis management, epinephrine use, and follow-up care. We used an NGT consensus methodology to develop an educational resource for primary care physicians and allergists to better understand how to manage patients with anaphylaxis. Next steps include testing our findings against observed data in primary care settings and to develop other strategies or tools to overcome gaps in anaphylaxis management.
Stemerding, D.; Krom, A.
Developments in public health genomics (PHG) hold the promise to be beneficial for individuals and to promote public health. Central to this paper is the idea that given the range of uncertainties and ambiguities related to genome-based information and technologies (GBIT), the responsible
... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL... another entity, such as a university). (ii) Has any employment, contractual, or other financial... remuneration (institution/self), time period, sponsor (government, firm, institution, individual), role of the...
Pathways: The Ontario Journal of Outdoor Education, 1997
Presents a rationale for integrating outdoor education with all subject areas that focuses on the interdisciplinary nature of outdoor education, authenticity of outdoor experiences, and affective component of outdoor education. Summarizes information submitted to Canada's Ministry of Education and Training from secondary science teachers and…
May 4, 2017 ... Canada-Latin America and Caribbean Zika Virus Research Program. A new funding opportunity on Zika virus is responding to the virus outbreak and the health threat it represents for the affected populations in the hardest hit countries in Latin America and the... View moreCanada-Latin America and ...
Kourtit, K.; Nijkamp, P.
International migration is a source of policy and research interest in many countries. This paper provides a review of experiences and findings from migration impact assessment worldwide. Various findings are briefly summarised in the context of a systematic migration SWOT analysis for five distinct
Herth, Felix J. F.; Slebos, Dirk-Jan; Rabe, Klaus F.; Shah, Pallav L.
Chronic obstructive pulmonary disease (COPD) is a progressive condition comprising a constellation of disorders from chronic bronchitis, airflow obstruction through to emphysema. The global burden of COPD is estimated at more than 6% of the population. The standard of care is based on a combination
López Martin, Inmaculada; Blanco Fernández, Ascensión; Pagán Marín, Rosa Ma.; Gazapo Andrade, Bienvenido; De Arana del Valle, José Ma.; Pizarro Juanas, Esther A.; Pascual, Beatriz Martínez
The implementation of a quality Tutorial Action Plan (TAP), in which the integral formation of students is the main objective, is a topical issue in the Spanish university environment. This paper aims to identify the actions contemplated in the TAPs of different Spanish universities and catalog the different types of activities performed by the…
... for Educators Search English Español Blood Test: Hepatic (Liver) Function Panel KidsHealth / For Parents / Blood Test: Hepatic ( ... or kidneys ) is working. What Is a Hepatic (Liver) Function Panel? A liver function panel is a ...
Metabolic panel - comprehensive; Chem-20; SMA20; Sequential multi-channel analysis with computer-20; SMAC20; Metabolic panel 20 ... Chernecky CC, Berger BJ. Comprehensive metabolic panel (CMP) - ... Diagnostic Procedures . 6th ed. St Louis, MO: Elsevier Saunders; ...
Dr. Peter Sloep; J. van Merrienboer; C. Carr; P. Kirschner
This paper discusses two studies - the one in a business context, the other in a university context - carried out with expert educational designers. The studies aimed to determine the priorities experts claim to employ when designing competence-based learning environments. Designers in both contexts
This paper argues that the concepts and techniques used in the development of expert systems should be expanded and applied to the field of education, particularly in the area of intelligent tutoring systems. It is noted that expert systems are a well known area of artificial intelligence and have been proven effective in well-defined topic areas.…
Experts' opinion is proposed as a valuable evaluation tool. Advantages of this method include the relative cost effectiveness when compared with other data collection methods. It is a time-saving method important in formative evaluation when a decision must be made concerning implementation of a course of action. When experts are carefully…
Hofmann, K.; Balog, K.; Bogers, T.; de Rijke, M.
Expertise-seeking research studies how people search for expertise and choose whom to contact in the context of a specific task. An important outcome are models that identify factors that influence expert finding. Expertise retrieval addresses the same problem, expert finding, but from a
Syme, Don; Cisternino, Antonio
Expert F# 2.0 is about practical programming in a beautiful language that puts the power and elegance of functional programming into the hands of professional developers. In combination with .NET, F# achieves unrivaled levels of programmer productivity and program clarity. Expert F# 2.0 is * The authoritative guide to F# by the inventor of F# * A comprehensive reference of F# concepts, syntax, and features * A treasury of expert F# techniques for practical, real-world programming F# isn't just another functional programming language. It's a general-purpose language ideal for real-world develop
As part of its evaluation of new technologies, the Artificial Intelligence Section of the Mission Planning and Analysis Div. at NASA-Johnson has made timing tests of several expert system building tools. Among the production systems tested were Automated Reasoning Tool, several versions of OPS5, and CLIPS (C Language Integrated Production System), an expert system builder developed by the AI section. Also included in the test were a Zetalisp version of the benchmark along with four versions of the benchmark written in Knowledge Engineering Environment, an object oriented, frame based expert system tool. The benchmarks used for testing are studied.
Bonet, Mercedes; Nogueira Pileggi, Vicky; Rijken, Marcus J; Coomarasamy, Arri; Lissauer, David; Souza, João Paulo; Gülmezoglu, Ahmet Metin
There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of
... Energy Regulatory Commission Panel Member List for Hydropower Licensing Study Dispute Resolution; Notice Extending Filing Date for Applications for Panel Member List for Hydropower Licensing Study Dispute...) requested applications to be included on a list of resource experts willing to serve as a third panel member...
Aspinall, W. P.; Cooke, R. M.; Havelaar, A. H.
languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert's statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values....... Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels...
Presents expert opinion on school construction management communication concerning educational needs, obtaining consensus among diverse groups, and envisioning what schools must offer in the future. Why furniture issues are also important is highlighted. (GR)
O'Leary, D Peter; Lynch, Noel; Clancy, Cillian; Winter, Desmond C; Myers, Eddie
This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. The Delphi study used 3 rounds of questions, after which the consensus statement was collated. A consensus statement related to the management of acute diverticulitis. Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.
Hill, Jacob; Hodsdon, Wendy; Schor, Jacob; McKinney, Neil; Rubin, Daniel; Seely, Dugald; Parmar, Gurdev; Birdsall, Tim; Alschuler, Lise; Lamson, Davis; Birdsall, Shauna; Zwickey, Heather
Naturopathic oncology is a relatively new and emerging field capable of providing professional integrative or alternative services to cancer patients. Foundational research is critical to identify topics in the clinical and research development of naturopathic oncology for future growth of the field. This study implements a modified Delphi protocol to develop expert consensus regarding ethics, philosophy, and research development in naturopathic oncology. The modified protocol implements a nomination process to select a panel of 8 physicians and to assist in question formulation. The protocol includes an in-person discussion of 6 questions with multiple iterations to maintain the concept of the Delphi methodology as well as a postdiscussion consensus survey. The protocol identified, ranked, and established consensus for numerous themes per question. Underlying key topics include integration with conventional medicine, evidence-based medicine, patient education, patient safety, and additional training requirements for naturopathic oncologists. The systematic nomination and questioning of a panel of experts provides a foundational and educational resource to assist in clarification of clinical ethics, philosophy, and research development in the emerging field of naturopathic oncology. © The Author(s) 2015.
Effing, T.W; Vercoulen, J.H; Bourbeau, J; Trappenburg, J; Lenferink, A; Cafarella, P; Coultas, D; Meek, P; Valk, P. van de; Bischoff, E.W; Bucknall, C; Dewan, N.A; Early, F; Fan, V; Frith, P; Janssen, D.J; Mitchell, K; Morgan, M; Nici, L; Patel, I; Walters, H; Rice, K.L; Singh, S; ZuWallack, R; Benzo, R; Goldstein, R; Partridge, M.R; van der Palen, J
...) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique...
Brannon, Nathan Gregory; L. Bertolini, N. Brannon, J. Olsen, B. Price, M. Steinzig, R. Wardle, & M. Winfield
Consolidated Nuclear Security (CNS) Pantex took the initiative to organize a Review Panel of subject matter experts to independently assess the adequacy of the Pantex Tripping Man Analysis methodology. The purpose of this report is to capture the details of the assessment including the scope, approach, results, and detailed Appendices. Along with the assessment of the analysis methodology, the panel evaluated the adequacy with which the methodology was applied as well as congruence with Department of Energy (DOE) standards 3009 and 3016. The approach included the review of relevant documentation, interactive discussion with Pantex staff, and the iterative process of evaluating critical lines of inquiry.
Jeste, Dilip V.; Ardelt, Monika; Blazer, Dan; Kraemer, Helena C.; Vaillant, George; Meeks, Thomas W.
Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53…
Full Text Available In 1999, Molodtsov introduced the concept of soft set theory as a general mathematical tool for dealing with uncertainty. Many researchers have studied this theory, and they created some models to solve problems in decision making and medical diagnosis, but most of these models deal only with one expert. This causes a problem with the user, especially with those who use questionnaires in their work and studies. In our model, the user can know the opinion of all experts in one model. So, in this paper, we introduce the concept of a soft expert set, which will more effective and useful. We also define its basic operations, namely, complement, union intersection AND, and OR. Finally, we show an application of this concept in decision-making problem.
... AGENCY Science Advisory Board Staff Office; Request for Nominations of Experts for the SAB Arsenic Review...: The Science Advisory Board (SAB) Staff Office is requesting public nominations of experts to form an... basis for Agency positions and regulations. The SAB Staff Office will form an expert panel to review ORD...
Full Text Available Abstract Background Smoking in the home is the major cause of exposure to second-hand smoke in children in the UK, particularly those living in low income households which have fewer restrictions on smoking in the home. Reducing children's exposure to second-hand smoke is an important public health and inequalities issue. Drawing on findings from a qualitative Scottish study, this paper identifies key issues and challenges that need to be considered when developing action to promote smoke-free homes at the national and local level. Methods Two panels of tobacco control experts (local and national from Scotland considered the implications of the findings from a qualitative study of smokers and non-smokers (who were interviewed about smoking in the home, for future action on reducing smoking in the home. Results Several key themes emerged through the expert panel discussions. These related to: improving knowledge about SHS among carers and professionals; the goal and approach of future interventions (incremental/harm reduction or total restrictions; the complexity of the interventions; and issues around protecting children. Conclusion The expert panels were very aware of the sensitivities around the boundary between the 'private' home and public health interventions; but also the lack of evidence on the relative effectiveness of specific individual and community approaches on increasing restrictions on smoking in the home. Future action on smoke-free homes needs to consider and address these complexities. In particular health professionals and other key stakeholders need appropriate training on the issues around smoking in the home and how to address these, as well as for more research to evaluate interventions and develop a more robust evidence base to inform effective action on this issue.
Coppersmith, K. J.
This report presents results of the Unsaturated Zone Flow Model Expert Elicitation (UZFMEE) project at Yucca Mountain, Nevada. This project was sponsored by the US Department of Energy (DOE) and managed by Geomatrix Consultants, Inc. (Geomatrix), for TRW Environmental Safety Systems, Inc. The objective of this project was to identify and assess the uncertainties associated with certain key components of the unsaturated zone flow system at Yucca Mountain. This assessment reviewed the data inputs, modeling approaches, and results of the unsaturated zone flow model (termed the ''UZ site-scale model'') being developed by Lawrence Berkeley National Laboratory (LBNL) and the US Geological Survey (USGS). In addition to data input and modeling issues, the assessment focused on percolation flux (volumetric flow rate per unit cross-sectional area) at the potential repository horizon. An understanding of unsaturated zone processes is critical to evaluating the performance of the potential high-level nuclear waste repository at Yucca Mountain. A major goal of the project was to capture the uncertainties involved in assessing the unsaturated flow processes, including uncertainty in both the models used to represent physical controls on unsaturated zone flow and the parameter values used in the models. To ensure that the analysis included a wide range of perspectives, multiple individual judgments were elicited from members of an expert panel. The panel members, who were experts from within and outside the Yucca Mountain project, represented a range of experience and expertise. A deliberate process was followed in facilitating interactions among the experts, in training them to express their uncertainties, and in eliciting their interpretations. The resulting assessments and probability distributions, therefore, provide a reasonable aggregate representation of the knowledge and uncertainties about key issues regarding the unsaturated zone at the Yucca
Scott, John Edward
Expert Oracle Application Express brings you groundbreaking insights into developing with Oracle's enterprise-level, rapid-development tool from some of the best practitioners in the field today. Oracle Application Express (APEX) is an entirely web-based development framework that is built into every edition of Oracle Database. The framework rests upon Oracle's powerful PL/SQL language, enabling power users and developers to rapidly develop applications that easily scale to hundreds, even thousands of concurrent users. The 13 authors of Expert Oracle Application Express build their careers aro
... Links Patient Resources For Health Professionals Subscribe Search Basic Metabolic Panel (BMP) Send Us Your Feedback Choose ... Screen Chem 7 SMA 7 SMAC7 Formal Name Basic Metabolic Panel This article was last reviewed on ...
McCullick, Bryan; Schempp, Paul; Hsu, Shan-Hui; Jung, Jin Hong; Vickers, Brad; Schuknecht, Greg
A distinguishing characteristic of expert teachers appears to be an excellent memory (Berliner, 1986; Tan, 1997). Possessing an excellent memory aids experts in building a substantial knowledge base relative to teaching and learning. Despite its importance, the memory skills of expert teachers have yet to be investigated. Therefore, the purpose of…
... AGENCY Request for Nominations of Experts for the Science Advisory Board's Animal Feeding Operation... at [email protected] . General information concerning the EPA Science Advisory Board can be found..., subcommittees and advisory panels; and, (f) for the Panel as a whole, diversity of expertise and viewpoints. The...
... AGENCY Request for Nominations of Experts To Augment the Science Advisory Board Chemical Assessment... Protection Agency (EPA). ACTION: Notice. SUMMARY: The EPA Science Advisory Board (SAB) Staff Office requests...) skills working in committees, subcommittees and advisory panels; and, (f) for the panel as a whole...
Dowell, Laurie; Gary, Jack; Illingworth, Bill; Sargent, Tom
Gathering information, necessary forms, and financial calculations needed to generate a "capital investment proposal" is an extremely complex and difficult process. The intent of the capital investment proposal is to ensure management that the proposed investment has been thoroughly investigated and will have a positive impact on corporate goals. Meeting this requirement typically takes four or five experts a total of 12 hours to generate a "Capital Package." A Capital Expert System was therefore developed using "Personal Consultant." The completed system is hybrid and as such does not depend solely on rules but incorporates several different software packages that communicate through variables and functions passed from one to another. This paper describes the use of expert system techniques, methodology in building the knowledge base, contexts, LISP functions, data base, and special challenges that had to be overcome to create this system. The Capital Expert System is the successful result of a unique integration of artificial intelligence with business accounting, financial forms generation, and investment proposal expertise.
Bernreuter, D. L.
The Site Specific Spectra Project (SSSP) was a multi-year study funded by the US Nuclear Regulatory Commission to provide estimates of the seismic hazards at a number of nuclear power plant sites in the Eastern US. A key element of our approach was the Peer Review Panel, which we formed in order to ensure that our use of expert opinion was reasonable. We discuss the Peer Review Panel results and provide the complete text of each member's report. In order to improve the ground motion model, an Eastern US Ground Motion Model Panel was formed. In Section 4 we tabulate the responses from the panel members to our feedback questionnaire and discuss the implications of changes introduced by them. We conclude that the net difference in seismic hazard values from those presented in Volume 4 is small and does not warrant a reanalysis. 22 figs.
Pedersen, Torben Bach; Lehner, Wolfgang
This panel paper aims at initiating discussion at the Second International Workshop on Energy Data Management (EnDM 2013) about the important research challenges within Energy Data Management. The authors are the panel organizers, extra panelists will be recruited before the workshop...
Abstract. Determination of levels of tolerance in delaminated composite panels is an important issue in composite structures technology. The primary intention is to analyse delaminated composite panels and estimate Strain. Energy Release Rate (SERR) parameters at the delamination front to feed into acceptability criteria.
Steinsvåg, Kjersti; Bråtveit, Magne; Moen, Bente; Austgulen, Li V-Torill; Hollund, Bjørg Eli; Haaland, Inger Margrethe; Naerheim, Jakob; Svendsen, Kristin; Kromhout, Hans
This study presents and evaluates an expert group's assessment of exposure to carcinogens for defined job categories in Norway's offshore petroleum industry, 1970-2005, to provide exposure information for a planned cohort study on cancer. Three university and five industry experts in occupational hygiene individually assessed the likelihood of exposure to 1836 combinations of carcinogens (n=17), job categories (n=27) and time periods (n=4). In subsequent plenary discussions, the experts agreed on exposed combinations. Agreement between the individual and the panel assessments was calculated by Cohen's kappa index. Using the panel assessment as reference, sensitivity and specificity were estimated. The eight experts assessed 63% of the 1836 combinations in plenary, resulting in 265 (14%) convened exposed combinations. Chlorinated hydrocarbons, benzene and inhalation of mineral oils had the highest number of exposed job categories (n=14, 9 and 10, respectively). The job categories classified as exposed to the highest numbers of carcinogens were the mechanics (n=10), derrick workers (n=6) and process technicians (n=5). The agreement between the experts' individual assessments and the panel assessment was kappa=0.53-0.74. The sensitivity was 0.55-0.86 and specificity 0.91-0.97. For these parameters, there were no apparent differences between the university experts and the industry experts. The resulting 265 of 1836 possible exposure combinations convened as "exposed" by expert assessment is presented in this study. The experts' individual ratings highly agreed with the succeeding panel assessment. Correlation was found between years of experience of the raters and agreement with the panel. The university experts and the industry experts' assessments had no apparent differences. Further validation of the exposure assessment is suggested, such as by new sampling data or observational studies.
Shamsudeen, Riyaj; Yu, Kai; Farooq, Tariq
Expert Oracle RAC 12c is a hands-on book helping you understand and implement Oracle Real Application Clusters (RAC), and to reduce the total-cost-of-ownership (TCO) of a RAC database. As a seasoned professional, you are probably aware of the importance of understanding the technical details behind the RAC stack. This book provides deep understanding of RAC concepts and implementation details that you can apply toward your day-to-day operational practices. You'll be guided in troubleshooting and avoiding trouble in your installation. Successful RAC operation hinges upon a fast-performing netwo
The expert system is a computer system that emulates the decision-making ability of a human expert, which aims to solve complex problems by reasoning knowledge. It is an important branch of artificial intelligence. In this paper, firstly, we briefly introduce the development and basic structure of the expert system. Then, from the perspective of the enabling technology, we classify the current expert systems and elaborate four expert systems: The Rule-Based Expert System, the Framework-Based Expert System, the Fuzzy Logic-Based Expert System and the Expert System Based on Neural Network.
Sliwa, Nancy E.; Cooper, Eric G.
Program provides additional level of interface to facilitate use of telerobotic system. ESG (Expert Script Generator) is software package automatically generating high-level task objective commands from complex menu-driven language of the NASA Intelligent Systems Research Laboratory (ISRL). Makes telerobotics laboratory accessible to researchers not familiar with comprehensive language developed by ISRL for interacting with various systems of ISRL test bed. Incorporates expert-system technology to capture typical rules of operation that skilled operator uses. Result: operator interfact optimizing ability of system to perform task remotely in hazardous environment, in timely manner, and without undue stress to operator, while minimizing change for operator erros that damage equipment. Written in CLIPS.
Along with rapidly expanding applications of life science and technology, technical experts have been implicated more and more often with ethical, social, and legal problems than before. It should be noted that in this background there are scientific and social uncertainty elements which are inevitable during the progress of life science in addition to the historically-established social unreliability to scientists and engineers. In order to solve these problems, therefore, we should establish the social governance with ‘relief’ and ‘reliance’ which enables for both citizens and engineers to share the awareness of the issues, to design social orders and criterions based on hypothetical sense of values for bioethics, to carry out practical use management of each subject carefully, and to improve the sense of values from hypothetical to universal. Concerning these measures, the technical experts can learn many things from the present performance in the medical field.
Expert PL/SQL Practices is a book of collected wisdom on PL/SQL programming from some of the best and the brightest in the field. Each chapter is a deep-dive into a specific problem, technology, or feature set that you'll face as a PL/SQL programmer. Each author has chosen their topic out of the strong belief that what they share can make a positive difference in the quality and scalability of code that you write. The path to mastery begins with syntax and the mechanics of writing statements to make things happen. If you've reached that point with PL/SQL, then let the authors of Expert PL/SQL
Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD).
Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly
Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.
A brief exposition of the nature and functions of expert systems (knowledge based systems) and some remarks upon the way in which they resemble, but fall far short of, the very largely intuitive action of the human brain are given. The remainder of the article consists of summaries of the work being done in this field by organisations in Italy, namely: ISPRA; Delphi Electronic Design Systems, VIAREGGIO; SPL Italia SPA, (VA), Milan; Italservice Srl, Milan; and Artificial Intelligence Software, Rovigo.
The ALICE experiment at CERN employs a number of human operators (shifters), who have to make sure that the experiment is always in a state compatible with taking Physics data. Given the complexity of the system and the myriad of errors that can arise, this is not always a trivial task. The aim of this paper is to describe an expert system that is capable of assisting human shifters in the ALICE control room. The system diagnoses potential issues and attempts to make smart recommendations for troubleshooting. At its core, a Prolog engine infers whether a Physics or a technical run can be started based on the current state of the underlying sub-systems. A separate C++ component queries certain SMI objects and stores their state as facts in a Prolog knowledge base. By mining the data stored in dierent system logs, the expert system can also diagnose errors arising during a run. Currently the system is used by the on-call experts for faster response times, but we expect it to be adopted as a standard tool by reg...
The emergence of large-scale freeform shapes in architecture poses big challenges to the fabrication of such structures. A key problem is the approximation of the design surface by a union of patches, socalled panels, that can be manufactured with a selected technology at reasonable cost, while meeting the design intent and achieving the desired aesthetic quality of panel layout and surface smoothness. The production of curved panels is mostly based on molds. Since the cost of mold fabrication often dominates the panel cost, there is strong incentive to use the same mold for multiple panels. We cast the major practical requirements for architectural surface paneling, including mold reuse, into a global optimization framework that interleaves discrete and continuous optimization steps to minimize production cost while meeting user-specified quality constraints. The search space for optimization is mainly generated through controlled deviation from the design surface and tolerances on positional and normal continuity between neighboring panels. A novel 6-dimensional metric space allows us to quickly compute approximate inter-panel distances, which dramatically improves the performance of the optimization and enables the handling of complex arrangements with thousands of panels. The practical relevance of our system is demonstrated by paneling solutions for real, cutting-edge architectural freeform design projects. © 2010 ACM.
The emergence of large-scale freeform shapes in architecture poses big challenges to the fabrication of such structures. A key problem is the approximation of the design surface by a union of patches, so-called panels, that can be manufactured with a selected technology at reasonable cost, while meeting the design intent and achieving the desired aesthetic quality of panel layout and surface smoothness. The production of curved panels is mostly based on molds. Since the cost of mold fabrication often dominates the panel cost, there is strong incentive to use the same mold for multiple panels. We cast the major practical requirements for architectural surface paneling, including mold reuse, into a global optimization framework that interleaves discrete and continuous optimization steps to minimize production cost while meeting user-specified quality constraints. The search space for optimization is mainly generated through controlled deviation from the design surface and tolerances on positional and normal continuity between neighboring panels. A novel 6-dimensional metric space allows us to quickly compute approximate inter-panel distances, which dramatically improves the performance of the optimization and enables the handling of complex arrangements with thousands of panels. The practical relevance of our system is demonstrated by paneling solutions for real, cutting-edge architectural freeform design projects.
Morris, Gavin; O'Connor, Donna
Experiential knowledge of elite National Rugby League (NRL) referees was investigated to determine the key attributes contributing to expert officiating performance. Fourteen current first-grade NRL referees were asked to identify the key attributes they believed contributed to their expert refereeing performance. The modified Delphi method involved a 3-round process of an initial semi-structured interview followed by 2 questionnaires to reach consensus of opinion. The data revealed 25 attributes that were rated as most important that underpin expert NRL refereeing performance. Results illustrate the significance of the cognitive category, with the top 6 ranked attributes all cognitive skills. Of these, the referees ranked decision-making accuracy as the most important attribute, followed by reading the game, communication, game understanding, game management and knowledge of the rules. Player rapport, positioning and teamwork were the top ranked game skill attributes underpinning performance excellence. Expert referees also highlighted a number of psychological attributes (e.g., concentration, composure and mental toughness) that were significant to performance. There were only 2 physiological attributes (fitness, aerobic endurance) that were identified as significant to elite officiating performance. In summary, expert consensus was attained which successfully provided a hierarchy of the most significant attributes of expert NRL refereeing performance.
The possible risks of a proposed nuclear waste repository at Yucca Mountain include the dozen or more young volcanos near by. Now some earth scientists have a new approach to evaluating hazards accounting for uncertainty at every step - `expert elicitation.` This pulls together a panel of experts, carefully assesses the uncertainties of each of their views then mathematically combines their risk estimates along with the accompanying uncertainties. The article goes on to describe just such a panel which considered seismic hazards to Yucca Mountain, how they came to their conclusions, the arguments about the conclusions, and the future of expert elicitation in evaluating the risks of nuclear waste disposal.
Schiltenwolf, Marcus; Beckmann, Nickolas; Gaidzik, Peter
Experts in criminal, civil and, increasingly, in social court cases have to present their expert opinions in court. This should be regarded not only as a burden, even if this may at times appear superfluous to the expert, perhaps because the discussion is mere repetition of the opinion he has already written, or because the questions appear to be biased against the expert. Nonetheless, the expert is always advised to appear calm and objective during the interrogation by judges and parties or participants and their legal representatives, and should not allow himself or herself to be provoked by questioning. Furthermore, it may be necessary to correct the written expert statement in the course of the interrogation, but this can be a sign of a truly competent medical expert. The expert consulted can be held liable for adverse health effects resulting from the interrogation and investigation, as well as for deliberate or grossly faulty reports. Georg Thieme Verlag KG Stuttgart · New York.
The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel [ATP] III) differs in several ways from the ATP II guidelines. Several principal advances include (1) new risk levels for major lipid measures, (2) increased emphasis on primary prevention, (3) inclusion of high-risk groups in secondary prevention, (4) broader lifestyle program, and (5) increased focus on implementation and adherence. The purpose of this article is to discuss the major changes in ATP III and to highlight the benefits of the new guidelines in the management of hypercholesterolemia in adults.
Plint, Amy C; Stang, Antonia S; Calder, Lisa A
Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for
Jurkiewicz, Dariusz; Czarnecka-Operacz, Magdalena M.; Pawliczak, Rafał; Woroń, Jarosław; Moniuszko, Marcin; Emeryk, Andrzej
Allergic diseases are the most common chronic conditions lasting throughout the patient’s life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society. Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and paediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases. What is the truth? What are the data from clinical trials and observational studies? Are all drugs equally effective and safe for the patient? According to a panel of experts representing various fields of medicine, inappropriate treatment of allergies can be very risky for patients, and seemingly equally acting medications may differ greatly. Therefore, a panel of experts gathered the latest data from the entire scientific literature and analysed the latest standards and recommendations prepared by scientific societies. This paper provides a summary of these studies and highlights the importance for the patient of the proper choice of drug to treat his allergies. PMID:28035215
Robert, P H; Konig, A; Andrieu, S; Bremond, F; Chemin, I; Chung, P C; Dartigues, J F; Dubois, B; Feutren, G; Guillemaud, R; Kenisberg, P A; Nave, S; Vellas, B; Verhey, F; Yesavage, J; Mallea, P
Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care providers, and also provide better tools for clinical research. In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association. The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.
A composite panel having front and back faces, the panel comprising facing reinforcement, backing reinforcement and matrix material binding to the facing and backing reinforcements, the facing and backing reinforcements each independently comprising one or more reinforcing sheets, the facing...... by matrix material, the facing and backing reinforcements being interconnected to resist out-of-plane relative movement. The reinforced composite panel is useful as a barrier element for shielding structures, equipment and personnel from blast and/or ballistic impact damage....
Mark N. Harris; Mark Rogers; Anthony Siouclis
Firm-level innovation is investigated using three probit panel estimators, which control for unobserved heterogeneity, and a standard probit estimator. Results indicate the standard probit model is misspecified and that inter-firm networks are important for innovation.
Diver, Jr., Richard B.; Grossman, James W [Albuquerque, NM; Reshetnik, Michael [Boulder, CO
A solar collector comprising a glass mirror, and a composite panel, wherein the back of the mirror is affixed to a front surface of the composite panel. The composite panel comprises a front sheet affixed to a surface of a core material, preferably a core material comprising a honeycomb structure, and a back sheet affixed to an opposite surface of the core material. The invention may further comprise a sealing strip, preferably comprising EPDM, positioned between the glass mirror and the front surface of the composite panel. The invention also is of methods of making such solar collectors.
Belin, S; Peuvergne, A; Sarfati, J
In the singing, which requires precise knowledge of the relevant musical code in use, accuracy of intonation plays a central role. Singing in tune requires to perceive pitch precisely and to memorize it before planning and executing the accurate vocal motion, which allows the exact emission of the correct pitch. Our work investigated the role of short term memory of pitch on singing accuracy. For that purpose, the experimental protocol of Deutsch (1970) was adapted for a perception and a production task. Participants were selected for their singing accuracy and separated into two groups of ten singing in tune and ten out-of-tune. All participants perceived pitch height exactly and were musically non-experts. For the perception and the production tasks, participants had to either compare or reproduce single pitches or two-pitch-sets. For the perception task, participants had to compare either single pitches or two-pitch patterns, all separated by a five seconds delay. For the production task, participants had to reproduce either single pitches or two-pitch patterns after a five seconds delay. The five seconds delay was either filled with intervening numbers, or with intervening tones, or without any disturbing sound. In perception and production task, the presence of intervening tones disturbs deeply the success of the subjects for every trial. Performance of the in-tune singing group is better for all the exercises while the other group had difficulties on single pitches and two-pitch patterns and was more disturbed by the effect of the intervening material. The outcome suggests that short term memory of pitch and accuracy of intonation would be closely linked. Further research needs to specify if that would mean that troubles in singing in tune are a consequence of a low-efficient short term memory of pitch, or if that troubles would hold up the right construction of the short term memory of pitch.
Şahin, Mehmet; Deli, İrfan; Uluçay, Vakkas
In this paper, we introduce concept of bipolar neutrosophic soft expert set and its some operations. Also, we propose score, certainty and accuracy functions to compare the bipolar neutrosophic soft expert sets. We give examples for these concepts.
Limitations of Expert Evidence Edited by Stephen Leadbeatter MB ChB MCRPath ISBN 1 86016 029 8 Printed in Great Britain by Cathedral Print Services Ltd, Salisbury, 1996 Kitap 25 Ekim 1994 te The Royal College of Physicians ve The Royal College of Pathologists tarafından düzenlenen konferanstan sonra hekimlere ve avukatlara konuyu tartışmaya açmak için basılmış. Bilirkişi görüşünün temel filozofisinin, bu görevi yapanlar ve bu hizmeti alanların yapabileceklerin...
Throughout history, advances in technology have come in spurts. A single great idea can often spur rapid change as the idea takes hold and is propagated, often in totally unexpected directions. Exadata embodies such a change in how we think about and manage relational databases. The key change lies in the concept of offloading SQL processing to the storage layer. That concept is a huge win, and its implementation in the form of Exadata is truly a game changer. Expert Oracle Exadata will give you a look under the covers at how the combination of hardware and software that comprise Exadata actua
Shadbolt, N. R.
This paper examines the origins, current state and future prospects for expert systems. The origins are traced from the schism with classic Artificial Intelligence. The characteristics of early expert systems are described and contrasted with more recent developments. A number of influential forces operating on present day systems are reviewed. The future trends in the evolution of expert systems are discussed.
Thomas Paul Slavin
Full Text Available Background: Multigene panels can be a cost- and time-effective alternative to sequentially testing multiple genes, especially with a mixed family cancer phenotype. However, moving beyond our single-gene testing paradigm has unveiled many new challenges to the clinician. The purpose of this article is to familiarize the reader with some of the challenges, as well as potential opportunities, of expanded hereditary cancer panel testing. Methods: We include results from 348 commercial multigene panel tests ordered from January 1, 2014, through October 1, 2014, by clinicians associated with the City of Hope’s Clinical Cancer Genetics Community of Practice. We also discuss specific challenging cases that arose during this period involving abnormalities in the genes: CDH1, TP53, PMS2, PALB2, CHEK2, NBN, and RAD51C. Results: If historically high risk genes only were included in the panels (BRCA1, BRCA2, MSH6, PMS2, TP53, APC, CDH1, the results would have been positive only 6.2% of the time, instead of 17%. Results returned with variants of uncertain significance (VUS 42% of the time. Conclusion: These figures and cases stress the importance of adequate pretest counseling in anticipation of higher percentages of positive, VUS, unexpected, and ambiguous test results. Test result ambiguity can be limited by the use of phenotype specific panels; if found, multiple resources (the literature, reference laboratory, colleagues, national experts, and research efforts can be accessed to better clarify counseling and management for the patient and family. For pathogenic variants in low and moderate risk genes, empiric risk modeling based on the patient’s personal and family history of cancer may supersede gene-specific risk. Commercial laboratory and patient contributions to public databases and research efforts will be needed to better classify variants and reduce clinical ambiguity of multigene panels.
Full Text Available En este artículo se estudia la fabricación y el comportamiento mecánico de paneles a base de papel reciclado. El objetivo principal del proyecto es producir un prototipo de panel que emplee elementos provenientes de residuos sólidos (papel periódico y de un material conglomerante (cemento Portland blanco. El panel debe ser económico, debe tener buenas propiedades mecánicas y debe tener dimensiones comerciales para su uso en muros tabiques y en cielos falsos en la industria de la construcción. El Recipanel es un panel no estructural a base de papel reciclado. El Recipanel cumple las normas colombianas en lo relativo a los paneles de uso no estructural y presenta además unas excelentes características mecánicas.
Glüer, C C
.... The performance of QUS techniques has been evaluated in a large number of studies. Reviewing existing knowledge, an international expert panel formulated the following consensus regarding the current status of this technology...
Antonio Donizette de Oliveira
Full Text Available The objective of this study is to estimate for several importing countries of fiberboard panels the income elasticities and price elasticities of total import demand and also the own-price and cross-price elasticities of demand for fiberboard panels, differentiated by country of origin. Time series data were used referring to the trade flow of the world’s largest exporters and importers of fiberboard panels. The demand model being used treats products as imperfect substitutes. It was concluded that in Germany, China and United Kingdom the total import demand for fiberboard panels was more sensitive to variations in price than in income, whereas in other importing countries the reverse happened. The own-price elasticity of demand for fiberboard panels, differentiated by country of origin, was higher than one in almost all markets, except in Germany and United Kingdom. The negative cross-price elasticities suggest that fiberboard panels imported from other exporting countries are complementary products.
Burden, Christy; Fox, Robert; Lenguerrand, Erik; Hinshaw, Kim; Draycott, Timothy J; James, Mark
To develop content for a basic laparoscopic curriculum in gynaecology. Prospective cross-sectional observational study. Modified Delphi method with three iterations undertaken by an invited group of national experts across the United Kingdom (UK). Two anonymous online surveys and a final physical group meeting were undertaken. Junior trainees in gynaecology undertook a parallel iteration of the Delphi process for external validation. Population included: expert panel - certified specialists in minimal-access gynaecological surgery, RCOG national senior trainee representatives, and medical educationalists, junior trainees group - regional trainees in gynaecology in first and second year of speciality training. Experts (n=37) reached fair to almost complete significant agreement (κ=0.100-0.8159; pcurriculum. Findings indicated that 39 categories should be included in the curriculum. Port placement, laparoscopic equipment and patient selection were ranked the most important theoretical categories. Hand-eye co-ordination, camera navigation and entry techniques were deemed the most valuable skills. Diagnostic laparoscopy, laparoscopic sterilisation, and laparoscopic salpingectomy were the operations agreed to be most important for inclusion. Simulation training was agreed as the method of skill development. The expert panel favoured box trainers, whereas the junior trainee group preferred virtual reality simulators. A basic simulation laparoscopic hand-eye co-ordination test was proposed as a final assessment of competence in the curriculum. Consensus was achieved on the content of a basic laparoscopic curriculum in gynaecology, in a cost- and time-effective, scientific process. The Delphi method provided a simple, structured consumer approach to curriculum development that combined views of trainers and trainees that could be used to develop curricula in other areas of post-graduate education. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Morton, Rebecca; Tyran, Jean-Robert
in information quality is large, we find that voting groups largely coordinate on the SVC equilibrium which is also Pareto Optimal. However, we find that when the asymmetry in information quality is not large and the Pareto Optimal equilibrium is for all to participate, significant numbers of voters with low...... quality information abstain. Furthermore, we find that information asymmetry induces voters with low quality information to coordinate on a non-equilibrium outcome. This suggests that coordination on "letting the experts" decide is a likely voting norm that sometimes validates SVC equilibrium predictions......We examine abstention when voters in standing committees are asymmetrically informed and there are multiple pure strategy equilibria-swing voter's curse (SVC) equilibria where voters with low quality information abstain and equilibria when all participants vote their information. When the asymmetry...
A panel session at the 1989 International Joint Conference on artificial intelligence in Los Angeles dealt with the subject of knowledge-based systems; the session was entitled "Expert Systems: How Far Can They Go?" The panelists included Randall Davis (Massachusetts Institute of Technology); Stuart Dreyfus (University of California at Berkeley); Brian Smith (Xerox Palo Alto Research Center); and Terry Winograd (Stanford University), chairman. The article begins with Winograd's original charg...
A panel session at the 1989 International Joint Conference on Artificial Intelligence in Los Angeles dealt with the subject of knowledge-based systems; the session was entitled "Expert Systems: How Far Can They Go?" The panelists included Randall Davis (Massachusetts Institute of Technology); Stuart Dreyfus (University of California at Berkeley); Brian Smith (Xerox Palo Alto Research Center); and Terry Winograd (Stanford University), chairman. Part 1 of this article, which appeared in the Spr...
Full Text Available Because of the fact that specialty agricultural assistance is not always available when the farmers need it, we identified expert systems as a strong instrument with an extended potential in agriculture. This started to grow in scale recently, including all socially-economic activity fields, having the role of collecting data regarding different aspects from human experts with the purpose of assisting the user in the necessary steps for solving problems, at the performance level of the expert, making his acquired knowledge and experience available. We opted for a general presentation of the expert systems as well as their necessity, because, the solution to develop the agricultural system can come from artificial intelligence by implementing the expert systems in the field of agricultural insurance, promoting existing insurance products, farmers finding options in depending on their necessities and possibilities. The objective of this article consists of collecting data about different aspects about specific areas of interest of agricultural insurance, preparing the database, a conceptual presentation of a pilot version which will become constantly richer depending on the answers received from agricultural producers, with the clearest exposure of knowledgebase possible. We can justify picking this theme with the fact that even while agricultural insurance plays a very important role in agricultural development, the registered result got from them are modest, reason why solutions need to be found in the scope of developing the agricultural sector. The importance of this consists in the proposal of an immediate viable solution to correspond with the current necessities of agricultural producers and in the proposal of an innovative solution, namely the implementation of expert system in agricultural insurance as a way of promoting insurance products. Our research, even though it treats the subject at an conceptual level, it wants to undertake an
Dirk van As
Full Text Available Thirty-four experts took part in a survey of the most important and challenging topics in the field of meltwater retention in snow and firn, to reveal those topics that present the largest potential for scientific advancement. The most important and challenging topic to the expert panel is spatial heterogeneity of percolation, both in measurement and model studies. Studying percolation blocking by ice layering, particularly in modeling, also provides large potential for science advancement, as well as hydraulic conductivity and capillary forces in snow/firn. Model studies can benefit from improved initialization, and improved calculation of accumulation and liquid water at the surface. Firn coring should be performed more often, though we argue that also data that are relatively simple to collect, but of great importance to retention such as surface accumulation, density and temperature, are too sparse due to the high logistical expenses involved in field campaigns. Generally speaking, retention changes are expected to be of importance to the surface mass balance and thus ice loss in coming decades, more so for Greenland than Antarctica or ice masses elsewhere.
Van den Besselaar, P.; Stout, L.; Gou, X
In this paper we explore the use of text analysis for deriving quality indicators of project proposals. We do full text analysis of 3030 review reports. After term extraction, we aggregate the term occurrences to linguistic categories. Using thse linguistic categories as independent variables, we study how well these predict the grading by the review panels. Together, the different linguistic categories explain about 50% of the variance in the grading of the applications. The relative importance of the different linguistic categories inform us about the way the panels work. This can be used to develop altmetrics for the quality of the peer and panel review processes. (Author)
Presents an activity in which students make a simulated solar panel to learn about the principles behind energy production using solar panels. Provides information about how solar panels function to produce energy. (MCO)
Azari, David P; Frasier, Lane L; Quamme, Sudha R Pavuluri; Greenberg, Caprice C; Pugh, Carla M; Greenberg, Jacob A; Radwin, Robert G
Computer vision was used to predict expert performance ratings from surgeon hand motions for tying and suturing tasks. Existing methods, including the objective structured assessment of technical skills (OSATS), have proven reliable, but do not readily discriminate at the task level. Computer vision may be used for evaluating distinct task performance throughout an operation. Open surgeries was videoed and surgeon hands were tracked without using sensors or markers. An expert panel of 3 attending surgeons rated tying and suturing video clips on continuous scales from 0 to 10 along 3 task measures adapted from the broader OSATS: motion economy, fluidity of motion, and tissue handling. Empirical models were developed to predict the expert consensus ratings based on the hand kinematic data records. The predicted versus panel ratings for suturing had slopes from 0.73 to 1, and intercepts from 0.36 to 1.54 (Average R = 0.81). Predicted versus panel ratings for tying had slopes from 0.39 to 0.88, and intercepts from 0.79 to 4.36 (Average R = 0.57). The mean square error among predicted and expert ratings was consistently less than the mean squared difference among individual expert ratings and the eventual consensus ratings. The computer algorithm consistently predicted the panel ratings of individual tasks, and were more objective and reliable than individual assessment by surgical experts.
Davito, A.; Baker, C.J.; King, C.J.; Costerus, B.; Nelson, T.; Prokosch, D.; Pastrnak, J.; Grace, P.
The POPOVER series of high explosive (HE) certification tests was conducted at the Big Explosives Experimental Facility (BEEF) in Area 4 of the Nevada Test Site (NTS). The two primary objectives of POPOVER were to certify that: (1) BEEF meets DOE requirements for explosives facilities and is safe for personnel-occupied operations during testing of large charges of conventional HE. (2) Facility structures and equipment will function as intended when subjected to the effects of these charges. After careful analysis of test results, the POPOVER Review Panel concludes that the POPOVER series met both objectives. Further details on the Review Panel`s conclusions are included in Section 7--Findings and Recommendations.
Cooper, E. G.
The Automation Technology Branch of NASA's Langley Research Center is employing increasingly complex degrees of operator/robot cooperation (telerobotics). A good relationship between the operator and computer is essential for smooth performance by a telerobotic system. ESG (Expert Script Generator) is a software package that automatically generates high-level task objective commands from the NASA Intelligent Systems Research Lab's (ISRL's) complex menu-driven language. ESG reduces errors and makes the telerobotics lab accessible to researchers who are not familiar with the comprehensive language developed by ISRL for interacting with the various systems of the ISRL testbed. ESG incorporates expert system technology to capture the typical rules of operation that a skilled operator would use. The result is an operator interface which optimizes the system's capability to perform a task remotely in a hazardous environment, in a timely manner, and without undue stress to the operator, while minimizing the chance for operator errors that may damage equipment. The intricate menu-driven command interface which provides for various control modes of both manipulators and their associated sensors in the TeleRobotic System Simulation (TRSS) has a syntax which is both irregular and verbose. ESG eliminates the following two problems with this command "language": 1) knowing the correct command sequence to accomplish a task, and 2) inputting a known command sequence without typos and other errors. ESG serves as an additional layer of interface, working in conjunction with the menu command processor, not supplanting it. By specifying task-level commands, such as GRASP, CONNECT, etc., ESG will generate the appropriate menu elements to accomplish the task. These elements will be collected in a script file which can then be executed by the ISRL menu command processor. In addition, the operator can extend the list of task-level commands to include customized tasks composed of sub
An NCI Cancer Currents blog by the NCI acting director thanking the cancer community for contributing to the Cancer Moonshot Blue Ribbon Panel report, which was presented to the National Cancer Advisory Board on September 7.
Liver disease test panel - autoimmune ... Autoimmune disorders are a possible cause of liver disease. The most common of these diseases are autoimmune hepatitis and primary biliary cholangitis (formerly called primary biliary cirrhosis). This group of tests ...
... Sequential multi-channel analysis with computer-7; SMA7; Metabolic panel 7; CHEM-7 ... Bope ET, Kellerman RD. Endocrine and metabolic disorders. In: Bope ET, ... PA: Elsevier; 2017:chap 5. Oh MS, Briefel G. Evaluation ...
... Testing Leptin Levetiracetam Lipase Lipid Profile Lipoprotein (a) Lithium Liver Panel Lp-PLA2 Lupus Anticoagulant Testing Luteinizing ... L. et. al. (2011 September 29). Kids in America Newborn Screening for Cystic Fibrosis. Medscape Today News ...
... AGENCY Science Advisory Board Staff Office; Request for Nominations of Experts To Augment the SAB...-mail at [email protected] . General information concerning the EPA Science Advisory Board can be... and advisory panels; and, (f) for the Panel as a whole, diversity of expertise and viewpoints. The SAB...
... AGENCY Science Advisory Board Staff Office Request for Nominations of Experts for the SAB Hydraulic...; and, (f) for the panel as a whole, diversity of expertise and viewpoints. The SAB Staff Office's...: Overview of the Panel Formation Process at the Environmental Protection Agency Science Advisory Board (EPA...
Carrascosa, J M; Galán, M; de Lucas, R; Pérez-Ferriols, A; Ribera, M; Yanguas, I
There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
Mekaru, M. M.; Wright, M. A.
The feasibility of implementing artificial intelligence on satellites is evaluated, with the aim of using an onboard expert system to perform effective stationkeeping functions without assistance from the ground. The Defense Satellite Communication System (DSCS III) is used as an example. The cost for implementing a satellite stationkeeping expert system is analyzed. A ground-based expert system could reduce the current number of support personnel for the stationkeeping task. Results of analyzing a possible flight system are quite promising. An expert system for satellite stationkeeping seems feasible, appears cost-effective, and offers increased satellite endurance through autonomous operations.
A solar energy panel comprises a support upon which silicon cells are arrayed. The cells are wafer thin and of two geometrical types, both of the same area and electrical rating, namely hexagon cells and hourglass cells. The hourglass cells are composites of half hexagons. A near perfect nesting relationship of the cells achieves a high density packing whereby optimum energy production per panel area is achieved.
Rubin, I. (Inventor)
A solar energy panel support is described upon which silicon cells are arrayed. The cells are wafer thin and of two geometrical types, both of the same area and electrical rating, namely hexagon cells and hourglass cells. The hourglass cells are composites of half hexagons. A near perfect nesting relationship of the cells achieves a high density packing whereby optimum energy production per panel area is achieved.
James Rosenquist's giant Pop-art panels included realistic renderings of well-known contemporary foods and objects, juxtaposed with famous people in the news--largely from the 1960s, '70s and '80s--and really serve as visual time capsules. In this article, eighth-graders focus on the style of James Rosenquist to create their own Pop-art panel that…
6 nov. 2017 ... The expert panel will be moderated by IDRC President Jean Lebel and features: Le débat d'experts sera animé par le président du CRDI, Jean Lebel. Les participants sont : Karen Craggs-Milne, directrice, groupe international, Institut africain des sciences mathématiques (Rwanda);; Jac sm Kee, ...
Shaoul, Jean; Smith, P. J.
Expert systems, rule-based knowledge systems, have been widely heralded as an important tool in management and accounting. Expert system shells have become available for personal computers, and accountants are investing in systems which are supposed to be capable of intelligent decisions. The limitations of rule-based knowledge systems are…
Ponte, Stefano; Cheyns, Emmanuelle
them, to shape standard setting and management to their advantage depends not only on overcoming important structural differences in endowments and access to resources, but also on more subtle games. These include promoting the enrolment of one expert group or kind of expert knowledge over another...
Truong, N.P.; Heuvelink, G.B.M.; Gosling, J.P.
The variogram is the keystone of geostatistics. Estimation of the variogram is deficient and difficult when there are no or too few observations available due to budget constraints or physical and temporal obstacles. In such cases, expert knowledge can be an important source of information. Expert
Packer, I K
Mental health experts are often called upon to testify in trials of battered woman who have killed their husbands. Such experts have an important role to play in educating both the public and the legal profession about the Battered Woman Syndrome.
Yutskovskaya, Yana; Gubanova, Elena; Khrustaleva, Irina; Atamanov, Vasiliy; Saybel, Anastasiya; Parsagashvili, Elena; Dmitrieva, Irina; Sanchez, Elena; Lapatina, Natalia; Korolkova, Tatiana; Saromytskaya, Alena; Goltsova, Elena; Satardinova, Elmira
Background Although there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians. Methods Thirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics. Results All experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies. Conclusion On the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for
Lo, Ching F.
This research project is designed to apply artificial intelligence technology including expert systems, dynamic interface of neural networks, and hypertext to construct an expert system developer. The developer environment is specifically suited to building expert systems which monitor the performance of ground support equipment for propulsion systems and testing facilities. The expert system developer, through the use of a graphics interface and a rule network, will be transparent to the user during rule constructing and data scanning of the knowledge base. The project will result in a software system that allows its user to build specific monitoring type expert systems which monitor various equipments used for propulsion systems or ground testing facilities and accrues system performance information in a dynamic knowledge base.
Sunaryo, Peter L; Svider, Peter F; Jackson-Rosario, Imani; Eloy, Jean Anderson
To evaluate the credentials of urologists choosing to testify as expert witnesses. As health care reform has become an increasingly important topic in national debate, medical malpractice and related issues have come to the forefront of topics for discussion by the medical community. Physicians are often recruited to testify as expert witnesses in malpractice cases. Defining what constitutes an expert in this setting has been an area of controversy. The Westlaw legal database was searched for medical malpractice litigation. Data regarding number of years of experience and practice setting were obtained for urologists using private practice and hospital listings, academic faculty profiles, and state medical licensing databases. Scholarly impact, as measured by the h-index, was calculated by the Scopus database. Plaintiff expert witnesses were found to have slightly more years of experience vs defendant expert witnesses (35.7 vs 32.2 years, P = .01), but had a lower h-index (6.8 vs 10.2, P = .03), were less likely to practice in the academic setting (39% vs 60%, P = .001), and were more likely to testify multiple times. Urologists testifying for plaintiffs and defendants both had over 30 years of experience on average, with those in the latter having slightly less experience. Defendant witnesses, however, had greater scholarly impact and were more likely to practice in an academic setting. Organizations such as the American Urological Association may wish to re-evaluate guidelines on expert witness testimony, particularly regarding those who testify frequently. Copyright © 2014 Elsevier Inc. All rights reserved.
Cudahy, J.; Escarda, T.; Gimpel, R. [and others
The U.S. Department of Energy (DOE) Office of Technology Development (OTD) commissioned two studies to evaluate nineteen thermal treatment technologies for treatment of DOE mixed low-level waste. These studies were called the Integrated Thermal Treatment System (ITTS) Phase I and Phase II. With the help of the DOE Office of Environmental Management (EM) Mixed Waste Focus Group, OTD formed an ITTS Internal Review Panel to review and comment on the ITTS studies. This Panel was composed of scientists and engineers from throughout the DOE complex, the U.S. Environmental Protection Agency, the California EPA, and private experts. The Panel met from November 15-18, 1994 to review the ITTS studies and to make recommendations on the most promising thermal treatment systems for DOE mixed low-level wastes and on research and development necessary to prove the performance of the technologies. This report describes the findings and presents the recommendations of the Panel.
van de Pol, Marjolein H J; Fluit, Cornelia R M G; Lagro, Joep; Slaats, Yvonne H P; Olde Rikkert, Marcel G M; Lagro-Janssen, Antoine L M
Shared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities. We used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model. Consensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). SDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker. The developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Schlender, Michael H.
Second in a series of monthly safety articles to be featured in the Tri-Cities Area Journal of Business. These articles will focus on safety tips and practices targeted businesses in the area. The first article focuses on safety tips for business owners who have high school and college students entering the workforce this summer.
Dewalle-Vignion, Anne-Sophie; Yeni, Nathanaëlle; Petyt, Grégory; Verscheure, Leslie; Huglo, Damien; Béron, Amandine; Adib, Salim; Lion, Georges; Vermandel, Maximilien
[¹⁸F]-Fluorodeoxyglucose PET has become an essential technique in oncology. Accurate segmentation is important for treatment planning. With the increasing number of available methods, it will be useful to establish a reliable evaluation tool. Five methods for [F]-fluorodeoxyglucose PET image segmentation (MIP-based, Fuzzy C-means, Daisne, Nestle and the 42% threshold-based approach) were evaluated on non-Hodgkin's lymphoma lesions by comparing them with manual delineations performed by a panel of experts. The results were analyzed using different similarity measures. Intraoperator and interoperator variabilities were also studied. The maximum of intensity projection-based method provided results closest to the manual delineations set [binary Jaccard index mean (SD) 0.45 (0.15)]. The fuzzy C-means algorithm yielded slightly less satisfactory results. The application of a 42% threshold-based approach yielded results furthest from the manual delineations [binary Jaccard index mean (SD) 0.38 (0.16)]; the Daisne and the Nestle methods yielded intermediate results. Important intraoperator and interoperator variabilities were demonstrated. A simple assessment framework based on comparisons with manual delineations was proposed. The use of a set of manual delineations performed by five different experts as the reference seemed to be suitable to take the intraoperator and the interoperator variabilities into account. The online distribution of the data set generated in this study will make it possible to evaluate any new segmentation method.
Ralph, E. L.; Linder, E.
This paper describes solar cell panel designs that utilize new hgih efficiency solar cells along with lightweight rigid panel technology. The resulting designs push the W/kg and W/sq m parameters to new high levels. These new designs are well suited to meet the demand for higher performance small satellites. This paper reports on progress made on two SBIR Phase 1 contracts. One panel design involved the use of large area (5.5 cm x 6.5 cm) GaAs/Ge solar cells of 19% efficiency combined with a lightweight rigid graphite fiber epoxy isogrid substrate configuration. A coupon (38 cm x 38 cm) was fabricated and tested which demonstrated an array specific power level of 60 W/kg with a potential of reaching 80 W/kg. The second panel design involved the use of newly developed high efficiency (22%) dual junction GaInP2/GaAs/Ge solar cells combined with an advanced lightweight rigid substrate using aluminum honeycomb core with high strength graphite fiber mesh facesheets. A coupon (38 cm x 38 cm) was fabricated and tested which demonstrated an array specific power of 105 W/kg and 230 W/sq m. This paper will address the construction details of the panels and an a analysis of the component weights. A strawman array design suitable for a typical small-sat mission is described for each of the two panel design technologies being studied. Benefits in respect to weight reduction, area reduction, and system cost reduction are analyzed and compared to conventional arrays.
Erck, R.A.; Erdemir, A.; Janghsing Hsieh; Lee, R.H.; Xian Zheng Pan; Deming Shu [Argonne National Lab., IL (United States); Feldman, A. [National Inst. of Standards and Technology, Gaithersburg, MD (United States); Glass, J.T. [North Carolina State Univ., Raleigh (United States); Kleimer, R. [Coors Ceramics Co., Golden, CO (United States); Lawton, E.A. [JPL/Caltech, Pasadena, CA (United States); McHargue, C.J. [Univ. of Tennessee, Knoxville (United States)
The task of this panel was to identify and prioritize needs in the area of characterization of diamond and diamond-like-carbon (DLC) films for use in the transportation industry. Until recent advances in production of inexpensive films of diamonds and DLC, it was not feasible that these materials could be mass produced. The Characterization Panel is restricting itself to identifying needs in areas that would be most useful to manufacturers and users in producing and utilizing diamond and DLC coatings in industry. These characterization needs include in-situ monitoring during growth, relation of structure to performance, and standards and definitions.
Esen, Hatice; Hatipoğlu, Tuğçen; Cihan, Ahmet; Fiğlali, Nilgün
Shift patterns, work hours, work arrangements and worker motivations have increasingly become key factors for job performance. The main objective of this article is to design an expert system that identifies the negative effects of shift work and prioritizes mitigation efforts according to their importance in preventing these negative effects. The proposed expert system will be referred to as the shift expert. A thorough literature review is conducted to determine the effects of shift work on workers. Our work indicates that shift work is linked to demographic variables, sleepiness and fatigue, health and well-being, and social and domestic conditions. These parameters constitute the sections of a questionnaire designed to focus on 26 important issues related to shift work. The shift expert is then constructed to provide prevention advice at the individual and organizational levels, and it prioritizes this advice using a fuzzy analytic hierarchy process model, which considers comparison matrices provided by users during the prioritization process. An empirical study of 61 workers working on three rotating shifts is performed. After administering the questionnaires, the collected data are analyzed statistically, and then the shift expert produces individual and organizational recommendations for these workers.
Keller, Edward A.
Gathering your own data and coming to your own conclusion through scientific research and discovery is the most important principle to remember when being an expert witness in geomorphology. You can only be questioned in deposition and trial in your area of expertise. You are qualified as an expert by education, knowledge, and experience. You will have absolutely nothing to fear from cross-examination if you are prepared and confident about your work. Being an expert witness requires good communication skills. When you make a presentation, speak clearly and avoid jargon, especially when addressing a jury. Keep in mind that when you take on a case that may eventually go to court as a lawsuit, the entire process, with appeals and so forth, can take several years. Therefore, being an expert may become a long-term commitment of your time and energy. You may be hired by either side in a dispute, but your job is the same - determine the scientific basis of the case and explain your scientific reasoning to the lawyers, the judge, and the jury. Your work, including pre-trial investigations, often determines what the case will be based on. The use of science in the discovery part of an investigation is demonstrated from a California case involving the Ventura River, where building of a flood control levee restricted flow to a narrower channel, increasing unit stream power as well as potential for bank erosion and landsliding.
O'Connor, Teresia M; Mâsse, Louise C; Tu, Andrew W; Watts, Allison W; Hughes, Sheryl O; Beauchamp, Mark R; Baranowski, Tom; Pham, Truc; Berge, Jerica M; Fiese, Barbara; Golley, Rebecca; Hingle, Melanie; Kremers, Stef P J; Rhee, Kyung E; Skouteris, Helen; Vaughn, Amber
Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing
Full Text Available Abstract Background Exposure to fine ambient particulate matter (PM has consistently been associated with increased morbidity and mortality. The relationship between exposure to ultrafine particles (UFP and health effects is less firmly established. If UFP cause health effects independently from coarser fractions, this could affect health impact assessment of air pollution, which would possibly lead to alternative policy options to be considered to reduce the disease burden of PM. Therefore, we organized an expert elicitation workshop to assess the evidence for a causal relationship between exposure to UFP and health endpoints. Methods An expert elicitation on the health effects of ambient ultrafine particle exposure was carried out, focusing on: 1 the likelihood of causal relationships with key health endpoints, and 2 the likelihood of potential causal pathways for cardiac events. Based on a systematic peer-nomination procedure, fourteen European experts (epidemiologists, toxicologists and clinicians were selected, of whom twelve attended. They were provided with a briefing book containing key literature. After a group discussion, individual expert judgments in the form of ratings of the likelihood of causal relationships and pathways were obtained using a confidence scheme adapted from the one used by the Intergovernmental Panel on Climate Change. Results The likelihood of an independent causal relationship between increased short-term UFP exposure and increased all-cause mortality, hospital admissions for cardiovascular and respiratory diseases, aggravation of asthma symptoms and lung function decrements was rated medium to high by most experts. The likelihood for long-term UFP exposure to be causally related to all cause mortality, cardiovascular and respiratory morbidity and lung cancer was rated slightly lower, mostly medium. The experts rated the likelihood of each of the six identified possible causal pathways separately. Out of these
Coppersmith, Kevin J.; Perman, Roseanne C.
This report presents results of the Saturated Zone Flow and Transport Expert Elicitation (SZEE) project for Yucca Mountain, Nevada. This project was sponsored by the US Department of Energy (DOE) and managed by Geomatrix Consultants, Inc. (Geomatrix), for TRW Environmental Safety Systems, Inc. The DOE's Yucca Mountain Site Characterization Project (referred to as the YMP) is intended to evaluate the suitability of the site for construction of a mined geologic repository for the permanent disposal of spent nuclear fuel and high-level radioactive waste. The SZEE project is one of several that involve the elicitation of experts to characterize the knowledge and uncertainties regarding key inputs to the Yucca Mountain Total System Performance Assessment (TSPA). The objective of the current project was to characterize the uncertainties associated with certain key issues related to the saturated zone system in the Yucca Mountain area and downgradient region. An understanding of saturated zone processes is critical to evaluating the performance of the potential high-level nuclear waste repository at Yucca Mountain. A major goal of the project was to capture the uncertainties involved in assessing the saturated flow processes, including uncertainty in both the models used to represent the physical processes controlling saturated zone flow and transport, and the parameter values used in the models. So that the analysis included a wide range of perspectives, multiple individual judgments were elicited from members of an expert panel. The panel members, who were experts from within and outside the Yucca Mountain project, represented a range of experience and expertise. A deliberate process was followed in facilitating interactions among the experts, in training them to express their uncertainties, and in eliciting their interpretations. The resulting assessments and probability distributions, therefore, provide a reasonable aggregate representation of the knowledge and
Disbrow, James D.; Duke, Eugene L.; Regenie, Victoria A.
Digital flight-control systems monitored by computer program that evaluates and recommends. Flight-systems engineers for advanced, high-performance aircraft use knowlege-acquisition tool for expert-system flight-status monitor suppling interpretative data. Interpretative function especially important in time-critical, high-stress situations because it facilitates problem identification and corrective strategy. Conditions evaluated and recommendations made by ground-based engineers having essential knowledge for analysis and monitoring of performances of advanced aircraft systems.
Wilson, Harold O.; Burford, Anna Marie
Delineates artificial intelligence/expert systems (AI/ES) concepts; provides an exposition of some business application areas; relates progress; and creates an awareness of the benefits, limitations, and reservations of AI/ES. (Author)
Herman, Rod A; Raybould, Alan
Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops. PMID:24637724
Janssen, José; Stoyanov, Slavi
Janssen, J., & Stoyanov, S. (2012, 20 November). Online Consultation for a Digital Competence Framework: Experts' views on Digital Competence. Workshop presentation at the Institute for Prospective Technological Studies, Seville, Spain.
Two-piece unit heats and presses protective layers to form laminate. Rubber diaphragm between upper and lower vacuum chambers alternates between neutral position and one that presses against solar-cell array, supplying distributed force necessary to press layers of laminate together. Encapsulation helps to protect cells from environment and to ensure long panel life while allowing efficient generation of electricity from Sunlight.
of MSc programmes, the MSc coordinator as well as the administrative secretary. A student panel meets with the department twice in the first year: Early in February to sum up experience from the first semester and in early in June to sum up experience from the second semester. At semester start each MSc...
Lisi, Anthony J; Breuer, Paula; Gallagher, Rollin M; Rodriguez, Eric; Rossi, Michelle I; Schmader, Kenneth; Scholten, Joel D; Weiner, Debra K
To present an algorithm of sequential treatment options for managing myofascial pain (MP) in older adults, along with a representative clinical case. A modified Delphi process was used to synthesize evidence-based recommendations. A multidisciplinary expert panel developed the algorithm, which was subsequently refined through an iterative process of input from a primary care physician panel. We present an algorithm and supportive materials to help guide the care of older adults with MP, an important contributor to chronic low back pain (CLBP). Addressing any perpetuating factors should be the first step of managing MP. Patients should be educated on self-care approaches, home exercise, and the use of safe analgesics when indicated. Trigger point deactivation can be accomplished by manual therapy, injection therapy, dry needling, and/or acupuncture. The algorithm presented gives a structured approach to guide primary care providers in planning treatment for patients with MP as a contributor to CLBP. Wiley Periodicals, Inc.
Herman, Rod A.; Raybould, Alan
Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years sp...
Hukki, Kristiina; Pulkkinen, Urho [VTT Industrial Systems (Finland)
Faced with problems of public acceptance most nuclear waste management organisations now acknowledge the importance of transparency in their pursuit of solutions for high-level nuclear waste disposal. To make progress the implementing organizations need the trust of other stakeholders in the decision-making process. For such trust these outside stakeholders need knowledge on the grounds for the judgments and decisions made in different scientific and technical disciplines. Transparency is, however, at least as important for the multidisciplinary expert communication itself. As a matter of fact, the transparency of the internal expert interaction processes is a prerequisite for the true transparency of the communication between the implementer and the external stakeholder groups. The introduced conceptual framework has been developed for the identification of the requirements of safety-informed communication in multidisciplinary expert work in nuclear waste management. The framework offers a common thinking model and common concepts which can be utilized in the development of the communication practices. The basis of the framework is on the possibility to understand the safety-critical significance of one's work. The transparency of communication is, for its part, based on making explicit the relevant knowledge necessary for gaining the understanding. This supplementary knowledge, which is related to the substance issues but is not scientific-technical by nature, enhances the experts' awareness of the context of their own contribution and of the background of the other experts' contributions. The common conceptualization and modelling of the knowledge-related dependencies between the tasks make it possible to realize the significance of the supplementary knowledge for transparent communication in actual situations. They also facilitate the recognition of the need for different types of supplementary knowledge in the interfaces between the tasks. By
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ENGLISH ABSTRACT: Artificial intelligence techniques are rapidly emerging as important contributors to more effective management. One of the greatest growth areas probably lies in the use of Expert System methodology for supporting managerial decision processes.
Existing Decision Support Systems often attempt to apply analytical techniques in combination with traditional data access and retrieval functions. One of the problems usually encountered while developing such decision support systems is the need to transform an unstructured problem environment into a structured analytical model. Using an expert system approach to strategic decision making in such unstructured problem environments may provide significant advantages.
The financial Risk diagnostic EXpert System (REXS concentrates on Financial Risk Analysis. Based on a Forecasting Model the system will, with the support of several expert system knowledge bases, attempt to evaluate the financial risk of a business and provide guidelines for improvement.
AFRIKAANSE OPSOMMING: Tegnieke gebaseer op Kunsmatige Intelligensie toon tans die belofte om belangrike bydraes te maak tot meerBestaande Besluitsteunstelsels poog dikwels om analitiese tegnieke en lradisionele datatoegang- en onttrekkingsfunksies te kombineer. Een van die probleme wat gewoonlik ondervind word gedurende die ontwikkeling van '0 besluitsteunstelsel bestaan uit die behoefte om 'n ongestruktueerde probleemomgewing te transformeer na 'n gestruktueerde analitiese model. 'n Ekspertstelselbenadering lot strategiese besluitneming in 'n ongeSlruktureerde probleemomgewing mag betekenisvolle voordele inhou.
Die "financial Risk diagnostic EXpert System (REXS" konsentreer op fmansiele risiko-analise. Uitgaande vanaf 'n Vooruitskattingsmode~ en deur gebruik te maak van verskeie ekspertstelselkennisbasisse, poog die stelsel om die fmansiele risiko van 'n onderneming te evalueer en riglyne vir moontlike verbetering
Full Text Available Limitations of Expert Evidence Edited by Stephen Leadbeatter MB ChB MCRPath ISBN 1 86016 029 8 Printed in Great Britain by Cathedral Print Services Ltd, Salisbury, 1996 Kitap 25 Ekim 1994 te The Royal College of Physicians ve The Royal College of Pathologists tarafından düzenlenen konferanstan sonra hekimlere ve avukatlara konuyu tartışmaya açmak için basılmış. Bilirkişi görüşünün temel filozofisinin, bu görevi yapanlar ve bu hizmeti alanların yapabileceklerinin sınırlarının tartışılması amaçlanmış.Seksen altı sayfadan oluşan kitabın fiatı on iki İngiliz Sterlini. Kitap üç bölüm ve bunların altında toplanan on ana başlıktan oluşmakta. Elinize aldığınızda küçük boyutu ve anlaşılır dili ile hemen okunup bitirelecek kitaplardan sanılıyor. En azından ben böyle düşünmüştüm. Ancak daha L A Tuınberg ve A J Bellinham’ın ön yazısında ben çarpıldım. Değerli yazarların kaleme aldığı başlıklar ve gündeme getirdiği tartışmaların tüm Adli Bilimlerle uğraşanların dikkatle okuması gereken cinsten olduğu kanısındayım. Birinci bölüm The Legal Perspective iki anabaşlıktan oluşuyor, The Criminal legal perspective Honour Judje Martin Stephens tarafından yazılmış,bilirkişi olarak görev yapabilmek için belgelenmiş bir eğitim olması gerektiği, mahkemelerde ya da yazılı raporlarda verilebilecek görüşlerin incelikleri tartışılmış. Bu bölümün ikinci anabaşlığı The civil legal perspective avukat Jennifer Cummin tarafından yazılmış. Toplum gözünde bilirkişinin anlamı ve mahkemenin bilirkişi görüşünü değişmez bilimsel doğru gibi algılayarak düştüğü bilimsel yanılgı ve raporlardaki kavram farkı dile getirilmiş. İkinci Bölüm The Medical And Scientific Perspective başlığı altında Roger C Evans MD Clinical evidence başlığında toplumun hasta tedavisi ve bilirkişilik hizmetinden beklentilerinin unrealistik olduğu ve
Panel shear strength along the thickness and planar shear along the length of wood panels laminated softwood oriented OSB 10 mm thick, conditioned at different moisture contents (anhydrous medium, ambient temperature and humid medium) was measured on standardized test specimens, cut in half lengthwise panel ...
Describes Liquid Crystal Display (LCD) panels and their use in the classroom. Topics discussed include active versus passive matrix panels; the number of pixels; projectors, including transmissive or reflective overhead projectors; costs; and vendors that supply LCDs. (LRW)
Minnesota Department of Natural Resources — This layer contains information about the Flood Insurance Rate Map (FIRM) panel areas. The spatial entities representing FIRM panels are polygons. The polygon for...
Cavieres, Andres; Al-Haddad, Tristan; Goodman, Joseph
A photovoltaic panel mounting clip comprising a base, central indexing tabs, flanges, lateral indexing tabs, and vertical indexing tabs. The mounting clip removably attaches one or more panels to a beam or the like structure, both mechanically and electrically. It provides secure locking of the panels in all directions, while providing guidance in all directions for accurate installation of the panels to the beam or the like structure.
Rahman, A.I.M.J.; Guns, R.; Leydesdorff, L.; Engels, T.C.E.
When research groups are evaluated by an expert panel, it is an open question how one can determine the match between panel and research groups. In this paper, we outline two quantitative approaches that determine the cognitive distance between evaluators and evaluees, based on the journals they
The Environmental Effects Assessment Panel (EEAP) is one of three Panels of experts that inform the Parties to the Montreal Protocol. The EEAP focuses on the effects of UV radiation on human health, terrestrial and aquatic ecosystems, air quality, and materials, as well as on the...
Join Together, Boston, MA.
Join Together convened a panel of experts to review U.S. policies for addiction treatment and recovery. Although the panel reached an agreement on six recommendations for policy changes that can make help more accessible and expand treatment to more people. These recommendations are: (1) treatment for alcoholism and other drug addiction must be…
Riber, Hans Jørgen
A non-linear structural model for composite panels is presented. The non-linear terms in the lateral displacements are modelled as an additional set of lateral loads acting on the panel. Hence the solution is reduced to that of an equivalent panel with small displacements In order to treat sandwich...
J.M. Pye; J.E. de Steiguer; C. Love
A panel of experts was surveyed to obtain five air pollutants (SO2 NO2, O3, H2SO4, and HNO3) on growth, mortality, and leaf area of forests of the continental U.S. for later input to economic analysis. Results from the first two of three...
Paredes, Roger; Tzou, Philip L.; van Zyl, Gert; Barrow, Geoff; Camacho, Ricardo; Carmona, Sergio; Grant, Philip M.; Gupta, Ravindra K.; Hamers, Raph L.; Harrigan, P. Richard; Jordan, Michael R.; Kantor, Rami; Katzenstein, David A.; Kuritzkes, Daniel R.; Maldarelli, Frank; Otelea, Dan; Wallis, Carole L.; Schapiro, Jonathan M.; Shafer, Robert W.
HIV-1 genotypic resistance test (GRT) interpretation systems (IS) require updates as new studies on HIV-1 drug resistance are published and as treatment guidelines evolve. An expert panel was created to provide recommendations for the update of the Stanford HIV Drug Resistance Database (HIVDB)
The photovoltaic solar panels penetration increases significantly in recent years in several European countries, mainly in the low voltage and medium voltage networks supported by governmental policies and incentives. Consequently, the acquisition and installation costs of PV panels decrease...... and the know–how increase significantly. Presently is important the use of new management methodologies in distribution networks to support the growing penetration of PV panels. In some countries, like in Germany and in Italy, the solar generation based in photovoltaic panels supply 40% of the demand in some...
Gonzelez, Avelino J.; Ragusa, James M.
Artificial intelligence (AI) technology, and in particular expert systems, has shown potential applicability in many areas of operation at the Kennedy Space Center (KSC). In an era of limited resources, the early identification of good expert system applications, and their segregation from inappropriate ones can result in a more efficient use of available NASA resources. On the other hand, the education of students in a highly technical area such as AI requires an extensive hands-on effort. The nature of expert systems is such that proper sample applications for the educational process are difficult to find. A pilot project between NASA-KSC and the University of Central Florida which was designed to simultaneously address the needs of both institutions at a minimum cost. This project, referred to as Expert Systems Prototype Training Project (ESPTP), provided NASA with relatively inexpensive development of initial prototype versions of certain applications. University students likewise benefit by having expertise on a non-trivial problem accessible to them at no cost. Such expertise is indispensible in a hands-on training approach to developing expert systems.
Meyer, M.A.; Booker, J.M.
Through two studies, this report seeks to identify the sources of correlation, or dependence, between experts' estimates. Expert estimates are relied upon as sources of data whenever experimental data is lacking, such as in risk analyses and reliability assessments. Correlation between experts is a problem in the elicitation and subsequent use of subjective estimates. Until now, there have been no data confirming sources of correlation, although the experts' background is commonly speculated to be one. Two different populations of experts were administered questions in their areas of expertise. Data on their professional backgrounds and means of solving the questions were elicited using techniques from educational psychology and ethnography. The results from both studies indicate that the way in which an expert solves the problem is the major source of correlation. The experts' background can not be shown to be an important source of correlation nor to influence his choice of method for problem solution. From these results, some recommendations are given for the elicitation and use of expert opinion.
Panneton, Robert J.; Ngo, John C.; Hwu, Shian U.; Johnson, Larry A.; Elmore, James D.; Lu, Ba P.; Kelley, James S.
Characterizing the scattering properties of the solar array panels is important in predicting Space Station antenna performance. A series of far-field, near-field, and radar cross section (RCS) scattering measurements were performed at S-Band and Ku-Band microwave frequencies on Space Station solar array panels. Based on investigation of the measured scattering patterns, the solar array panels exhibit similar scattering properties to that of the same size aluminum or copper panel mockup. As a first order approximation, and for worse case interference simulation, the solar array panels may be modeled using perfect reflecting plates. Numerical results obtained using the Geometrical Theory of Diffraction (GTD) modeling technique are presented for Space Station antenna pattern degradation due to solar panel interference. The computational and experimental techniques presented in this paper are applicable for antennas mounted on other platforms such as ship, aircraft, satellite, and space or land vehicle.
Baisden, Denise L.; Billica, Roger (Technical Monitor)
The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.
Vredeveldt, A.W.; Janssen, G.Th.M.
The small structural weight of fast large ships such as fast mono hulls or catamaran type of ships is of extreme importance to their success. One possible light weight structural solution is the sandwich panel with fibre reinforced laminates and a balsa, honeycomb or foam core. A severe obstacle for
Kirkwood, N.; Weeks, D. J.
Power for the Hubble Space Telescope comes from a system of 20 solar panel assemblies (SPAs) and six nickel-cadmium batteries. The HST battery system is simulated by the HST Electrical Power System (EPS) testbed at Marshall Space Flight Center. The Nickel Cadmium Battery Expert System (NICBES) is being used to diagnose faults of the testbed system, evaluate battery status and provide decision support for the engineer. Extensive telemetry of system operating conditions is relayed through a DEC LSI-11. A BASIC program running on a PC monitors the flow of data, figures cell divergence and recharge ratio, and stores these values, along with other selected data, for use by the expert system.
Viborg Andersen, Kim; Debenham, John; Wagner, Roland
This book constitutes the refereed proceedings of the 16th International Conference on Database and Expert Systems Applications, DEXA 2005, held in Copenhagen, Denmark, in August 2005.The 92 revised full papers presented together with 2 invited papers were carefully reviewed and selected from 390......, reasoning and learning, network management and mobile systems, expert systems and decision support, and information modelling.......This book constitutes the refereed proceedings of the 16th International Conference on Database and Expert Systems Applications, DEXA 2005, held in Copenhagen, Denmark, in August 2005.The 92 revised full papers presented together with 2 invited papers were carefully reviewed and selected from 390...... submissions. The papers are organized in topical sections on workflow automation, database queries, data classification and recommendation systems, information retrieval in multimedia databases, Web applications, implementational aspects of databases, multimedia databases, XML processing, security, XML...
Paredes, Roger; Tzou, Philip L; van Zyl, Gert; Barrow, Geoff; Camacho, Ricardo; Carmona, Sergio; Grant, Philip M; Gupta, Ravindra K; Hamers, Raph L; Harrigan, P Richard; Jordan, Michael R; Kantor, Rami; Katzenstein, David A; Kuritzkes, Daniel R; Maldarelli, Frank; Otelea, Dan; Wallis, Carole L; Schapiro, Jonathan M; Shafer, Robert W
HIV-1 genotypic resistance test (GRT) interpretation systems (IS) require updates as new studies on HIV-1 drug resistance are published and as treatment guidelines evolve. An expert panel was created to provide recommendations for the update of the Stanford HIV Drug Resistance Database (HIVDB) GRT-IS. The panel was polled on the ARVs to be included in a GRT report, and the drug-resistance interpretations associated with 160 drug-resistance mutation (DRM) pattern-ARV combinations. The DRM pattern-ARV combinations included 52 nucleoside RT inhibitor (NRTI) DRM pattern-ARV combinations (13 patterns x 4 NRTIs), 27 nonnucleoside RT inhibitor (NNRTI) DRM pattern-ARV combinations (9 patterns x 3 NNRTIs), 39 protease inhibitor (PI) DRM pattern-ARV combinations (13 patterns x 3 PIs) and 42 integrase strand transfer inhibitor (INSTI) DRM pattern-ARV combinations (14 patterns x 3 INSTIs). There was universal agreement that a GRT report should include the NRTIs lamivudine, abacavir, zidovudine, emtricitabine, and tenofovir disoproxil fumarate; the NNRTIs efavirenz, etravirine, nevirapine, and rilpivirine; the PIs atazanavir/r, darunavir/r, and lopinavir/r (with "/r" indicating pharmacological boosting with ritonavir or cobicistat); and the INSTIs dolutegravir, elvitegravir, and raltegravir. There was a range of opinion as to whether the NRTIs stavudine and didanosine and the PIs nelfinavir, indinavir/r, saquinavir/r, fosamprenavir/r, and tipranavir/r should be included. The expert panel members provided highly concordant DRM pattern-ARV interpretations with only 6% of NRTI, 6% of NNRTI, 5% of PI, and 3% of INSTI individual expert interpretations differing from the expert panel median by more than one resistance level. The expert panel median differed from the HIVDB 7.0 GRT-IS for 20 (12.5%) of the 160 DRM pattern-ARV combinations including 12 NRTI, two NNRTI, and six INSTI pattern-ARV combinations. Eighteen of these differences were updated in HIVDB 8.1 GRT-IS to reflect the
Full Text Available HIV-1 genotypic resistance test (GRT interpretation systems (IS require updates as new studies on HIV-1 drug resistance are published and as treatment guidelines evolve.An expert panel was created to provide recommendations for the update of the Stanford HIV Drug Resistance Database (HIVDB GRT-IS. The panel was polled on the ARVs to be included in a GRT report, and the drug-resistance interpretations associated with 160 drug-resistance mutation (DRM pattern-ARV combinations. The DRM pattern-ARV combinations included 52 nucleoside RT inhibitor (NRTI DRM pattern-ARV combinations (13 patterns x 4 NRTIs, 27 nonnucleoside RT inhibitor (NNRTI DRM pattern-ARV combinations (9 patterns x 3 NNRTIs, 39 protease inhibitor (PI DRM pattern-ARV combinations (13 patterns x 3 PIs and 42 integrase strand transfer inhibitor (INSTI DRM pattern-ARV combinations (14 patterns x 3 INSTIs.There was universal agreement that a GRT report should include the NRTIs lamivudine, abacavir, zidovudine, emtricitabine, and tenofovir disoproxil fumarate; the NNRTIs efavirenz, etravirine, nevirapine, and rilpivirine; the PIs atazanavir/r, darunavir/r, and lopinavir/r (with "/r" indicating pharmacological boosting with ritonavir or cobicistat; and the INSTIs dolutegravir, elvitegravir, and raltegravir. There was a range of opinion as to whether the NRTIs stavudine and didanosine and the PIs nelfinavir, indinavir/r, saquinavir/r, fosamprenavir/r, and tipranavir/r should be included. The expert panel members provided highly concordant DRM pattern-ARV interpretations with only 6% of NRTI, 6% of NNRTI, 5% of PI, and 3% of INSTI individual expert interpretations differing from the expert panel median by more than one resistance level. The expert panel median differed from the HIVDB 7.0 GRT-IS for 20 (12.5% of the 160 DRM pattern-ARV combinations including 12 NRTI, two NNRTI, and six INSTI pattern-ARV combinations. Eighteen of these differences were updated in HIVDB 8.1 GRT-IS to reflect
Agung, I Gusti Ngurah
A comprehensive and accessible guide to panel data analysis using EViews software This book explores the use of EViews software in creating panel data analysis using appropriate empirical models and real datasets. Guidance is given on developing alternative descriptive statistical summaries for evaluation and providing policy analysis based on pool panel data. Various alternative models based on panel data are explored, including univariate general linear models, fixed effect models and causal models, and guidance on the advantages and disadvantages of each one is given. Panel Data Analysis
Viborg Andersen, Kim; Debenham, John; Wagner, Roland
This book constitutes the refereed proceedings of the 16th International Conference on Database and Expert Systems Applications, DEXA 2005, held in Copenhagen, Denmark, in August 2005.The 92 revised full papers presented together with 2 invited papers were carefully reviewed and selected from 390...... submissions. The papers are organized in topical sections on workflow automation, database queries, data classification and recommendation systems, information retrieval in multimedia databases, Web applications, implementational aspects of databases, multimedia databases, XML processing, security, XML......, reasoning and learning, network management and mobile systems, expert systems and decision support, and information modelling....
Tavella, Elena; Papadopoulos, Thanos
This paper provides an empirical study based on action research in which expert and novice facilitators in facilitated modelling workshops are compared. There is limited empirical research analysing the differences between expert and novice facilitators. Aiming to address this gap we study......, and empirically supports the claim that facilitation skills can be taught to participants to enable them to self-facilitate workshops. Differences were also found, which led to the introduction of a new dimension—‘internal versus external’ facilitation. The implications of our findings for effective training...
Stefancich, Marco; Simpson, Lin; Chiesa, Matteo
Long-term acquisition of solar panel performance parameters, for panels operated at maximum power point in their real environment, is of critical importance in the photovoltaic research sector. However, few options exist for the characterization of non-standard panels such as concentrated photovoltaic systems, heavily soiled or shaded panels or those operating under non-standard spectral illumination; certainly, it is difficult to find such a measurement system that is flexible and affordable enough to be adopted by the smaller research institutes or universities. We present here an instrument aiming to fill this gap, autonomously tracking and maintaining any solar panel at maximum power point while continuously monitoring its operational parameters and dissipating the produced energy without connection to the power grid. The instrument allows periodic acquisition of current-voltage curves to verify the employed maximum power point tracking approach. At the same time, with hardware schematics and software code being provided, it provides a flexible open development environment for the monitoring of non-standard generators like concentrator photovoltaic systems and to test novel power tracking approaches. The key issues, and the corresponding solutions, encountered in the design are analyzed in detail and the relevant schematics presented.
Stefancich, Marco [Consiglio Nazionale delle Ricerce, Istituto dei Materiali per l’Elettronica ed il Magnetismo (CNR-IMEM), Parco Area delle Scienze 37/A, 43124 Parma, Italy; Simpson, Lin [National Renewable Energy Laboratory, 15013 Denver West Parkway, Golden, Colorado 80401, USA; Chiesa, Matteo [Masdar Institute of Science and Technology, P.O. Box 54224, Masdar City, Abu Dhabi, United Arab Emirates
Long-term acquisition of solar panel performance parameters, for panels operated at maximum power point in their real environment, is of critical importance in the photovoltaic research sector. However, few options exist for the characterization of non-standard panels such as concentrated photovoltaic systems, heavily soiled or shaded panels or those operating under non-standard spectral illumination; certainly, it is difficult to find such a measurement system that is flexible and affordable enough to be adopted by the smaller research institutes or universities. We present here an instrument aiming to fill this gap, autonomously tracking and maintaining any solar panel at maximum power point while continuously monitoring its operational parameters and dissipating the produced energy without connection to the power grid. The instrument allows periodic acquisition of current-voltage curves to verify the employed maximum power point tracking approach. At the same time, with hardware schematics and software code being provided, it provides a flexible open development environment for the monitoring of non-standard generators like concentrator photovoltaic systems and to test novel power tracking approaches. The key issues, and the corresponding solutions, encountered in the design are analyzed in detail and the relevant schematics presented.
Holen-Rabbersvik, Elisabeth; Eikebrokk, Tom Roar; Fensli, Rune Werner; Thygesen, Elin; Slettebø, Åshild
Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. This study identified several important challenges for coordination and it supports previous
Louis, Edouard; Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan
The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. © European Crohn’s and Colitis Organisation 2015.
... Voice in Health Care Decisions Blood Test: Comprehensive Metabolic Panel (CMP) KidsHealth > For Parents > Blood Test: Comprehensive Metabolic Panel ( ... or kidneys) is working. What Is a Comprehensive Metabolic Panel (CMP)? The comprehensive metabolic panel (CMP) is a ...
Ciappio, Eric D; Lesser, Mary N R
In today's world in which there is a surplus of both scientists and online nutrition "experts," how do young professionals establish themselves? Becoming established as an expert requires selling yourself and your ideas to your colleagues and the general public by using effective communication skills. Helping young professionals develop these skills was the goal of a panel held at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2015. This panel featured a set of distinguished speakers who discussed techniques and strategies to enhance professional reputations centered around effectively leveraging communication platforms and opportunities to engage with colleagues. Early-career nutrition scientists can use the guidance provided by the panelists to improve their visibility and be a champion for themselves in order to establish themselves as experts in the field. © 2016 American Society for Nutrition.
Hassan, Norlida; Arbaiy, Nureize; Shah, Noor Aziyan Ahmad; Afizah Afif@Afip, Zehan
Heart attack is one of the serious illnesses and reported as the main killer disease. Early prevention is significant to reduce the risk of having the disease. The prevention efforts can be strengthen through awareness and education about risk factor and healthy lifestyle. Therefore the knowledge dissemination is needed to play role in order to distribute and educate public in health care management and disease prevention. Since the knowledge dissemination in medical is important, there is a need to develop a knowledge based system that can emulate human intelligence to assist decision making process. Thereby, this study utilized hybrid artificial intelligence (AI) techniques to develop a Fuzzy Expert System for Diagnosing Heart Attack Disease (HAD). This system integrates fuzzy logic with expert system, which helps the medical practitioner and people to predict the risk and as well as diagnosing heart attack based on given symptom. The development of HAD is expected not only providing expert knowledge but potentially become one of learning resources to help citizens to develop awareness about heart-healthy lifestyle.
Taylor, Stephanie L; Dy, Sydney; Foy, Robbie; Hempel, Susanne; McDonald, Kathryn M; Ovretveit, John; Pronovost, Peter J; Rubenstein, Lisa V; Wachter, Robert M; Shekelle, Paul G
Differences in contexts (eg, policies, healthcare organisation characteristics) may explain variations in the effects of patient safety practice (PSP) implementations. However, knowledge of which contextual features are important determinants of PSP effectiveness is limited and consensus is lacking on a taxonomy of which contexts matter. Iterative, formal discussions were held with a 22-member technical expert panel composed of experts or leaders in patient safety, healthcare systems, and methods. First, potentially important contextual features were identified, focusing on five PSPs. Then, two surveys were conducted to determine the context likely to influence PSP implementations. The panel reached a consensus on a taxonomy of four broad domains of contextual features important for PSP implementations: safety culture, teamwork and leadership involvement; structural organisational characteristics (eg, size, organisational complexity or financial status); external factors (eg, financial or performance incentives or PSP regulations); and availability of implementation and management tools (eg, training organisational incentives). Panelists also tended to rate specific patient safety culture, teamwork and leadership contexts as high priority for assessing their effects on PSP implementations, but tended to rate specific organisational characteristic contexts as high priority only for use in PSP evaluations. Panelists appeared split on whether specific external factors and implementation/management tools were important for assessment or only description. This work can guide research commissioners and evaluators on the contextual features of PSP implementations that are important to report or evaluate. It represents a first step towards developing guidelines on contexts in PSP implementation evaluations. However, the science of context measurement needs maturing.
Gaweł, M.; Tataj, E.; Dunin-Wąsowicz, D.
Expert Systems are found to be very promising as an important advisory tool. They can be useful in different situations where human expert is not available and decision should be undertaken quickly. Expert systems can also be useful in medicine to help doctors or even non-trained personnel (when the doctor is not available). These systems are important in clinical practice and could help in rapid finding of etiology and treatment. To fulfill such requirement in this contribution, we discuss an implementation of expert system, which is written in Prolog language. Since this language has its syntactical limitations, we have developed a general architecture of a shell type, to overcome these difficulties. Next, we have demonstrated its practical utility, by applying the knowledge taken from medical practice.
Avery, Peter; Barzilai, Nir; Benetos, Athanase; Bilianou, Helen; Capri, Miriam; Caruso, Calogero; Franceschi, Claudio; Katsiki, Niki; Mikhailidis, Dimitri P; Panotopoulos, George; Sikora, Ewa; Tzanetakou, Irene P; Kolovou, Genovefa
In May 2012, a group of scientists and clinicians met in Athens (Greece) to consider the relevance of ageing, longevity, exceptional longevity and related genetic and non genetic markers. During this meeting, we firstly reviewed recent epidemiological and clinical studies on ageing, longevity and exceptional longevity, briefly analyzed the ageing theories and discussed successful and unsuccessful ageing also taking into account the evolutionary perspective. Secondly, we considered the three phenotypes based on the definition of ageing, longevity and exceptional longevity and the associated biomarkers. Third, we discussed proposed treatments suitable to counteract or slow down ageing. Finally, this panel produced a consensus statement to highlight the importance of ageing, longevity and exceptional longevity, since this is a rapidly increasing phenotype worldwide. We acknowledge that not all experts in this field may completely agree with this statement.
Viborg Andersen, Kim; Debenham, John; Wagner, Roland
submissions. The papers are organized in topical sections on workflow automation, database queries, data classification and recommendation systems, information retrieval in multimedia databases, Web applications, implementational aspects of databases, multimedia databases, XML processing, security, XML......, reasoning and learning, network management and mobile systems, expert systems and decision support, and information modelling....
TNO Physics and Electronics laboratory, in collaboration with the University of Limburg and the Research Institute for Knowledge Systems, worked on a technology project named 'QUEST: Quality of Expert Systems' [FEL90]. QUEST was carried out under commision of the Dutch Ministry of Defence. A strong
Discusses the nature of expert systems, including various techniques they use to represent knowledge (such as production rules, semantic networks, frames, first-order logic, and others), system interactions, and such problem domains as science, medicine, computer configuration, trouble-shooting/repair, and oil/mineral exploration. Also discusses…
This paper model an expert system called LAPTEX for troubleshooting LaserJet printers' faults. Today, with the innumerable advances in information technologies, computerizing printer's fault troubleshooting and identifying faults is far becoming so vital. Also, printers' fault detection is a complicated process that requires a ...
Wu, Abraham J., E-mail: firstname.lastname@example.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bosch, Walter R. [Washington University, St. Louis, Missouri (United States); Chang, Daniel T. [Stanford Cancer Institute, Stanford, California (United States); Hong, Theodore S. [Massachusetts General Hospital, Boston, Massachusetts (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Kleinberg, Lawrence R. [Johns Hopkins Medical Center, Baltimore, Maryland (United States); Mamon, Harvey J. [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Thomas, Charles R. [Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon (United States); Goodman, Karyn A. [Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future.
Timpson, William M.; Jones, Christine
Mentorship programs are described which involve gifted students and subject experts with no prior knowledge about students' personalities or preconceptions about their abilities, known as "naive experts." The students are challenged by the experts' high expectations and respond to the experts' enthusiasm for sharing their knowledge and…
Cashion, Steven A; Bowser, Michael R; Farrelly, Mark B; Hines, Braden E; Holmes, Howard C; Johnson, Jr., Richard L; Russell, Richard J; Turk, Michael F
The present invention relates to photovoltaic power systems, photovoltaic concentrator modules, and related methods. In particular, the present invention features concentrator modules having interior points of attachment for an articulating mechanism and/or an articulating mechanism that has a unique arrangement of chassis members so as to isolate bending, etc. from being transferred among the chassis members. The present invention also features adjustable solar panel mounting features and/or mounting features with two or more degrees of freedom. The present invention also features a mechanical fastener for secondary optics in a concentrator module.
Brown, Malcolm P.; Mittan, Margaret Birmingham; Miros, Robert H. J.; Stancel, Robert
A photovoltaic panel clamp includes an upper and lower section. The interface between the assembled clamp halves and the module edge is filled by a flexible gasket material, such as EPDM rubber. The gasket preferably has small, finger like protrusions that allow for easy insertion onto the module edge while being reversed makes it more difficult to remove them from the module once installed. The clamp includes mounting posts or an integral axle to engage a bracket. The clamp also may include a locking tongue to secure the clamp to a bracket.
Health care has traditionally been delivered primarily by experts working individually in a decentralized system lacking cohesive organization among professional disciplines. Only recently have the advantages of teamwork training been acknowledged in health care. This article explores the history, benefits, and recommendations for team training in neonatal care. TeamSTEPPS (Rockville, MD) and the revised Neonatal Resuscitation Program are cited as promising models for improved neonatal outcomes through professional teamwork.
Beasley, Christopher; Torres-Harding, Susan; Pedersen, Paula J
Recent societal trends indicate more tolerance for homosexuality, but prejudice remains on college campuses. Speaker panels are commonly used in classrooms as a way to educate students about sexual diversity and decrease negative attitudes toward sexual diversity. The advent of computer delivered instruction presents a unique opportunity to broaden the impact of traditional speaker panels. The current investigation examined the influence of an interactive "virtual" gay and lesbian speaker panel on cognitive, affective, and behavioral homonegativity. Findings suggest the computer-administered panel is lowers homonegativity, particularly for affective experiential homonegativity. The implications of these findings for research and practice are discussed.
Brown, Rachel M; Zatorre, Robert J; Penhune, Virginia B
In this chapter, we explore what happens in the brain of an expert musician during performance. Understanding expert music performance is interesting to cognitive neuroscientists not only because it tests the limits of human memory and movement, but also because studying expert musicianship can help us understand skilled human behavior in general. In this chapter, we outline important facets of our current understanding of the cognitive and neural basis for music performance, and developmental factors that may underlie musical ability. We address three main questions. (1) What is expert performance? (2) How do musicians achieve expert-level performance? (3) How does expert performance come about? We address the first question by describing musicians' ability to remember, plan, execute, and monitor their performances in order to perform music accurately and expressively. We address the second question by reviewing evidence for possible cognitive and neural mechanisms that may underlie or contribute to expert music performance, including the integration of sound and movement, feedforward and feedback motor control processes, expectancy, and imagery. We further discuss how neural circuits in auditory, motor, parietal, subcortical, and frontal cortex all contribute to different facets of musical expertise. Finally, we address the third question by reviewing evidence for the heritability of musical expertise and for how expertise develops through training and practice. We end by discussing outlooks for future work. © 2015 Elsevier B.V. All rights reserved.
Mutschler, Jr., Edward Charles (Inventor)
A spacecraft includes a plurality of solar panels interconnected with a power coupler and an electrically operated device to provide power to the device when the solar cells are insolated. The solar panels are subject to bending distortion when entering or leaving eclipse. Spacecraft attitude disturbances are reduced by mounting each of the solar panels to an elongated boom made from a material with a low coefficient of thermal expansion, so that the bending of one panel is not communicated to the next. The boom may be insulated to reduce its bending during changes in insolation. A particularly advantageous embodiment mounts each panel to the boom with a single mounting, which may be a hinge. The single mounting prevents transfer of bending moments from the panel to the boom.
Español Lifante, Albert
Crystalline silicon Modules are formed by single silicon photovoltaic cells. Since each one of these cells individually contributes to the overall electric power of the panel, the failure of one of them directly affects to its benefits and performance. To Minimize these negative effects, junction boxes with few bypass diodes are usually included in Photovoltaic Solar panels. A still experimental way to built solar panels is to integrate bypass diodes in every single cell, which would in...
Salter, B. [University Utah (United States)
In this interactive session, lung SBRT patient cases will be presented to highlight real-world considerations for ensuring safe and accurate treatment delivery. An expert panel of speakers will discuss challenges specific to lung SBRT including patient selection, patient immobilization techniques, 4D CT simulation and respiratory motion management, target delineation for treatment planning, online treatment alignment, and established prescription regimens and OAR dose limits. Practical examples of cases, including the patient flow thought the clinical process are presented and audience participation will be encouraged. This panel session is designed to provide case demonstration and review for lung SBRT in terms of (1) clinical appropriateness in patient selection, (2) strategies for simulation, including 4D and respiratory motion management, and (3) applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent, and (4) image guidance in treatment delivery. Learning Objectives: Understand the established requirements for patient selection in lung SBRT Become familiar with the various immobilization strategies for lung SBRT, including technology for respiratory motion management Understand the benefits and pitfalls of applying multi imaging modality (4D CT imaging, MRI, PET) for tumor volume delineation and motion extent determination for lung SBRT Understand established prescription regimes and OAR dose limits.
Full Text Available Panel Absorpsi Difusor Bunu adalah panel akustik yang berfungsi sebagai penyerap sekaligus pemencar bunyi yang terbuat dari sabut kelapa (bunu. Panel ini digunakan untuk mendapatkan Waktu Dengung (ReveberationTime sesuai standar kenyamanan pendengaran didalam ruang teater rumah (home theater, ruang karaoke, studio penyiaran radio, studio rekaman, ruang kelas/siding ,ruangi badah, auditorium. Bunu sebagai bahan yang melimpah di seluruh pelosok Nusantara yang dikenal dengan sebutan kepulauan Nyiur Melambai perlu dimaksimalkan pemanfaatannya. Didaerah umumnya bunu hanya dijadikan sebagai bahan bakar memasak, malah menjadi limbah dari hasil pengolahan kopra. Panel dikerjakan di AKAS desa Rantewringin kabupaten Kebumen provinsi Jawa Tengah dengan cara manua lkecual idalam menguraikan sabut kelapa menjadi serat (coirfibre dan serbuk (cocopeat. Bahan pembuat panel adalah seratnya yang disusun berlapis. Panel dibuat dalam 2 (dua jenis terdiri dari yang datar yang disebut panel indrabunu 01 dan piramida disebut indrabunu 02, untuk mendapatkan nilai koefisien serap αyang berbeda. Pengujian nilai α dari panel dilakukan di Laboratorium Akustik Pusat Penelitian Metrologi LIPI Serpong. Kata Kunci : bunu,panel,absorpsi,difusor
Hall, D.L. (ed.)
Pacific Northwest Laboratory (PNL) is examining the analysis of large data sets (ALDS). After one year's work, a panel was convened to evaluate the project. This document is the permanent record of that panel review. It consists of edited transcripts of presentations made to the panel by the PNL staff, a summary of the responses of the panel to these presentations, and PNL's plans for the development of the ALDS project. The representations of the PNL staff described various aspects of the project and/or the philosophy surrounding the project. Supporting materials appear in appendixes. 20 figures, 4 tables. (RWR)
Lallave, Juan Antonio; Gutheil, Thomas Gordon
Jung's theories of archetype, shadow, and the personal and collective unconscious provide a postmodern framework in which to consider the role of the expert witness in judicial proceedings. Archetypal themes, motifs, and influences help to illuminate the shadow of the judicial system and projections and behaviors among the cast of the court in pursuing justice. This article speaks to archetypal influences and dialectical tensions encountered by the expert witness in this judicial drama. The archetype of Justice is born from the human need for order and relational fairness in a world of chaos. The persona of justice is the promise of truth in the drama. The shadow of justice is untruth, the need to win by any means. The dynamics of the trickster archetype serve and promote injustice. These influences are examined by means of a case example. This approach will deepen understanding of court proceedings and the role of the expert witness in the heroic quest for justice. Copyright © 2012 Elsevier Ltd. All rights reserved.
Gupta, Shri N.; Arshak, Khalil I.; McDonnell, Pearse; Boyce, Conor; Duggan, Andrew
With the developments in the techniques of artificial intelligence over the last few years, development of advisory, scheduling and similar class of problems has become very convenient using tools such as PROLOG. In this paper an expert system has been described which helps lithographers and process engineers in several ways. The methodology used is to model each work station according to its input, output and control parameters, combine these work stations in a logical sequence based on past experience and work out process schedule for a job. In addition, all the requirements vis-a-vis a particular job parameters are converted into decision rules. One example is the exposure time, develop time for a wafer with different feature sizes would be different. This expert system has been written in Turbo Prolog. By building up a large number of rules, one can tune the program to any facility and use it for as diverse applications as advisory help, trouble shooting etc. Leitner (1) has described an advisory expert system that is being used at National Semiconductor. This system is quite different from the one being reported in the present paper. The approach is quite different for one. There is stress on job flow and process for another.
... COMMISSION Certain Flat Panel Digital Televisions and Components Thereof; Notice of Investigation AGENCY: U.S... importation of certain flat panel digital televisions and components thereof by reason of infringement of... certain flat panel digital televisions and components thereof that infringe one or more of claims 22-25 of...
Seabrooke, Leonard; Tsingou, Eleni
to understand the different stresses in reports with and without clear mandates, and the role of important members of the policy community in promoting particular reform ideas. The contribution finds that differences in ideas emerging from the financial reform expert groups reflect nested power relationships......Who determines what ideas matter in reform debates? This contribution examines reform proposals from the expert groups that emerged during the recent international financial crisis. To do so it follows fractal distinctions – distinctions that replicate themselves in subsequent iterations – among...... the reports. Fractal distinctions, such as between ‘behaviour’ or ‘system’ as a reform focus, allow us to locate the object of regulation within expert groups, the experts' professional context and the politics behind the commissioning of work. Analysing fractal distinctions provides a useful way...
Sasaki, Keisuke; Motoyama, Michiyo; Narita, Takumi; Hagi, Tatsuro; Ojima, Koichi; Oe, Mika; Nakajima, Ikuyo; Kitsunai, Katsuhiro; Saito, Yosuke; Hatori, Hikari; Muroya, Susumu; Nomura, Masaru; Miyaguchi, Yuji; Chikuni, Koichi
Meat tenderness is an important characteristic in terms of consumer preference and satisfaction. However, each consumer may have his/her own criteria to judge meat tenderness, because consumers are neither selected nor trained like an expert sensory panel. This study aimed to characterize consumer tenderness using descriptive texture profiles such as chewiness and hardness assessed by a trained panel. Longissimus muscles cooked at four different end-point temperatures were subjected to a trained sensory panel (n=18) and consumer (n=107) tenderness tests. Multiple regression analysis showed that consumer tenderness was characterized as 'low-chewiness and low hardness texture.' Subsequently, consumers were divided into two groups by cluster analysis according to tenderness perceptions in each participant, and the two groups were characterized as 'tenderness is mainly low-chewiness' and 'tenderness is mainly low-hardness' for tenderness perception, respectively. These results demonstrate objective characteristics and variability of consumer meat tenderness, and provide new information regarding the evaluation and management of meat tenderness for meat manufacturers. © 2013.
Robinson, Rodney A
.... Projects that have provided important reference information have also been beneficial. This Task has also assessed the opinion of the shipyard using community on the administration and management of Panel SP-7 itself...
Leibach, Elizabeth Kenimer
Grounded theory and methods related to expert practice development in medical laboratory science were described using data from a large national survey of medical laboratory scientists (MLS) overlaid on findings from analysis of expert practice domains reported in nursing literature. An extensive focus group/expert review iterative process followed by a survey of MLS practitioners produced 25 critical thinking (CT) behaviors important in expert practice. Factor analysis was applied to discern common threads or themes linking the CT behaviors. The 25 important CT behaviors were reduced to a 7-factor structure representing constructs underlying the individual, observable CT behaviors. This 7-factor structure in MLS was compared to the 7 practice domains identified in expert nursing practice. The comparison yielded commonality between MLS and nursing in CT behaviors observed in the 7 expert practice domains of both professions: professional techniques, caring communication, growing professionally, setting priorities, practicing with judgment, anticipating/revising, and creating unique meaning. Emergent grounded theory is that (1) critical thinking is a metaprocess that facilitates learning by interlinking the more basic processes associated with different learning orientations: cognitivist, behaviorist, humanist (affective), and situated/contextual learning, (2) CT behaviors are observable events following from the CT metaprocess, and (3) observations of CT behaviors increase as practice advances from novice to expert. Identification and definition of CT behaviors, i.e., practice competencies, along the continuum of novice to expert can serve as the foundation for MLS curriculum and instructional design as well as measurement and evaluation in both formal and continuing education settings.
Antoine, Edwige; Grabar, Natalia
Technical medical terms are complicated to be correctly understood by non-experts. Vocabulary, associating technical terms with layman expressions, can help in increasing the readability of technical texts and their understanding. The purpose of our work is to build this kind of vocabulary. We propose to exploit the notion of reformulation following two methods: extraction of abbreviations and of reformulations with specific markers. The segments associated thanks to these methods are aligned with medical terminologies. Our results allow to cover over 9,000 medical terms and show precision of extractions between 0.24 and 0.98. The results and analyzed and compared with the existing work.
Full Text Available User interfaces in digital libraries are responsible for interaction among users and information environment and creation the feedback. Therefore, the aim of this study was offering a model to find of importance the characteristics of Iranian digital libraries user interface based of Delphi method. In relation, after study of the related literature and providing the researcher constructed checklist regarding the Delphi panel, ten key criteria (search, consistency, guidance, navigation, design, error correction, presentation, user control, interface language, and simplicity included 114 features and sub-components were selected to find of importance of them in the design of Iranian digital libraries user interfaces. Then, based on obtained scores from the Delphi panel, importance of each sub-feature determined in the design of Iranian digital libraries user interfaces. Finally, the criteria of the interface language and error correction in sequence gained the highest and lowest score. Although the difference among of criteria's and sub-components were low and according to the Delphi panel using them in the design of Iranian digital libraries user interface offered. It was hope that the results of this study could present needed features and their importance in designing in digital libraries user interface. On the other hand, it could be used as a tool for the determination of capabilities of Iran digital libraries user interfaces from experts and their user's opinion.
Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science).
Kumanyika, Shiriki K; Obarzanek, Eva; Stettler, Nicolas; Bell, Ronny; Field, Alison E; Fortmann, Stephen P; Franklin, Barry A; Gillman, Matthew W; Lewis, Cora E; Poston, Walker Carlos; Stevens, June; Hong, Yuling
Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. To prevent the development of overweight and obesity throughout the life course, population-based strategies that improve social and physical environmental contexts for healthful eating and physical activity are essential. Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. This American Heart Association scientific statement aims: 1) to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2) to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3) to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4) to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5) to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches. The evidence-based experience for population-wide approaches to obesity prevention is highlighted.
Decroix, Marjolein; Wazir, Mohd Rozilee Wazir Norjali; Zeuwts, Linus; Deconinck, Frederik; Lenoir, Matthieu; Vansteenkiste, Pieter
The aim of this study was to investigate visual behaviour of expert and non-expert ski athletes during an alpine slalom. Fourteen non-experts and five expert slalom skiers completed an alpine slalom course in an indoor ski slope while wearing a head-mounted eye tracking device. Experts completed the slalom clearly faster than non-experts, but no significant difference was found in timing and position of the turn initiation. Although both groups already looked at future obstacles approximately...
Runge, Michael C.; Converse, Sarah J.; Lyons, James E.
Natural resource management is plagued with uncertainty of many kinds, but not all uncertainties are equally important to resolve. The promise of adaptive management is that learning in the short-term will improve management in the long-term; that promise is best kept if the focus of learning is on those uncertainties that most impede achievement of management objectives. In this context, an existing tool of decision analysis, the expected value of perfect information (EVPI), is particularly valuable in identifying the most important uncertainties. Expert elicitation can be used to develop preliminary predictions of management response under a series of hypotheses, as well as prior weights for those hypotheses, and the EVPI can be used to determine how much management could improve if uncertainty was resolved. These methods were applied to management of whooping cranes (Grus americana), an endangered migratory bird that is being reintroduced in several places in North America. The Eastern Migratory Population of whooping cranes had exhibited almost no successful reproduction through 2009. Several dozen hypotheses can be advanced to explain this failure, and many of them lead to very different management responses. An expert panel articulated the hypotheses, provided prior weights for them, developed potential management strategies, and made predictions about the response of the population to each strategy under each hypothesis. Multi-criteria decision analysis identified a preferred strategy in the face of uncertainty, and analysis of the expected value of information identified how informative each strategy could be. These results provide the foundation for design of an adaptive management program.
Sales, J. H. O.; Suzuki, A. T.
We present a plane and parabolic collector that absorbs radiant energy and transforms it in heat. Therefore we have a panel to heat water. We study how to increment this capture of solar beams onto the panel in order to increase its efficiency in heating water.
González, Andrés; Terasvirta, Timo; Dijk, Dick van
We introduce the panel smooth transition regression model. This new model is intended for characterizing heterogeneous panels, allowing the regression coefficients to vary both across individuals and over time. Specifically, heterogeneity is allowed for by assuming that these coefficients are bou...
Cavieres, Andres; Al-Haddad, Tristan; Goodman, Joseph; Valdes, Francisco
An exemplary mounting clip for removably attaching panels to a supporting structure comprises a base, spring locking clips, a lateral flange, a lever flange, and a spring bonding pad. The spring locking clips extend upwardly from the base. The lateral flange extends upwardly from a first side of the base. The lateral flange comprises a slot having an opening configured to receive at least a portion of one of the one or more panels. The lever flange extends outwardly from the lateral flange. The spring bonding flange extends downwardly from the lever flange. At least a portion of the first spring bonding flange comprises a serrated edge for gouging at least a portion of the one or more panels when the one or more panels are attached to the mounting clip to electrically and mechanically couple the one or more panels to the mounting clip.
Reiman, M P; Thorborg, K; Covington, K
PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally...... defined from international publications and presentations was utilized. RESULTS: All six domains (subjective examination, patient-reported outcome measures, physical examination, special tests, physical performance measures, and diagnostic imaging) had at least one descriptor with 75% consensus agreement...
Gernaey, Krist; Baganz, Frank; Franco-Lara, Ezequiel
This perspective article is based on an expert panel review on microbioreactor applications in biochemical and biomedical engineering that was organized by the M3C (measurement, monitoring, modelling and control) Working Group of the European Section of Biochemical Engineering Science (ESBES......) in the European Federation of Biotechnology (EFB). The aim of the panel was to provide an updated view on the present status of the subject and to identify critical needs and issues for furthering the successful development of microbioreactor monitoring and control. This will benefit future bioprocess development...... and in vitro toxicity testing. The article concludes with a set of recommendations for extended use and further development of microbioreactors....
Expert SQL Server 2008 Development is aimed at SQL Server developers ready to move beyond Books Online. Author and experienced developer Alastair Aitchison shows you how to think about SQL Server development as if it were any other type of development. You'll learn to manage testing in SQL Server and to properly deal with errors and exceptions. The book also covers critical, database-centric topics such as managing concurrency and securing your data and code through proper privileges and authorization. Alastair places focus on sound development and architectural practices that will help you be
Full Text Available The use of Serious Games (SG in the health domain is expanding. In the field of neurodegenerative disorders (ND such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014. The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI. SG are more adapted for use with trained caregivers (both at home and in clinical settings, with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game, and should be personalized with the help of a clinician.
Hachenberg, T; Neu, J; Werner, S; Wiedemann, D; Schaffartzik, W
Expert opinions have an important place for expert testimony in medical disputes. The report should contain a summary about facts and causality between the damage and the medical treatment in question as well as describe the current medical standard. The fulfillment of scientific criteria was investigated in 179 anesthesiological expert opinions from 150 arbitration cases. Anesthesiological expert reports (2005-2007) of the Arbitration Board of the North German Medical Associations were analyzed in terms of structure, general form of assessment and scientific substantiation of statements. Patient damage was confirmed in 76%, treatment failure in 29% and negligent malpractice in 17% of the reports. In 78% of the reports the facts were presented correctly and in 64% the question was answered whether the incident would have occurred even during adequate and professional action. Conclusive statements about the causality between the damage and the medical treatment in question were available only in 60% of the reports. The study findings suggest that anesthesia expert reports present a high incidence of non-scientific claims. The development of guidelines for expert witnesses by the medical societies is urgently recommended.
Full Text Available Expert systems are built with the help of: specialised programming languages or expert system generators (shell. But this structure was reached after tens of years of work and research, because expert systems are nothing but pragmatic capitalisation of the results of research carried out in artificial intelligence and theory of knowledge.
Karake, Zeinab A.
Discusses the use of artificial intelligence and expert system shells to enhance the learning process of graduate or undergraduate statistics students. A student exercise is described using STAT-EXPERT, an expert system designed to help students select the appropriate statistical analysis technique. (25 references) (LRW)
Canal-Bruland, Rouwen; Mooren, Merel; Savelsbergh, Geert J. P.
In this study, we examined how perceptual-motor expertise and watching experience contribute to anticipating the outcome of opponents' attacking actions in beach volleyball. To this end, we invited 8 expert beach volleyball players, 8 expert coaches, 8 expert referees, and 8 control participants with no beach volleyball experience to watch videos…
Robert E. Martin
Predicting the effects of fires in the year 2000 and beyond will be enhanced by the use of expert systems. Although our predictions may have broad confidence limits, expert systems should help us to improve the predictions and to focus on the areas where improved knowledge is most needed. The knowledge of experts can be incorporated into previously existing knowledge...
R. Legerstee (Rianne)
textabstractThis thesis is about forecasting situations which involve econometric models and expert intuition. The first three chapters are about what it is that experts do when they adjust statistical model forecasts and what might improve that adjustment behavior. It is investigated how expert
Hofmann, Katja; Balog, Krisztian; Bogers, Toine
-seeking models, are rarely taken into account. In this article, we extend content-based expert-finding approaches with contextual factors that have been found to influence human expert finding. We focus on a task of science communicators in a knowledge-intensive environment, the task of finding similar experts...
Stock, Todd; Stachowitz, Rolf; Chang, Chin-Liang; Combs, Jacqueline
An overview of the Expert System Validation Assistant (EVA) is being implemented in Prolog at the Lockheed AI Center. Prolog was chosen to facilitate rapid prototyping of the structure and logic checkers and since February 1987, we have implemented code to check for irrelevance, subsumption, duplication, deadends, unreachability, and cycles. The architecture chosen is extremely flexible and expansible, yet concise and complementary with the normal interactive style of Prolog. The foundation of the system is in the connection graph representation. Rules and facts are modeled as nodes in the graph and arcs indicate common patterns between rules. The basic activity of the validation system is then a traversal of the connection graph, searching for various patterns the system recognizes as erroneous. To aid in specifying these patterns, a metalanguage is developed, providing the user with the basic facilities required to reason about the expert system. Using the metalanguage, the user can, for example, give the Prolog inference engine the goal of finding inconsistent conclusions among the rules, and Prolog will search the graph intantiations which can match the definition of inconsistency. Examples of code for some of the checkers are provided and the algorithms explained. Technical highlights include automatic construction of a connection graph, demonstration of the use of metalanguage, the A* algorithm modified to detect all unique cycles, general-purpose stacks in Prolog, and a general-purpose database browser with pattern completion.
Full Text Available The concept of “expert patient” has been developed in the last two decades to define a patient who has a significant knowledge of his/her disease and treatment in addition to self-management skills. However, this concept has evolved over the last years, and these patients are now considered, not only to be more efficient in the management of their own condition and communicating effectively with health professionals, but to also act as educators for other patients and as resources for the last, provide feedback on care delivery, and be involved in the production and implementation of practice guidelines, as well as in the development and conduct of research initiatives. There are some barriers, however, to the integration of this new contributor to the health care team, and specific requirements need to be considered for an individual to be considered as an expert. This new player has, however, a potentially important role to improve current care, particularly in respiratory health.
... 7 Agriculture 13 2010-01-01 2009-01-01 true Rural Economic Development Review Panel Grant (Panel... of Certain Rural Development Programs § 1940.968 Rural Economic Development Review Panel Grant (Panel... associated with a State rural economic development review panel. (b) Objective. The objective of the Panel...
Suen, Ching Y
This book is part of a new series on operational expert systems worldwide. Expert systems are now widely used in different parts of the world for various applications. The past four years have witnessed a steady growth in the development and deployment of expert systems in Canada. Research in this field has also gained considerable momentum during the past few years. However, the field of expert systems is still young in Canada. This book contains 13 chapters contributed by 31 experts from both universities and industries across Canada covering a wide range of applications related to electric
Bauer, J. L. JR.
Lightweight panel cost-effective. Integrally-molded intrusion strap key feature of composite outer door panel. Strap replaces bulky and heavy steel instrusion beam of conventional door. Standard steel inner panel used for demonstration purposes. Door redesigned to exploit advantages of composite outer panel thinner. Outer panel for automobilie door, made of glass/epoxy composite material, lighter than conventional steel door panel, meets same strength requirements, and less expensive.
... COMMISSION In the Matter of Certain Flat Panel Digital Televisions and Components Thereof; Notice of... United States after importation of certain flat panel digital televisions and components thereof by... after importation of certain flat panel digital televisions and components thereof that infringe one or...
Full Text Available Operator's role in industrial control centers takes place in time, which is one of the most important determinants of whether an expected action is going to be successful or not. In certain situations, due to the complex nature of the work, the existing interfaces and already prepared procedures do not meet the dynamic requirements of operator's cognitive demands, making the control tasks unnecessarily difficult. This study was conducted to identify ergonomic issues with a specific industrial control panel, and redesign its layout and elements to enhance its usability. Task and link analysis methodologies were implemented. All essential functions and supporting operations were identified at the required trivial levels. Next, the weight of any possible link between the elements of the panel was computed as a composite index of frequency and importance. Finally, all components were rearranged within a new layout, and a computerized mockup was generated. A total of 8 primary tasks was identified, including 4 system failure handling tasks, switching between manual and automated modes, and 3 types of routine vigilance and control tasks. These tasks were broken down into 28 functions and 145 supporting operations, accordingly. Higher link values were observed between hand rest position and 2 elements. Also, 6 other components showed robust linkages. In conclusion, computer modeling can reduce the likelihood of accidents and near misses in industrial control rooms by considering the operators' misperception or mental burden and correcting poor design of the panels and inappropriate task allocation.
Neary, J. K.
Hydraulic jacks simultaneously apply torsion, axial compression, and lateral compression to structural panels. Jacks are suitable for testing large panels used in aircraft, lightweight trucks, and buses.
Allen, Lawrence E.; Silva, Matthew K.; Channell, James K.; Abel, John F.; Morgan, Dudley R.
A key component in the design of the WIPP repository is the installation of concrete structures as panel seals in the intake and exhaust drifts after a panel has been filled with waste containers. As noted in the EPA final rule, the panel seal closure system is intended to block brine flow between the waste panels at the WIPP. On April 17, 2001, the DOE proposed seven modifications to the EPA concerning the design of the panel closure system. EPA approval of these modifications is necessary since the details of the panel design are specified in EPA’s final rule as a condition for WIPP certification. However, the EPA has not determined whether a rulemaking would be required for these proposed design modifications. On September 4, 2001, the DOE withdrew the request, noting that it would be resubmitted on a future date. The Environmental Evaluation Group (EEG) contracted with two engineers, Dr. John Abel and Dr. Rusty Morgan, to evaluate the proposed modifications. The EEG has accepted the conclusions and recommendations from these two experts: 1) replacement of Salado Mass Concrete with a generic salt-based concrete; 2) replacement of the explosion wall with a construction wall; 3) replacement of freshwater grouting with salt-based grouting; 4) option to allow surface or underground mixing; and 5) option to allow up to one year for completion of closure. The proposed modification to allow local carbonate river rock as aggregate is acceptable pending demonstration that no problems will exist in the resulting concrete. The proposed modification to give the contractor discretion in removal of steel forms is not supported. Instead, several recommendations are made to specifically reduce the number of forms left, thereby reducing potential migration pathways.
This paper examines the role of the expert witness in the process of justice administration. As the saying goes, not all 'experts' make good 'expert witness' as there is more to being an 'expert witness' than there is to being an 'expert'. That is, being an 'expert witness' does not necessarily connote that the witness is an expert ...
Hu, Aixue; Levis, Samuel; Meehl, Gerald A.; Han, Weiqing; Washington, Warren M.; Oleson, Keith W.; van Ruijven, Bas J.; He, Mingqiong; Strand, Warren G.
Regardless of the harmful effects of burning fossil fuels on global climate, other energy sources will become more important in the future because fossil fuels could run out by the early twenty-second century given the present rate of consumption. This implies that sooner or later humanity will rely heavily on renewable energy sources. Here we model the effects of an idealized large-scale application of renewable energy on global and regional climate relative to a background climate of the representative concentration pathway 2.6 scenario (RCP2.6; ref. ). We find that solar panels alone induce regional cooling by converting incoming solar energy to electricity in comparison to the climate without solar panels. The conversion of this electricity to heat, primarily in urban areas, increases regional and global temperatures which compensate the cooling effect. However, there are consequences involved with these processes that modulate the global atmospheric circulation, resulting in changes in regional precipitation.
Pedersen, Mogens Jin; Nielsen, Christian Videbæk
experiment among 6,162 members of an online survey panel, this article shows how low-cost incentives and cost-free text appeal interventions may impact the survey response rate in online panels. The experimental treatments comprise (a) a cash prize lottery incentive, (b) two donation incentives equating......Identifying ways to efficiently maximize the response rate to surveys is important to survey-based research. However, evidence on the response rate effect of donation incentives and especially altruistic and egotistic-type text appeal interventions is sparse and ambiguous. By a randomized survey...... survey response with a monetary donation to a good cause, (c) an egotistic-type text appeal, and (d) an altruistic-type text appeal. Relative to a control group, we find higher response rates among the recipients of the egotistic-type text appeal and the lottery incentive. Donation incentives yield lower...
Viborg Andersen, Kim; Debenham, John; Wagner, Roland
schemata, query evaluation, semantic processing, information retrieval, temporal and spatial databases, querying XML, organisational aspects of databases, natural language processing, ontologies, Web data extraction, semantic Web, data stream management, data extraction, distributed database systems......This book constitutes the refereed proceedings of the 16th International Conference on Database and Expert Systems Applications, DEXA 2005, held in Copenhagen, Denmark, in August 2005.The 92 revised full papers presented together with 2 invited papers were carefully reviewed and selected from 390...... submissions. The papers are organized in topical sections on workflow automation, database queries, data classification and recommendation systems, information retrieval in multimedia databases, Web applications, implementational aspects of databases, multimedia databases, XML processing, security, XML...
Hagemann, Kit S.; Scholderer, Joachim
Novel foods have been the object of intense public debate in recent years. Despite efforts to communicate the outcomes of risk assessments to consumers, public confidence in the management of potential risks has been low. Various reasons behind this have been identified, chiefly a disagreement...... between technical experts and consumers over the nature of the hazards on which risk assessments should focus, and perceptions of insufficient openness about uncertainties in risk assessment. Whilst previous research has almost exclusively focused on genetically modified foods, the present paper...... of uncertainty. Furthermore, a number of misconceptions became apparent in the study of laypeople's mental models, often related to the regulatory system governing risk assessments of novel foods. Critical issue are outlined and communication needs are discussed....
Full Text Available Some remarks on the problem of knowledge representation and processing, as recognized in connection with the use of computers in the scientific research work, emphasizes the relevance of these problems for the studies on both the theory of languages and the expert system. A consideration of the common traits in the recent history of these studies, with reference to the use of computers on texts in natural language motivates the introduction of set theoretic and algebraic methods, suitable for applications in the analysis and in the automatic treatment of languages, based on the concept of model sets and on relational structures suggested from the connections between syntax and semantics evidenced in some example of sub-languages corresponding to theories of different classes of physical phenomena. Some details of these methods are evidenced, which have already successfully used or whose applications appears suggestive of interesting development.
In many data exploratory tasks, extraordinary and rarely occurring patterns called outliers are more interesting than the prevalent ones. For example, they could represent frauds in insurance, intrusions in network and system monitoring, or motion in video surveillance. Decades of research have...... produced various outlier detection algorithms. It is commonly known that these algorithms are difficult to apply and interpret in practice for a variety of reasons. In this thesis we propose novel algorithms that provide robust performance, support for validation and interpretability for outlier detection...... in practice and we empirically evaluate them on synthetic and real world data sets. First, we tackle the problem that most algorithms leave the end user without any explanation of how or why the identified outliers deviate. Such knowledge is important for domain experts in order to be able to validate...
Brito, J. de; Branco, F. A.; Thoft-Christensen, Palle
The importance of bridge repair versus new bridge construction has risen in recent decades due to high deterioration rates that have been observed in these structures. Budgets both for building new bridges and keeping the existing ones are always limited. To help rational decision-making, bridge...... management systems are presently being implemented by bridge authorities in several countries. The prototype of an expert system for concrete bridge management is presented in this paper, with its functionality relying on two modules. The inspection module relies on a periodic acquisition of field...... information complemented by a knowledge-based interactive system, BRIDGE-1. To optimize management strategies at the headquarters, the BRIDGE-2 module was implemented, including three submodules: inspection strategy, maintenance and repair....
Gobet, F; Simon, H A
After reviewing the relevant theory on chess expertise, this paper re-examines experimentally the finding of Chase and Simon (1973a) that the differences in ability of chess players at different skill levels to copy and to recall positions are attributable to the experts' storage of thousands of chunks (patterned clusters of pieces) in long-term memory. Despite important differences in the experimental apparatus, the data of the present experiments regarding latencies and chess relations between successively placed pieces are highly correlated with those of Chase and Simon. We conclude that the two-second inter-chunk interval used to define chunk boundaries is robust, and that chunks have psychological reality. We discuss the possible reasons why Masters in our new study used substantially larger chunks than the Master of the 1973 study, and extend the chunking theory to take account of the evidence for large retrieval structures (templates) in long-term memory.
Khaleel, Mohammad A.
The Exascale Review Panel consists of 12 scientists and engineers with experience in various aspects of high-performance computing and its application, development, and management. The Panel hear presentations by several representatives of the workshops and town meetings convened over the past few years to examine the need for exascale computation capability and the justification for a U.S. Department of Energy (DOE) program to develop such capability. This report summarizes information provided by the presenters and substantial written reports to the Panel in advance of the meeting in Washington D.C. on January 19-20, 2010. The report also summarizes the Panel's conclusions with regard to the justification of a DOE-led exascale initiative.
Lin, Jizhen; Hafrén, Hena; Kerschner, Joseph; Li, Jian-Dong; Brown, Steve; Zheng, Qing Y; Preciado, Diego; Nakamura, Yoshihisa; Huang, Qiuhong; Zhang, Yan
Objective The objective is to perform a comprehensive review of the literature up to 2015 on the genetics and precision medicine relevant to otitis media. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels were formed comprising experts in the genetics and precision medicine of otitis media. Each of the panels reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a merged draft was created. The entire panel met at the 18th International Symposium on Recent Advances in Otitis Media in June 2015 and discussed the review and refined the content. A final draft was made, circulated, and approved by the panel members. Conclusion Many genes relevant to otitis media have been identified in the last 4 years in advancing our knowledge regarding the predisposition of the middle ear mucosa to commensals and pathogens. Advances include mutant animal models and clinical studies. Many signaling pathways are involved in the predisposition of otitis media. Implications for Practice New knowledge on the genetic background relevant to otitis media forms a basis of novel potential interventions, including potential new ways to treat otitis media.
Malesker, Mark A; Callahan-Lyon, Priscilla; Ireland, Belinda; Irwin, Richard S
Acute cough associated with the common cold (CACC) causes significant impairment in quality of life. Effective treatment approaches are needed for CACC. We conducted a systematic review on the management of CACC to update the recommendations and suggestions of the CHEST 2006 guideline on this topic. This systematic review of randomized controlled trials (RCTs) asked the question: Is there evidence of clinically relevant treatment effects for pharmacologic or nonpharmacologic therapies in reducing the duration/severity of acute CACC? Studies of adults and pediatric patients with CACC were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on using the American College of Chest Physicians organization methodology. Six systematic reviews and four primary studies identified from updated literature searches for each of the reviews or from hand searching were included and reported data on 6,496 participants with CACC who received one or more of a variety of interventions. The studies used an assortment of descriptors and assessments to identify CACC. The evidence supporting the management of CACC is overall of low quality. This document provides treatment suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research. Copyright © 2017 American College of Chest Physicians. All rights reserved.
als with known sedative properties, anabolic steroids and their precursors, creatine, glan- dular extracts , echinacea, and other substances.1 U.S...Projects Agency worked with a small startup company to produce and test a chewable form of quercetin, a plant flavonoid with antioxidant effects that
Lorell, Beverly H; Mikita, J Stephen; Anderson, Annick; Hallinan, Zachary P; Forrest, Annemarie
Informed consent is the cornerstone for protection of human subjects in clinical trials. However, a growing body of evidence suggests that reform of the informed consent process in the United States is needed. The Clinical Trials Transformation Initiative conducted interviews with 25 experienced observers of the informed consent process to identify limitations and actionable recommendations for change. There was broad consensus that current practices often fail to meet the ethical obligation to inform potential research participants during the informed consent process. The most frequent single recommendation, which would affect all participants in federally regulated clinical research, was reform of the informed consent document. The interviews also identified the need for reform of clinical research review by institutional review boards, including transitioning to a single institutional review board for multi-site trials. The consensus recommendations from the interviewees provide a framework for meaningful change in the informed consent process. Although some proposed changes are feasible for rapid implementation, others such as substantive reform of the informed consent document may require change in federal regulations. © The Author(s) 2015.
Gourova, Elissaveta; Ducatel, Ken; Gavigan, James; Scapolo, Fabiana; Di Pietrogiacomo, Paola
The next 10 years provide an opportunity for the European Union (EU) to renew the science and technology (S&T) base and build necessary knowledge-society capacities and capabilities in Pre-Accession Countries (PACs). Applied research has faced a major downsize; redressing the balance in the research and development systems is urgently needed.…
Erlangsen, Annette; Nordentoft, Merete; Conwell, Yeates
The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide....
Murrell, Dedee F.; Daniel, Benjamin S.; Joly, Pascal; Borradori, Luca; Amagai, Masayuki; Hashimoto, Takashi; Caux, Frederic; Marinovic, Branka; Sinha, Animesh A.; Hertl, Michael; Bernard, Philippe; Sirois, David; Cianchini, Giuseppe; Fairley, Janet A.; Jonkman, Marcel F.; Pandya, Amit G.; Rubenstein, David; Zillikens, Detlef; Payne, Aimee S.; Woodley, David; Zambruno, Giovanna; Aoki, Valeria; Pincelli, Carlo; Diaz, Luis; Hall, Russell P.; Meurer, Michael; Mascaro, Jose M.; Schmidt, Enno; Shimizu, Hiroshi; Zone, John; Swerlick, Robert; Mimouni, Daniel; Culton, Donna; Lipozencic, Jasna; Bince, Benjamin; Grando, Sergei A.; Bystryn, Jean-Claude; Werth, Victoria P.
Our scientific knowledge of bullous pemphigoid (BP) has dramatically progressed in recent years. However, despite the availability of various therapeutic options for the treatment of inflammatory diseases, only a few multicenter controlled trials have helped to define effective therapies in BP. A
Nov 6, 2017 ... Inaugurated in 2011, Gender Summits are a series of action-based global events to promote gender equality in research and innovation. Held in Canada for the first time, the Gender Summit North America 2017 brings together advocates of gender equality policy from the fields of science, innovation, and ...
Rid, Annette; Saxena, Abha; Baqui, Abdhullah H; Bhan, Anant; Bines, Julie; Bouesseau, Marie-Charlotte; Caplan, Arthur; Colgrove, James; Dhai, Ames; Gomez-Diaz, Rita; Green, Shane K; Kang, Gagandeep; Lagos, Rosanna; Loh, Patricia; London, Alex John; Mulholland, Kim; Neels, Pieter; Pitisuttithum, Punee; Sarr, Samba Cor; Selgelid, Michael; Sheehan, Mark; Smith, Peter G
Vaccines are among the most cost-effective interventions against infectious diseases. Many candidate vaccines targeting neglected diseases in low- and middle-income countries are now progressing to large-scale clinical testing. However, controversy surrounds the appropriate design of vaccine trials and, in particular, the use of unvaccinated controls (with or without placebo) when an efficacious vaccine already exists. This paper specifies four situations in which placebo use may be acceptable, provided that the study question cannot be answered in an active-controlled trial design; the risks of delaying or foregoing an efficacious vaccine are mitigated; the risks of using a placebo control are justified by the social and public health value of the research; and the research is responsive to local health needs. The four situations are: (1) developing a locally affordable vaccine, (2) evaluating the local safety and efficacy of an existing vaccine, (3) testing a new vaccine when an existing vaccine is considered inappropriate for local use (e.g. based on epidemiologic or demographic factors), and (4) determining the local burden of disease. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
Deprez, P H; Bergman, J J; Meisner, S
cancer; 2) treatment aims for R0 resection; 3) ESD should meet quality standards; 4) ESD should be performed following national or European Society of Gastrointestinal Endoscopy (ESGE) guidelines or under institutional review board approval; and 5) ESD cases should be registered. Due to the high level...... of expertise needed to perform the technique safely, ESD should be performed in a step-up approach, starting with lesions presenting in the rectum or in the distal stomach, then colon, proximal stomach, and finally in the esophagus. Registration is advised either at the local site or at a national or ESGE...
Fox, Mary A; Baksh, Sheriza; Lam, Juleen; Resnick, Beth
Since 2002, the national Environmental Health Tracking Program of the Centers for Disease Control and Prevention (CDC) has provided vital support to state environmental public health efforts while simultaneously building a nationwide network of state, local, and academic partners to improve our nation’s capacity to understand and respond to environmental threats to public health. As part of program review and strategic planning, national thought leaders in environmental public health were convened to assess progress, identify gaps and challenges, and provide recommendations for enhancing the utility and impact of the Tracking Program. Several opportunities were identified. Chief among these was the need for continued and expanded CDC leadership to develop a coordinated Tracking Program agenda identifying specific scientific goals, data needs, and initiatives. Recommendations for future growth included expanded data availability and program coverage: i.e., making data available at the community scale and establishing tracking programs in all 50 states. Finally, a set of recommendations emphasizing communication to decision makers and the public was made that will be integral to the future utility and success of the Tracking Program.
Garber, Alan J; Blonde, Lawrence; Bloomgarden, Zachary T; Handelsman, Yehuda; Dagogo-Jack, Samuel
To review available data on the efficacy and safety of bromocriptine-QR (BQR) and to consider its role in the management of Type 2 diabetes mellitus (T2DM). Published literature reporting the efficacy and safety of BQR in the treatment of T2DM was reviewed, including peer-reviewed abstracts and poster presentations. BQR is an oral hypoglycemic agent with a novel mechanism of action that appears to involve enhancement of morning central nervous system (CNS) dopaminergic activity, resulting in improved insulin sensitivity and reduced hepatic glucose output. Adjunctive treatment with BQR in the dosing range of 1.6 to 4.8 mg/d may result in a mean (95% confidence interval [CI]) reduction in glycated hemoglobin (A1c) levels of 0.69% (0.97%, 0.41%). Treatment with BQR appears to be associated with minimal intrinsic risk of hypoglycemia, and does not appear to be associated with clinically significant adverse effects on weight, triglycerides, free fatty acids, or blood pressure. The favorable cardiovascular risk profile of BQR suggests that it may be useful in the treatment of patients with T2DM with a history of cardiovascular disease (CVD) or who have significant risk factors for CVD. However, knowledge of the efficacy and safety of BQR is limited by the relatively small clinical trials database. As a result, there is currently insufficient information on the safety and efficacy of adjunctive BQR in T2DM patients being treated with several common diabetes regimens (e.g., thiazolidinediones, insulin).
Heldreth, Bart; Bergfeld, Wilma F; Belsito, Donald V; Hill, Ronald A; Klaassen, Curtis D; Liebler, Daniel; Marks, James G; Shank, Ronald C; Slaga, Thomas J; Snyder, Paul W; Andersen, F Alan
Alkyl acetates, as well as acetic acid and acetate salts, are widely used cosmetic ingredients, with a wide range of functions as fragrances, solvents, or skin-conditioning agents, depending on the specific ingredient. Available data on alkyl acetates, and acetic acid and the alcohol to which they could be metabolized, were considered adequate to support the safety of the entire group in the present practices of use and concentration in cosmetics.
married to Sandy Decker, a former city council member and mayor of Los Gatos , California, where they both currently reside. Gil maintains an active...interest in national security and defense, the local government of Los Gatos , and youth science education. William H. (Bud) Forster Bud Forster
Bandello, F.; Cunha-Vaz, J.; Chong, N. V.; Lang, G. E.; Massin, P.; Mitchell, P.; Porta, M.; Prünte, C.; Schlingemann, R.; Schmidt-Erfurth, U.
The current standard therapy for patients with diabetic macular oedema (DME)-Ffocal/grid laser photocoagulation-usually does not improve impaired vision, and many patients lose vision despite laser therapy. Recent approval of ranibizumab by the European Medicines Agency to treat visual impairment
Banach, Maciej; Rizzo, Manfredi; Toth, Peter P; Farnier, Michel; Davidson, Michael H; Al-Rasadi, Khalid; Aronow, Wilbert S; Athyros, Vasilis; Djuric, Dragan M; Ezhov, Marat V; Greenfield, Robert S; Hovingh, G Kees; Kostner, Karam; Serban, Corina; Lighezan, Daniel; Fras, Zlatko; Moriarty, Patrick M; Muntner, Paul; Goudev, Assen; Ceska, Richard; Nicholls, Stephen J; Broncel, Marlena; Nikolic, Dragana; Pella, Daniel; Puri, Raman; Rysz, Jacek; Wong, Nathan D; Bajnok, Laszlo; Jones, Steven R; Ray, Kausik K; Mikhailidis, Dimitri P
Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin-associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10 - 15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
Interns were promised pizza, but they got more than just food as they watched “Someone You Love: The HPV Epidemic” at this summer’s second student seminar. In the Building 549 auditorium, students learned about human papillomavirus (HPV) infection, the most common sexually transmitted infection (STI).
de Kleijn, Renske A. M.; Meijer, Paulien C.; Brekelmans, Mieke; Pilot, Albert
Several researchers have suggested the importance of being responsive to students' needs in research supervision. Adapting support strategies to students' needs in light of the goals of a task is referred to as "adaptivity." In the present study, the practice of adaptivity is explored by interviewing expert thesis supervisors about…
Calabrese Barton, Angela; Birmingham, Daniel; Sato, Takumi; Tan, Edna; Calabrese Barton, Scott
In this paper, the authors examine what it means to become a community science expert (CSE) and why this goal is important for youth in afterschool environments. Using "Green Energy Technology in the City" (GET City) as a case study, they describe how this afterschool program nurtures youth as CSEs. They draw on data gathered in…
Ronteltap, A.; Trijp, van J.C.M.; Renes, R.J.
Public adoption of new technologies is an important determinant for their success. In this paper we examined a specific case of new technology in the nutrition domain ¿ nutrigenomics ¿ the interaction between nutrition and human genes. From 29 semi-structured interviews with Dutch experts in the
Pressley, Lauren; Gilbertson, Kevin
People see challenges to libraries in funding, in ebooks, and in the internet. However, in this information-rich age, librarians' roles are even more important. They are information experts. They know how to think about the changing information environment, and they know the impact--both positive and negative--it can have on people whose jobs…
Jacobs, R A
This article reviews statistical techniques for combining multiple probability distributions. The framework is that of a decision maker who consults several experts regarding some events. The experts express their opinions in the form of probability distributions. The decision maker must aggregate the experts' distributions into a single distribution that can be used for decision making. Two classes of aggregation methods are reviewed. When using a supra Bayesian procedure, the decision maker treats the expert opinions as data that may be combined with its own prior distribution via Bayes' rule. When using a linear opinion pool, the decision maker forms a linear combination of the expert opinions. The major feature that makes the aggregation of expert opinions difficult is the high correlation or dependence that typically occurs among these opinions. A theme of this paper is the need for training procedures that result in experts with relatively independent opinions or for aggregation methods that implicitly or explicitly model the dependence among the experts. Analyses are presented that show that m dependent experts are worth the same as k independent experts where k < or = m. In some cases, an exact value for k can be given; in other cases, lower and upper bounds can be placed on k.
Malchow-Møller, Nikolaj; Munch, Jakob Roland; Rose Skaksen, Jan
of domestic firms. Using matched worker-firm data from Denmark and a difference-indifferences matching approach, we then find that firms that hire foreign experts – defined as employees eligible for reduced taxation under the Danish "Tax scheme for foreign researchers and key employees" – both become more......While most countries welcome (and some even subsidise) high-skilled immigrants, there is very limited evidence of their importance for domestic firms. To guide our empirical analysis, we first set up a simple theoretical model to show how foreign experts may impact on the productivity and wages...
Adamo-Villani, Nicoletta; Popescu, Voicu; Lestina, Jason
We describe a graphical user interface designed to allow non-expert users to pose 3D characters to create American Sign Language (ASL) computer animation. The interface is an important component of a software system that allows educators of the Deaf to add sign language translation, in the form of 3D character animations, to digital learning materials, thus making them accessible to deaf learners. A study indicates that users with no computer animation expertize can create animated ASL signs quickly and accurately.
Hingole, Rahulkumar Shivajirao
This comprehensive book offers a clear account of the theory and applications of advanced metal forming. It provides a detailed discussion of specific forming processes, such as deep drawing, rolling, bending extrusion and stamping. The author highlights recent developments of metal forming technologies and explains sound, new and powerful expert system techniques for solving advanced engineering problems in metal forming. In addition, the basics of expert systems, their importance and applications to metal forming processes, computer-aided analysis of metalworking processes, formability analysis, mathematical modeling and case studies of individual processes are presented.
Novita Sari, Felisia; Insap Santosa, Paulus; Wibirama, Sunu
E-Learning is an important media that an educational institution must have. Successful information design for e-learning depends on its user's characteristics. This study explores differences between novice and expert users' eye movement data. This differences between expert and novice users were compared and identified based on gaze features. Each participant must do three main tasks of e-learning. This paper gives the result that there are differences between gaze features of experts and novices.
Quay, Herbert C; Hogan, Anne E; Donohue, Keith F
We report on data provided by a nationwide panel of 23 infant mental health (IMH) experts who provided numerical ratings of the relative importance of 143 competencies desirable for licensed mental health therapists working with infants/children birth to 5 years of age and their families/caregivers. The competencies were developed based on prior state and national efforts and our own experience in training IMH therapists. The competencies were grouped conceptually into seven areas: (a) Normal infant and toddler development; (b) Atypical development (perturbations in development); (c) Emotional/behavioral disorders in infants and young children; (d) Assessment; (e) Intervention; (f) Community resources and referrals; and (g) Organization, communication, and collaboration. We calculated means, SDs, 95% confidence intervals to rank order each competency. We conducted reliability analyses and tested for mean differences in ratings for the seven areas. Interrater and intraclass correlations were modest, likely the result of restriction of range in the ratings. The seven areas showed high levels of internal consistency and, with few exceptions, did not significantly differ in the means of their ratings. The utility of the competencies are discussed as a framework for training and professional development for IMH clinicians. Copyright © 2009 Michigan Association for Infant Mental Health.
Ojczyk, C.; Huelman, P.; Carmody, J.
In the Expert Meeting Plan, the NorthernSTAR Team proposed to host two Expert Meetings in calendar year 2011. Invitees to the meetings would include experts in the current field of study, other BA team members, and representatives from DOE and NREL. They will invite leading industry experts to present at these meetings. The Expert Meetings will focus on key systems areas that will be required to meet the Building America performance goals and shall be sufficiently narrow in scope that specific conclusions, action items, and delegation of future tasks can be identified and completed. The two expert meeting topics are 'Foundations' and 'Window Retrofit.' The first session is designed as a webinar only and the second will be a live meeting.
Kaufmann, Paul M
Clinical neuropsychologists engage increasingly in forensic consulting activities because such expert opinions are generally relevant, reliable and helpful in resolving certain legal claims, especially those related to traumatic brain injury. Consequently, practitioners of law, medicine and psychology would benefit from understanding the nature of neuropsychological evidence, the standards for its admissibility, and its expanding role in neurolaw. This article reviews important evidentiary rules regulating relevance, preliminary questions, and expert testimony, while tracing federal key court decisions and progeny. Civil and criminal cases are detailed to illustrate the application of these rules and case law to neuropsychological evidence, with suggestions for overcoming motions to exclude such evidence. Expert neuropsychologists have a role in forensic consultation on brain trauma cases, even as the interdisciplinary dialog and understanding among law, medicine, and psychology continues to expand. Copyright © 2013 John Wiley & Sons, Ltd.
The purpose of the Expert System CRN5EXP is to assist in checking the quality of the coils at two very important mills: Hot Rolling and Cold Rolling in a steel plant. The system interprets the statistical quality control charts, diagnoses and predicts the quality of the steel. Measurements of process control variables are recorded in a database and sample statistics such as the mean and the range are computed and plotted on a control chart. The chart is analyzed through patterns using the C Language Integrated Production System (CLIPS) and a forward chaining technique to reach a conclusion about the causes of defects and to take management measures for the improvement of the quality control techniques. The Expert System combines the certainty factors associated with the process control variables to predict the quality of the steel. The paper presents the approach to extract data from the database, the reason to combine certainty factors, the architecture and the use of the Expert System. However, the interpretation of control charts patterns requires the human expert's knowledge and lends to Expert Systems rules.
Hardré, Patricia L; Nihira, Mikio; LeClaire, Edgar; Moen, Michael
The aim of this study was to describe how professional expertise is defined and understood among gynecologic surgeons and what experiential factors contribute to that understanding. Semistructured interviews with 16 experts in Female Pelvic Medicine and Reconstructive Surgery were conducted to identify how expertise in their field is defined, recognized, and assessed. Independent thematic analysis of the interview transcripts was performed by each member of the research team and then distilled and synthesized into convergent themes. Experts described surgical expertise as difficult to define but with several dominant themes including knowledge, technical skills, clinical experience, adaptability, continuous learning, communication, and professional recognition. Expertise requires judgment in applying technical skills to meet each patient's specific needs. Experts described unique ways of seeing and thinking during surgery, characterized by spatial awareness of relevant anatomy, temporal awareness of future changes, and rapidly adaptive application of their skills enabling them to do difficult tasks with fluidity, making the tasks seem easy to observers. These expert surgeons acknowledged that achieving expertise requires hard work and maintaining expertise requires continuous learning, highlighted by challenge seeking to do the most difficult tasks in their field. They also noted the importance of effective communication of their knowledge to others, which contributes to their perception as experts by colleagues in the field. Surgical expertise is a complex phenomenon with several meaningful themes. Understanding the authentic nature of surgical expertise can be used to support the development of competencies and the effective mentoring of promising surgical trainees to achieve surgical expertise.
T. B. Baltrukova
Full Text Available Modification of attitude to labor in the society, in professional communities and among people is necessary for further development of society and national economy. This goal may be achieved if the system of professional training is modified: switched to competence approach which should include training of experts, including those in radiation hygiene, with a set of general cultural and professional competences. The system of future experts training should be based on traditions of domestic and international education; it should use modern forms of active and interactive education (computer simulations, business games and role-playing, analysis of concrete situations, portfolio, psychological and other trainings, remote education, etc. It should consider actuality of knowledge and skills and develop independence and responsibility that will enable the young expert to be competitive at the modern labor market and to meet employers’ expectations. Under the new federal educational standard on radiation hygiene accepted in 2014 at present primary specialization in radiation hygiene takes place in internship. At training of experts the new standard provides great use of on-the-job training, independent work, scientific and practical work. Employers should play an important role in training of experts.
Heeren, Alexander; Karns, Gabriel; Bruskotter, Jeremy; Toman, Eric; Wilson, Robyn; Szarek, Harmony
Decisions concerning the appropriate listing status of species under the U.S. Endangered Species Act (ESA) can be controversial even among conservationists. These decisions may determine whether a species persists in the near term and have long-lasting social and political ramifications. Given the ESA's mandate that such decisions be based on the best available science, it is important to examine what factors contribute to experts' judgments concerning the listing of species. We examined how a variety of factors (such as risk perception, value orientations, and norms) influenced experts' judgments concerning the appropriate listing status of the grizzly bear (Ursus arctos horribilis) population in the Greater Yellowstone Ecosystem. Experts were invited to complete an online survey examining their perceptions of the threats grizzly bears face and their listing recommendation. Although experts' assessments of the threats to this species were strongly correlated with their recommendations for listing status, this relationship did not exist when other cognitive factors were included in the model. Specifically, values related to human use of wildlife and norms (i.e., a respondent's expectation of peers' assessments) were most influential in listing status recommendations. These results suggest that experts' decisions about listing, like all human decisions, are subject to the use of heuristics (i.e., decision shortcuts). An understanding of how heuristics and related biases affect decisions under uncertainty can help inform decision making about threatened and endangered species and may be useful in designing effective processes for protection of imperiled species. © 2016 Society for Conservation Biology.
Carley, Joseph A; Karp, Jordan F; Gentili, Angela; Marcum, Zachary A; Reid, M Carrington; Rodriguez, Eric; Rossi, Michelle I; Shega, Joseph; Thielke, Stephen; Weiner, Debra K
To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression. The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice. We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP. Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented. Wiley Periodicals, Inc.
Weiner, Debra K; Fang, Meika; Gentili, Angela; Kochersberger, Gary; Marcum, Zachary A; Rossi, Michelle I; Semla, Todd P; Shega, Joseph
To present the first in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on hip osteoarthritis (OA). The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice. We present an algorithm and supportive materials to help guide the care of older adults with hip OA, an important contributor to CLBP. The case illustrates an example of complex hip-spine syndrome, in which hip OA was an important contributor to disability in an older adult with CLBP. Hip OA is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatment can be designed. © 2015 American Academy of Pain Medicine.
Carley, Joseph A.; Karp, Jordan F.; Gentili, Angela; Marcum, Zachary A.; Reid, M. Carrington; Rodriguez, Eric; Rossi, Michelle I.; Shega, Joseph; Thielke, Stephen; Weiner, Debra K.
Objective To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression. Methods The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice. Results We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP. Conclusions Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented. PMID:26539754
Martin, Tara G; Burgman, Mark A; Fidler, Fiona; Kuhnert, Petra M; Low-Choy, Samantha; McBride, Marissa; Mengersen, Kerrie
Expert knowledge is used widely in the science and practice of conservation because of the complexity of problems, relative lack of data, and the imminent nature of many conservation decisions. Expert knowledge is substantive information on a particular topic that is not widely known by others. An expert is someone who holds this knowledge and who is often deferred to in its interpretation. We refer to predictions by experts of what may happen in a particular context as expert judgments. In general, an expert-elicitation approach consists of five steps: deciding how information will be used, determining what to elicit, designing the elicitation process, performing the elicitation, and translating the elicited information into quantitative statements that can be used in a model or directly to make decisions. This last step is known as encoding. Some of the considerations in eliciting expert knowledge include determining how to work with multiple experts and how to combine multiple judgments, minimizing bias in the elicited information, and verifying the accuracy of expert information. We highlight structured elicitation techniques that, if adopted, will improve the accuracy and information content of expert judgment and ensure uncertainty is captured accurately. We suggest four aspects of an expert elicitation exercise be examined to determine its comprehensiveness and effectiveness: study design and context, elicitation design, elicitation method, and elicitation output. Just as the reliability of empirical data depends on the rigor with which it was acquired so too does that of expert knowledge. ©2011 Australian Governmemt Conservation Biology©2011 Society for Conservation Biology.
... 7 Agriculture 15 2010-01-01 2010-01-01 false Composite panels. 2902.19 Section 2902.19 Agriculture... Composite panels. (a) Definitions. (1) Plastic lumber composite panels. Engineered products suitable for non... composite panels. Engineered products designed for use as structural and sound deadening material suitable...
Panels bent permanently without cracking. In restraint age forming, panel wrapped onto mandrel having necessary curved contour, restrained on mandrel clamps and vacuum, and heat treated. When panel released after end of heat treatment, retains contour of mandrel except for small springback. Process repeatable: panels subsequently processed under same mechanical and thermal conditions on same contour emerge with same final contour.
Race, Margaret S.; MacGregor, Donald G.; Slovic, Paul
As space scientists and engineers plan new missions to Mars and other planets in our solar system, they will face critical questions about the potential for biological contamination of planetary surfaces. In a society that places ever-increasing importance on the role of public involvement in science and technology policy, questions about risks of biological contamination will be examined and debated in the media, and will lead to the formation of public perceptions of planetary-contamination risks. These perceptions will, over time, form an important input to the development of space policy. Previous research in public and expert perceptions of technological risks and hazards has shown that many of the problems faced by risk-management organizations are the result of differing perceptions of risk (and risk management) between the general public and scientific and technical experts. These differences manifest themselves both as disagreements about the definition (and level) of risk associated with a scientific, technological or industrial enterprise, and as distrust about the ability of risk-management organizations (both public and private) to adequately protect people's health and safety. This report presents the results of a set of survey studies designed to reveal perceptions of planetary exploration and protection from a wide range of respondents, including both members of the general public and experts in the life sciences. The potential value of this research lies in what it reveals about perceptions of risk and benefit that could improve risk-management policies and practices. For example, efforts to communicate with the public about Mars sample return missions could benefit from an understanding of the specific concerns that nonscientists have about such a mission by suggesting areas of potential improvement in public education and information. Assessment of both public and expert perceptions of risk can also be used to provide an advanced signal of
Kirk, Bernadette Lugue [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Cain, Ronald A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Dewji, Shaheen A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Agreda, Carla L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)
This report describes a methodology for identifying, evaluating, and mitigating the loss of key technical skills at nuclear operations facilities. The methodology can be adapted for application within regulatory authorities and research and development organizations, and can be directly applied by international engagement partners of the Department of Energy’s National Nuclear Security Administration (NNSA). The resultant product will be of direct benefit to two types of NNSA missions: (1) domestic human capital development programs tasked to provide focused technical expertise to succeed an aging nuclear operations workforce, and (2) international safeguards programs charged with maintaining operational safeguards for developing/existing nuclear power program in nations where minimal available resources must be used effectively. This report considers succession planning and the critical skills necessary to meet an institution’s goals and mission. Closely tied to succession planning are knowledge management and mentorship. In considering succession planning, critical skill sets are identified and are greatly dependent on the subject matter expert in question. This report also provides examples of critical skills that are job specific.
Blavin, Fredric Evan; Buntin, Melinda Beeuwkes
To promote the widespread adoption and use of electronic health records (EHRs), in 2011, CMS started making Medicare and Medicaid incentive payments to providers who demonstrate that they are "meaningful users" of certified EHR systems. This paper combines an expert opinion method, a modified Delphi technique, with a technological diffusion framework to create a forecast of the percent of office-based physicians who will become adopters and "meaningful users" of health information technology from 2012 to 2019. The panel consisted of 18 experts from industry, academia, and government who are knowledgeable about the adoption and use of EHRs in office-based settings and are recognized as opinion leaders in their respective professions. Overall, the expert panel projected that primary care physicians in large group practices are more likely to achieve the meaningful use of EHRS relative to primary care physicians in small group practices and all other specialists: the group projected that 65 percent of primary care physicians in large group practices, 45 percent of primary care physicians in small group practices, and 44 percent of all other specialists could achieve meaningful use by 2015. In 2019, these projections increase to 80 percent, 65 percent, and 66 percent for these three groups, respectively. The information from this study is especially valuable when there is a lack of data and a high degree of uncertainty in a new policy environment and could help inform and evaluate government programs, such as the Regional Extension Centers (REC), by providing data from leading experts.
Zarri, Gian Piero
Operational Expert System Applications in Europe describes the representative case studies of the operational expert systems (ESs) that are used in Europe.This compilation provides examples of operational ES that are realized in 10 different European countries, including countries not usually examined in the standard reviews of the field.This book discusses the decision support system using several artificial intelligence tools; expert systems for fault diagnosis on computerized numerical control (CNC) machines; and expert consultation system for personal portfolio management. The failure prob
Sopocy, D.M.; Glazer, A.R. (Sargent and Lundy, Chicago, IL (USA)); Jonas, O. (Jonas, Inc., Wilmington, DE (US)); Rice, J.K. (James K. Rice, Chartered, Olney, MD (US))
Prospective expert system applications in the power industry generally are in one of the following categories:esign, information management, plant operations, and equipment diagnostics. Many power facility expert system efforts are four plant operations. Several of these applications help optimize plant operation and also detect developing problems and suggest remedial action before the occurrence of any serious consequences. Many types of plant processes and equipment can benefit from routine trending and evaluation of operating data by this type of expert system. This paper discusses a variety of special considerations for the development and implementation of expert systems for plant operations, both in general and as exemplified by CYCLEXPRT.
Т. А. Сухопарова
Full Text Available Problem of parallel import is urgent question at now. Parallel import legalization in Russia is expedient. Such statement based on opposite experts opinion analysis. At the same time it’s necessary to negative consequences consider of this decision and to apply remedies to its minimization.Purchase on Elibrary.ru > Buy now
Papakonstantinou, Christos G.
High strength composites are being used for making lightweight structural panels that are being employed in aerospace, naval and automotive structures. Recently, there is renewed interest in use of these panels. The major problem of most commercial available sandwich panels is the fire resistance. A recently developed inorganic matrix is investigated for use in cases where fire and high temperature resistance are necessary. The focus of this dissertation is the development of a fireproof composite structural system. Sandwich panels made with polysialate matrices have an excellent potential for use in applications where exposure to high temperatures or fire is a concern. Commercial available sandwich panels will soften and lose nearly all of their compressive strength temperatures lower than 400°C. This dissertation consists of the state of the art, the experimental investigation and the analytical modeling. The state of the art covers the performance of existing high temperature composites, sandwich panels and reinforced concrete beams strengthened with Fiber Reinforced Polymers (FRP). The experimental part consists of four major components: (i) Development of a fireproof syntactic foam with maximum specific strength, (ii) Development of a lightweight syntactic foam based on polystyrene spheres, (iii) Development of the composite system for the skins. The variables are the skin thickness, modulus of elasticity of skin and high temperature resistance, and (iv) Experimental evaluation of the flexural behavior of sandwich panels. Analytical modeling consists of a model for the flexural behavior of lightweight sandwich panels, and a model for deflection calculations of reinforced concrete beams strengthened with FRP subjected to fatigue loading. The experimental and analytical results show that sandwich panels made with polysialate matrices and ceramic spheres do not lose their load bearing capability during severe fire exposure, where temperatures reach several
... ADMINISTRATION Occupational Information Development Advisory Panel Meeting AGENCY: Social Security Administration... Occupational Information Development Advisory Panel (Panel) is a discretionary panel, established under the... Information Development Advisory Panel, Social Security Administration, 6401 Security Boulevard, Robert M...
MacDonald, Jacqueline Anne; Small, Mitchell J; Morgan, M G
This article reports on a study to quantify expert beliefs about the explosion probability of unexploded ordnance (UXO). Some 1,976 sites at closed military bases in the United States are contaminated with UXO and are slated for cleanup, at an estimated cost of $15-140 billion. Because no available technology can guarantee 100% removal of UXO, information about explosion probability is needed to assess the residual risks of civilian reuse of closed military bases and to make decisions about how much to invest in cleanup. This study elicited probability distributions for the chance of UXO explosion from 25 experts in explosive ordnance disposal, all of whom have had field experience in UXO identification and deactivation. The study considered six different scenarios: three different types of UXO handled in two different ways (one involving children and the other involving construction workers). We also asked the experts to rank by sensitivity to explosion 20 different kinds of UXO found at a case study site at Fort Ord, California. We found that the experts do not agree about the probability of UXO explosion, with significant differences among experts in their mean estimates of explosion probabilities and in the amount of uncertainty that they express in their estimates. In three of the six scenarios, the divergence was so great that the average of all the expert probability distributions was statistically indistinguishable from a uniform (0, 1) distribution-suggesting that the sum of expert opinion provides no information at all about the explosion risk. The experts' opinions on the relative sensitivity to explosion of the 20 UXO items also diverged. The average correlation between rankings of any pair of experts was 0.41, which, statistically, is barely significant (p= 0.049) at the 95% confidence level. Thus, one expert's rankings provide little predictive information about another's rankings. The lack of consensus among experts suggests that empirical studies
Booker, J.M.; Picard, R.R.; Meyer, M.A.
Expert opinion is data given by a qualified person in response to a technical question. In these analyses, expert opinion provides information where other data are either sparse or non-existent. Improvements in forecasting result from the advantageous addition of expert opinion to observed data in many areas, such as meteorology and econometrics. More generally, analyses of large, complex systems often involve experts on various components of the system supplying input to a decision process; applications include such wide-ranging areas as nuclear reactor safety, management science, and seismology. For large or complex applications, no single expert may be knowledgeable enough about the entire application. In other problems, decision makers may find it comforting that a consensus or aggregation of opinions is usually better than a single opinion. Many risk and reliability studies require a single estimate for modeling, analysis, reporting, and decision making purposes. For problems with large uncertainties, the strategy of combining as diverse a set of experts as possible hedges against underestimation of that uncertainty. Decision makers are frequently faced with the task of selecting the experts and combining their opinions. However, the aggregation is often the responsibility of an analyst. Whether the decision maker or the analyst does the aggregation, the input for it, such as providing weights for experts or estimating other parameters, is imperfect owing to a lack of omniscience. Aggregation methods for expert opinions have existed for over thirty years; yet many of the difficulties with their use remain unresolved. The bulk of these problem areas are summarized in the sections that follow: sensitivities of results to assumptions, weights for experts, correlation of experts, and handling uncertainties. The purpose of this paper is to discuss the sources of these problems and describe their effects on aggregation.
Nielsen, Kirsten Mølgaard; Pedersen, Tom Søndergaard
This paper treats the subject of analysis, design and development of the control system for a solar panel based milk pasteurization system to be used in small villages in Tanzania. The analysis deals with the demands for an acceptable pasteurization, the varying energy supply and the low cost, low...... complexity, simple user interface and high reliability demands. Based on these demands a concept for the pasteurization system is established and a control system is developed. A solar panel has been constructed and the energy absorption has been tested in Tanzania. Based on the test, the pasteurization...... system is dimensioned. A functional prototype of the pasteurization facility with a capacity of 200 l milk/hour has been developed and tested. The system is prepared for solar panels as the main energy source and is ready for a test in Tanzania....
Nielsen, Kirsten Mølgaard; Pedersen, Tom Søndergaard
This paper treats the subject of analysis, design and development of the control system for a solar panel based milk pasteurization system to be used in small villages in Tanzania. The analysis deals with the demands for an acceptable pasteurization, the varying energy supply and the low cost, low...... complexity, simple user interface and high reliability demands. Based on these demands a concept for the pasteurization system is established and a control system is developed. A solar panel has been constructed and the energy absorption has been tested in Tanzania. Based on the test, the pasteurization...... system is dimensioned. A functional prototype of the pasteurization facility with a capacity of 200 l milk/hour has been developed and tested. The system is prepared for solar panels as the main energy source and is ready for a test in Tanzania....
. The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics. Results: All experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies. Conclusion: On the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for augmentation of glabellar lines, periorbital wrinkles, forehead lines, bunny lines, perioral wrinkles, depressor anguli oris, mentalis, masseters and platysmal bands, and performing the Nefertiti lift, are presented here. Keywords: incobotulinumtoxinA, free from complexing proteins, consensus guidelines, facial lines, dosage, aesthetics, Russia
Over the years, demand on space systems has increased tremendously and this trend will continue for the near future. Enhanced capabilities of space systems, however, can only be met with increased complexity and sophistication of onboard and ground systems. Artificial Intelligence and expert system techniques have great potential in space applications. Expert systems could facilitate autonomous decision making, improve in-orbit fault diagnosis and repair, enhance performance and reduce reliance on ground support. However, real-time expert systems, unlike conventional off-line consultative systems, have to satisfy certain special stringent requirements before they could be used for onboard space applications. Challenging and interesting new environments are faced while developing expert system space applications. This paper discusses the special characteristics, requirements and typical life cycle issues for onboard expert systems. Further, it also describes considerations in design, development, and implementation which are particularly important to real-time expert systems for space applications.
A method is presented for process control which has the properties of being incremental, cyclic and top-down. It is described on the basis of the development of an expert controller for a simple, but nonlinear control route. A quality comparison between expert controller and process operator shows the ability of the method for knowledge acquisition.
In our courtrooms you can meet, up to this day, experts of dubious qualities if not mere shams and deceivers. They are found in all sciences, but also in pseudo-sciences as paramedicine and parapsychology. In any case such expert pretenders must be exposed by the judge to prevent dangerous miscarriage of justice. Examples are given how to unmask the fraudulent rascals.
Siegel, Stefan; Rau, Heinrich; Dors, Simone; Brants, Loni; Börner, Michaela; Mahnke, Manuel; Zimmermann, Peter L; Willmund, Gerd; Ströhle, Andreas
The number of service members of the German armed forces suffering from deployment-related mental health problems is increasing. However, less than 50 % seek professional help, and there is little knowledge about the barriers to treatment-seeking. The article presents data gathered by the Delphi technique combined with focus groups from 55 health service experts regarding the evaluated barriers to treatment-seeking among German veterans. According to the interviewed experts, major contextual barriers to treatment-seeking include: 1) intimidating processes and structures, 2) actual stigmatization and discrimination, and 3) health service deficits. Major individual barriers to treatment were: 4) health beliefs, self-perception and fear of stigmatization, and 5) avoidance behavior related to psychopathology. In addition, there is another both contextual and individual barrier, i.e., 6) information deficits. Individual internal factors like the soldiers' self-perception and their fear of being stigmatized were considered important barriers to treatment-seeking. The experts' opinion about avoidance behavior related to psychopathology and deficits in health services and information coincides with international findings. Compared to research in other countries, actual stigmatization and discrimination were regarded to be an important barrier in itself. According to our findings daunting/intimidating processes and structures like time-consuming and complex expert medical reports rather seem to be a German phenomenon. Copyright © 2017. Published by Elsevier GmbH.
Beasley, Christopher; Torres-Harding, Susan; Pedersen, Paula J.
Recent societal trends indicate more tolerance for homosexuality, but prejudice remains on college campuses. Speaker panels are commonly used in classrooms as a way to educate students about sexual diversity and decrease negative attitudes toward sexual diversity. The advent of computer-delivered instruction presents a unique opportunity to…
Scientific Opinion of the Panel on Genetically Modified Organisms on an application (Reference EFSA-GMO-CZ-2006-33) for the placing on the market of the insect-resistant and glyphosate-tolerant genetically modified maize MON 88017 x MON 810, for food and feed uses, import and processing under
Sørensen, Ilona Kryspin
or survival of feral maize plants in case of accidental release into the environment of maize MON 88017 x MON 810 viable grains during transportation and processing. The scope of the post-market environmental monitoring plan provided by the applicant is in line with the intended uses of maize MON 88017 x MON......Following a request from Monsanto within the framework of Regulation (EC) No 1829/2003 on genetically modified food and feed, the Panel on Genetically Modified Organisms was asked to deliver a scientific opinion on the authorisation of the insect-resistant, glyphosatetolerant genetically modified...... MON 88017 x MON 810 and all derived products, but excluding cultivation in the EU. The EFSA GMO Panel assessed maize MON 88017 x MON 810 with reference to the intended uses and the appropriate principles described in the Guidance Document of the Scientific Panel on Genetically Modified Organisms...
Stumme, James M.
The monograph is intended to help school psychologists understand the special procedures, techniques, and considerations necessary for providing effective courtroom interventions, specifically expert testimony and written reports. Beginning with an explanation of lay and expert witnesses, the monograph goes on to stress the importance of pretrial…
The present research was conducted to identify the most important suggestions for educational curriculum improvement in Jordan, from the expert's point of view. A descriptive survey through data and information collection tool (questionnaire) was used as an approach. The study sample consisted of (620) educational experts in the field of…
Cole Bryan R
Full Text Available Abstract Background Delphi surveys with panels of experts in a particular area of interest have been widely utilized in the fields of clinical medicine, nursing practice, medical education and healthcare services. Despite this wide applicability of the Delphi methodology, there is no clear identification of what constitutes a sufficient number of Delphi survey participants to ensure stability of results. Methods The study analyzed the response characteristics from the first round of a Delphi survey conducted with 23 experts in healthcare quality and patient safety. The panel members had similar training and subject matter understanding of the Malcolm Baldrige Criteria for Performance Excellence in Healthcare. The raw data from the first round sampling, which usually contains the largest diversity of responses, were augmented via bootstrap sampling to obtain computer-generated results for two larger samples obtained by sampling with replacement. Response characteristics (mean, trimmed mean, standard deviation and 95% confidence intervals for 54 survey items were compared for the responses of the 23 actual study participants and two computer-generated samples of 1000 and 2000 resampling iterations. Results The results from this study indicate that the response characteristics of a small expert panel in a well-defined knowledge area are stable in light of augmented sampling. Conclusion Panels of similarly trained experts (who possess a general understanding in the field of interest provide effective and reliable utilization of a small sample from a limited number of experts in a field of study to develop reliable criteria that inform judgment and support effective decision-making.
Wesson, D R; Hink, R H
Computer programs can assist humans in solving complex problems that cannot be solved by traditional computational techniques using mathematic formulas. These programs, or "expert systems," are commonly used in finance, engineering, and computer design. Although not routinely used in medicine at present, medical expert systems have been developed to assist physicians in solving many kinds of medical problems that traditionally require consultation from a physician specialist. No expert systems are available specifically for drug abuse treatment, but at least one is under development. Where access to a physician specialist in substance abuse is not available for consultation, this expert system will extend specialized substance abuse treatment expertise to nonspecialists. Medical expert systems are a developing technologic tool that can assist physicians in practicing better medicine.
The book is a comprehensive narration of the use of expertise in international criminal trials offering reflection on standards concerning the quality and presentation of expert evidence. It analyzes and critiques the rules governing expert evidence in international criminal trials...... and the strategies employed by counsel and courts relying upon expert evidence and challenges that courts face determining its reliability. In particular, the author considers how the procedural and evidentiary architecture of international criminal courts and tribunals influences the courts' ability to meaningfully...... incorporate expert evidence into the rational fact-finding process. The book provides analysis of the unique properties of expert evidence as compared with other forms of evidence and the challenges that these properties present for fact-finding in international criminal trials. It draws conclusions about...
Conlon, S C; Hambric, S A
Modern satellites are constructed of large, lightweight equipment panels that are strongly excited by acoustic pressures during launch. During design, performing vibroacoustic analyses to evaluate and ensure the integrity of the complex electronics mounted on the panels is critical. In this study the attached equipment is explicitly addressed and how its properties affect the panel responses is characterized. FEA and BEA methods are used to derive realistic parameters to input to a SEA hybrid model of a panel with multiple attachments. Specifically, conductance/modal density and radiation efficiency for nonhomogeneous panel structures with and without mass loading are computed. The validity of using the spatially averaged conductance of panels with irregular features for deriving the structure modal density is demonstrated. Maidanik's proposed method of modifying the traditional SEA input power is implemented, illustrating the importance of accounting for system internal couplings when calculating the external input power. The predictions using the SEA hybrid model agree with the measured data trends, and are found to be most sensitive to the assumed dynamic mass ratio (attachments/structure) and the attachment internal loss factor. Additional experimental and analytical investigations are recommended to better characterize dynamic masses, modal densities and loss factors.
Full Text Available The aim of this study was to examine the information acquisition strategies of expert and competent non-expert intensive care physicians during two simulated diagnostic scenarios involving respiratory distress in an infant. Specifically, the information acquisition performance of six experts and 12 competent non-experts was examined using an eye tracker during the initial 90 seconds of the assessment of the patient. The results indicated that, in comparison to competent non-experts, experts recorded longer mean fixations, irrespective of the scenario. When the dwell times were examined against specific areas of interest, the results revealed that competent non-experts recorded greater overall dwell times on the nurse, where experts recorded relatively greater dwell times on the head and face of the manikin. In the context of the scenarios, experts recorded differential dwell times, spending relatively more time on the head and face during the seizure scenario than during the coughing scenario. The differences evident between experts and competent non-experts were interpreted as evidence of the relative availability of task-specific cues or heuristics in memory that might direct the process of information acquisition amongst expert physicians. The implications are discussed for the training and assessment of diagnostic skills.
Wendt, Sabrina Lyngbye; Welinder, Peter; Sørensen, Helge Bjarup Dissing
Objectives To measure the inter-expert and intra-expert agreement in sleep spindle scoring, and to quantify how many experts are needed to build a reliable dataset of sleep spindle scorings. Methods The EEG dataset was comprised of 400 randomly selected 115 s segments of stage 2 sleep from 110 sl...
Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell; Goodman, Joseph; Nolan, Wade; Pitelka, Taylor; Rahimzadeh, Keyan; Brooks, Bradley; Lohr, Joshua; Crooks, Ryan; Porges, Jamie; Rubin, Daniel
An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the base rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.
Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell; Goodman, Joseph; Nolan, Wade; Pitelka, Taylor; Rahimzadeh, Keyan; Brooks, Bradley; Lohr, Joshua; Crooks, Ryan; Porges, Jamie; Rubin, Daniel
An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the base rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.
Al-Haddad, Tristan Farris; Cavieres, Andres; Gentry, Russell; Goodman, Joseph; Nolan, Wade; Pitelka, Taylor; Rahimzadeh, Keyan; Brooks, Bradley; Lohr, Joshua; Crooks, Ryan; Porges, Jamie; Rubin, Daniel
An exemplary embodiment of the present invention provides a solar panel truss mounting system comprising a base and a truss assembly coupled to the base. The truss assembly comprises a first panel rail mount, second panel rail mount parallel to the first panel rail mount, base rail mount parallel to the first and second panel rail mounts, and a plurality of support members. A first portion of the plurality of support members extends between the first and second panel rail mounts. A second portion of the plurality of support members extends between the first panel rail mount and the base rail mount. A third portion of the plurality of support members extends between the second panel rail mount and the base rail mount. The system can further comprise a plurality of connectors for coupling a plurality of photovoltaic solar panels to the truss assembly.
During many years of occupational stress research, mostly within the German governmental program for "Humanization of Work Life'', remarkable deficits concerning visual work were seen, the most striking being the lack of cooperation between the different experts. With regard to this article hard arguments and ideas for solutions had to be found. A pilot study in 21 enterprises was realized (1602 employees with different visual work tasks). A test set of screening parameters (visual acuity, refraction, phoria, binocular cooperation and efficiency, accommodation range and color vision) were measured. The glasses and/or contact lenses worn were registered and the visual tasks analyzed. In work at visual display units (VDU) the eye movements were recorded and standardized questionnaires were given (health, stress, visual work situation). Because of the heterogeneity of the sample only simple statistics were applied: in groups of different visual work the complaints, symptoms, hassles and uplifts were clustered (SAS software) and correlated with the results of the visual tests. Later a special project in 8 companies (676 employees) was carried out. The results were published in . Discomfort and asthenopic symptoms could be seen as an interaction of the combination of tasks and working conditions with the clusters of individual functionalisms, frequently originating in postural compromises. Mainly three causes for stress could be identified: 1. demands inadequate with regard to intensity, resolution, amount and/or time structure; 2. prevention of elementary perceptive needs; 3. entire use of partial capacities of the visual organ. Symptoms also were correlated with heteronomy. Other findings: influence of adaptation/accommodation ratio, the distracting role of attractors, especially in multitasking jobs; influence of high luminance differences. Dry eyes were very common, they could be attributed to a high screen position, low light, monotonous tasks and office
Full Text Available The molecular receptive range (MRR of a mammalian odorant receptor (OR is the set of odorant structures that activate the OR, while the distribution of these odorant structures across odor space is the tuning breadth of the OR. Variation in tuning breadth is thought to be an important property of ORs, with the MRRs of these receptors varying from narrowly to broadly tuned. However, defining the tuning breadth of an OR is a technical challenge. For practical reasons, a screening panel that broadly covers odor space must be limited to sparse coverage of the many potential structures in that space. When screened with such a panel, ORs with different odorant specificities, but equal tuning breadths, might appear to have different tuning breadths due to chance. We hypothesized that ORs would maintain their tuning breadths across distinct odorant panels. We constructed a new screening panel that was broadly distributed across an estimated odor space and contained compounds distinct from previous panels. We used this new screening panel to test several murine ORs that were previously characterized as having different tuning breadths. ORs were expressed in Xenopus laevis oocytes and assayed by two-electrode voltage clamp electrophysiology. MOR256-17, an OR previously characterized as broadly tuned, responded to nine novel compounds from our new screening panel that were structurally diverse and broadly dispersed across an estimated odor space. MOR256-22, an OR previously characterized as narrowly tuned, responded to a single novel compound that was structurally similar to a previously known ligand for this receptor. MOR174-9, a well-characterized receptor with a narrowly tuned MRR, did not respond to any novel compounds in our new panel. These results support the idea that variation in tuning breadth among these three ORs is not an artifact of the screening protocol, but is an intrinsic property of the receptors.
By means of a panel discussion and extensive audience interaction, explore the current challenges and progress to date in applying risk considerations to decisionmaking related to low-level waste. This topic is especially timely because of the proposed legislation pertaining to risk-based decisionmaking and because of the increased emphasis placed on radiological performance assessments of low-level waste disposal.
The panel on RFID security and privacy included Ross Anderson, Jon Callas, Yvo Desmedt, and Kevin Fu. Topics for discussion included the "chip and PIN" EMV payment systems, e-Passports, "mafia" attacks, and RFID-enabled credit cards. Position papers by the panelists appear in the following pages, and the RFID-enabled credit card work appears separately in these proceedings.
Genevieve DAPHIN TANGUY
Full Text Available In this paper a methodology for extremal control of photovoltaic panels has been designed through the use of an embedded polynomial controller using robust approaches and algorithms. Also, a framework for testing solar trackers in a hard ware in the loop (HIL configuration has been established. Efficient gradient based optimization methods were put in place in order to determine the parameters of the employed photovoltaic panel, as well as for computing the Maximum Power Point (MPP. Further a numerical RST controller has been computed in order to allow the panel to follow the movement of the sun to obtain a maximum energetic efficiency. A robustness analysis and correction procedure has been done on the RST polynomial algorithm. The hardware in the loop configuration allows for the development of a test and development platform which can be used for bringing improvements to the current design and also test different control approaches. For this, a microcontroller based solution was chosen. The achieved performances of the closed loop photovoltaic panel (PP system are validated in simulation using the MATLAB / SIMULINK environment and the WinPim & WinReg dedicated software. As it will be seen further in this paper, the extremal control of this design resides in a sequential set of computations used for obtaining the new Maximum Power Point at each change in the system.
Nowobilski, Jeffert J.; Owens, William J.
A thermal insulation panel which is lightweight, load bearing, accommodates thermal stress, and has excellent high temperature insulation capability comprising high performance insulation between thin metal walls supported by high density, high strength glass pegs made in compliance with specified conditions of time, temperature and pressure.
Katzoff, Judith A.
A study prepared by a top-level panel says that current export controls on militarily sensitive U.S. technology may be “overcorrecting” previous weaknesses in that system, resulting in “a complex and confusing control system” that makes it more difficult for U.S. businesses to compete in international markets. Moreover, this control system has “an increasingly corrosive effect” on U.S. relations with allies. The panel recommended that the United States concentrate more effort on bringing about uniformity in the export control policies of countries belonging to the Coordinating Committee on Multilateral Export Controls (CoCom), i.e., most of the member nations in NATO (the North Atlantic Treaty Organization) and Japan.The 21-member panel was appointed by the Committee on Science, Engineering, and Public Policy (COSEPUP), a joint unit of the National Academy of Sciences (NAS), the National Academy of Engineering (NAE), and the Institute of Medicine (IOM). The panel, composed of administrators, researchers, and former government officials, was chaired by AGU member Lew Allen, Jr., director of the Jet Propulsion Laboratory (Pasadena, Calif.) and former chief of staff of the U.S. Air Force. Their report was supported by NAS funds, by a number of private organizations (including AGU), by the U.S. Departments of Commerce, Defense, Energy, and State, by the National Science Foundation, and by the National Aeronautics and Space Administration.
Proceedings of the ASIST Annual Meeting, 2003
Forty-six panels address topics including women in information science; users and usability; information studies; reference services; information policies; standards; interface design; information retrieval; information networks; metadata; shared access; e-commerce in libraries; knowledge organization; information science theories; digitization;…
de Bruijne, M.A.; Wijnant, A.
This article investigates unintended mobile access to surveys in online, probability-based panels. We find that spontaneous tablet usage is drastically increasing in web surveys, while smartphone usage remains low. Further, we analyze the bias of respondent profiles using smartphones and tablets
Panjwani, Manoj Kumar; Panjwani, Suresh Kumar; Mangi, Fareed Hussain; Khan, Danish; Meicheng, Li
The paper examines the impact of the humidity on the Solar panels which makes a space for the drastic variation in the power generated and makes the device less efficient. Humidity readily affects the efficiency of the solar cells and creates a minimal layer of water on its surface. It also decreases the efficiency by 10-20% of the total power output produced. Moreover, to handle this issue, all around characterized measures are required to be taken to guarantee the smooth working of the solar panels utilized in humid areas. In connection with this issue, Karachi, the biggest city of Pakistan which is located near the costal line touching Arabian Sea, was taken as a reference city to measure the humidity range. In Karachi, the average humidity lies between 25-70% (as per Pakistan Meteorological Department PMD), that indirectly leads in decreasing power acquired from a Solar Panel and develops various complexities for the solar system. The system on average experiences stability issues, such as those of power fluctuations etc., due to which, the whole solar system installed observes abnormal variations in acquired power. Silica Gel was used as a desiccant material in order to assure dryness over the solar panel. More than four experiments were conducted with the usage of water absorbent to improve the efficiency and to make system more power efficient.