WorldWideScience

Sample records for expert panel recommendations

  1. Implications of the Recommendations of the Expert Panel on Federal Support to Research and Development

    Directory of Open Access Journals (Sweden)

    Preston Manning

    2012-03-01

    Full Text Available Canada lags behind many of its First World counterparts when it comes to business innovation, and urgently needs to improve its performance if it is to remain competitive and attractive to investment. The Expert Panel Report on Federal Support to Research and Development has recommended several policy initiatives that governments need to enact to close the gap. This paper reviews all six major recommendations made by the Expert Panel and provides thorough assessments of each, with ample consideration given to their implications for the private sector. The two most promising are: (1 the consolidation of research and development spending programs at the federal level and (2 the adoption of smart procurement as a means of spurring innovation in the non-government sector. While some of the other recommendations need refinement and raise concerns about their impact on the economy, the message for government and business is clear: the former can and should facilitate Canadian business innovation by removing tax and regulatory burdens and facilitating better public-private cooperation, while the latter must make innovation a major part of corporate culture. This paper explains the consequences of the Panel’s recommendations for both sectors, identifies the deficiencies, and offers clear-eyed guidance for ameliorating them.

  2. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel.

    Science.gov (United States)

    Döhner, Hartmut; 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

    2017-01-26

    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. © 2017 by The American Society of Hematology.

  3. The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

    Science.gov (United States)

    2013-01-01

    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

  4. Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

    Energy Technology Data Exchange (ETDEWEB)

    Samim, Morsal [University Medical Center Utrecht, Department of Surgery, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Veenendaal, Linde M. van; Braat, Manon N.G.J.A.; Hoven, Andor F. van den; Bosch, Maurice A.A.J. van den; Lam, Marnix G.E.H. [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Hillegersberg, Richard van [University Medical Center Utrecht, Department of Surgery, Utrecht (Netherlands); Sangro, Bruno [Clinica Universidad de Navarra-IDISNA and CIBEREHD, Liver Unit, Pamplona (Spain); Kao, Yung Hsiang [Cabrini Hospital, Department of Nuclear Medicine, Melbourne (Australia); Liu, Dave [Vancouver General Hospital, University of British Columbia, Department of Radiology, Vancouver, British Columbia (Canada); Louie, John D.; Sze, Daniel Y. [Stanford University Medical Center, Division of Interventional Radiology, Stanford (United States); Rose, Steven C. [University of California, Department of Radiology, San Diego (United States); Brown, Daniel B. [Vanderbilt University, Medical Center North, Department of Radiology, Nashville (United States); Ahmadzadehfar, Hojjat [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); Kim, Edward [Icahn School of Medicine at Mount Sinai, Division of Vascular and Interventional Radiology, New York (United States)

    2017-12-15

    Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ({sup 90}Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres {sup 90}Y-RE, and to draw recommendations on activity prescription based on an expert consensus. The variability in activity prescription between centres was investigated by a survey of international experts in the field of {sup 90}Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated. Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum D{sub Target} of 50 Gy was recommended. With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing {sup 90}Y-RE exists. In consensus, D{sub Target} ≤50 Gy is recommended. (orig.)

  5. Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

    International Nuclear Information System (INIS)

    Samim, Morsal; Veenendaal, Linde M. van; Braat, Manon N.G.J.A.; Hoven, Andor F. van den; Bosch, Maurice A.A.J. van den; Lam, Marnix G.E.H.; Hillegersberg, Richard van; Sangro, Bruno; Kao, Yung Hsiang; Liu, Dave; Louie, John D.; Sze, Daniel Y.; Rose, Steven C.; Brown, Daniel B.; Ahmadzadehfar, Hojjat; Kim, Edward

    2017-01-01

    Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ( 90 Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres 90 Y-RE, and to draw recommendations on activity prescription based on an expert consensus. The variability in activity prescription between centres was investigated by a survey of international experts in the field of 90 Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated. Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum D Target of 50 Gy was recommended. With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing 90 Y-RE exists. In consensus, D Target ≤50 Gy is recommended. (orig.)

  6. Expert Panel Recommendations for Hanford Double-Shell Tank Life Extension

    Energy Technology Data Exchange (ETDEWEB)

    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

    2001-06-29

    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.

  7. Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain.

    Science.gov (United States)

    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

    2017-08-01

    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.

  8. High-level panel of experts to recommend future course for IAEA

    International Nuclear Information System (INIS)

    2008-01-01

    Full text: A high-level panel of experts, charged by IAEA Director General Mohamed ElBaradei with making an assessment of the challenges the IAEA will face up to the year 2020 and beyond, holds its initial meetings in Vienna 25 - 26 February. The Commission of Eminent Persons, under the chairmanship of former Mexican President, Ernesto Zedillo, includes 18 senior international figures, and will make recommendations on ways in which the Agency can prepare to meet its expanding workload. The Commission's findings are intended to stimulate further discussion - among Member States, between the States and the IAEA Secretariat, and by the broader public - about the future of the Agency and how best it can contribute in the coming years to the efforts of the international community to achieve development, peace and security, said IAEA Director General Mohamed ElBaradei. The members of the Commission are: Dr. Ernesto Zedillo (Chairman) - Director of the Yale Center for the Study of Globalization; former President of Mexico; Ambassador Oluyemi Adeniji - former Minister of Foreign Affairs, Nigeria; former Member of the Board of Governors of the IAEA; Lakhdar Brahimi - Visiting Scholar at the Institute for Advanced Study, Princeton, New Jersey; former UN Under-Secretary-General, Special Adviser to the Secretary-General, and Chair of the Panel on UN Peace Operations; Lajos Bokros - Professor of Economics and Public Policy, and Chief Operating Officer of the Central European University, Budapest, Hungary; Dr. Rajagopala Chidambaram - Principal Scientific Advisor to the Government of India; DAE Homi Bhabha Professor; former Chairman of the Atomic Energy Commission; former Director of the Bhabha Atomic Research Centre; Senator Lamberto Dini - President of the Foreign Affairs Committee of the Italian Senate; Gareth Evans - President and Chief Executive Officer, International Crisis Group, Brussels; former Australian Foreign Minister 1988-1998; former Minister for Resources and

  9. Magmaris preliminary recommendation upon commercial launch: a consensus from the expert panel on 14 April 2016.

    Science.gov (United States)

    Fajadet, Jean; Haude, Michael; Joner, Michael; Koolen, Jacques; Lee, Michael; Tölg, Ralph; Waksman, Ron

    2016-09-18

    Bioresorbable scaffolds represent an exciting milestone in the development of coronary stent technology with the potential to substantially improve the management of patients with coronary artery disease. In an attempt to provide first recommendations for the technology, experienced experts involved in the first-in-man studies met in Zurich on the 14 April 2016 in order to reach consensus on a responsible market introduction. This document will be updated regularly as new information from clinical trials becomes available and should be understood as a review of current data, opportunities, expectations, advice, and recommendations for future investigations.

  10. Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

    Science.gov (United States)

    Scheuring, Richard A.; Hamilton, Doug; Jones, Jeffrey A.; Alexander, David

    2009-01-01

    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.

  11. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop

    International Nuclear Information System (INIS)

    Fox, Mary A.; Nachman, Keeve E.; Anderson, Breeana; Lam, Juleen

    2016-01-01

    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.

  12. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Mary A., E-mail: mfox9@jhu.edu [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

    2016-06-01

    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.

  13. The Pathway to a Safe and Effective Spaceflight Medication Formulary: Expert Review Panel Recommendations

    Science.gov (United States)

    Daniels, V. R.; Bayuse, T. M.; Mulcahy, R. A.; McGuire, R. K. M.; Antonsen, E. L.

    2018-01-01

    Exploration spaceflight poses several challenges to the provision of a comprehensive medication formulary. This formulary must accommodate the size and space limitations of the spacecraft, while addressing individual medication needs and preferences of the crew, consequences of a degrading inventory over time, the inability to resupply used or expired medications, and the need to forecast the best possible medication candidates to treat conditions that may occur. The Exploration Medical Capability (ExMC) Element's Pharmacy Project Team has developed a research plan (RP) that is focused on evidence-based models and theories as well as new diagnostic tools, treatments, or preventive measures aimed to ensure an available, safe, and effective pharmacy sufficient to manage potential medical threats during exploration spaceflight. Here, we will discuss the ways in which the ExMC Pharmacy Project Team pursued expert evaluation and guidance, and incorporated acquired insight into an achievable research pathway, reflected in the revised RP.

  14. Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel.

    Science.gov (United States)

    Bonta, Peter I; Chanez, Pascal; Annema, Jouke T; Shah, Pallav L; Niven, Robert

    2018-01-01

    Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined

  15. Expert Panel Elicitation

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, M. [Swedish Radiation Protection Authority, Stockholm (Sweden). Dept. of Waste Management and Environmental Protection; Hora, S.C. [Univ. of Hawaii, Hilo, HI (United States)

    2005-09-15

    Scientists are now frequently in a situation where data cannot be easily assessed, since they may have conflicting or uncertain sources. While expert judgment reflects private choices, it is possible both reduce the personal aspect as well as in crease confidence in the judgments by using formal protocols for choice and elicitation of experts. A full-scale elicitation made on seismicity following glaciation, now in its late phase and presented here in a preliminary form, illustrates the value of the technique and some essential issues in connection with the decision to launch such a project. The results show an unusual low variation between the experts.

  16. ExpertFOAF recommends experts

    DEFF Research Database (Denmark)

    Iofcu, Tereza; Diederich, Joerg; Dolog, Peter

    2007-01-01

    FOAF files are often used for publishing simple information about persons and about their community. Our proposal is to extend the user's FOAF files with automatically generated user profiles, which are based on a histogram of the user's interest and which are also semantically enriched using...... recommender systems for finding users with similar interests and, hence, expertise in different domains. We consider a well-defined user profile to express best the user's current interests in a domain, where the domain (such as the research environment with students and professors) is defined by a collection...

  17. Aflibercept treatment for neovascular AMD beyond the first year: consensus recommendations by a UK expert roundtable panel, 2017 update

    Directory of Open Access Journals (Sweden)

    Patel PJ

    2017-11-01

    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

  18. Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

    Directory of Open Access Journals (Sweden)

    Baiju Ahemmed

    2017-01-01

    Full Text Available 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.

  19. [Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel].

    Science.gov (United States)

    Granacher, U; Muehlbauer, T; Gschwind, Y J; Pfenninger, B; Kressig, R W

    2014-08-01

    The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

  20. Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

    Science.gov (United States)

    Ahemmed, Baiju; Sundarapandian, Vani; Gutgutia, Rohit; Balasubramanyam, Sathya; Jagtap, Richa; Biliangady, Reeta; Gupta, Priti; Jadhav, Sachin; Satwik, Ruma; Thakor, Priti

    2017-01-01

    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. PMID:28246628

  1. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.

    Science.gov (United States)

    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

    2017-10-01

    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.

  2. Geothermal Technologies Program Blue Ribbon Panel Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2011-06-17

    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

  3. Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients: Consensus Recommendations from a Children’s Oncology Group Expert Panel

    Science.gov (United States)

    Landier, Wendy; Ahern, JoAnn; Barakat, Lamia P.; Bhatia, Smita; Bingen, Kristin M.; Bondurant, Patricia G.; Cohn, Susan L.; Dobrozsi, Sarah K.; Haugen, Maureen; Herring, Ruth Anne; Hooke, Mary C.; Martin, Melissa; Murphy, Kathryn; Newman, Amy R.; Rodgers, Cheryl C.; Ruccione, Kathleen S.; Sullivan, Jeneane; Weiss, Marianne; Withycombe, Janice; Yasui, Lise; Hockenberry, Marilyn

    2016-01-01

    There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children’s Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology. PMID:27385664

  4. The Art of Sharing the Diagnosis and Management of Alzheimer's Disease With Patients and Caregivers: Recommendations of an Expert Consensus Panel

    Science.gov (United States)

    Christensen, Daniel D.; Griffith, Patrick A.; Kerwin, Diana R.; Hunt, Gail; Hall, Eric J.

    2010-01-01

    Objective: To develop a set of recommendations for primary care physicians (PCPs) suggesting how best to communicate with patients, caregivers, and other family members regarding the diagnosis and management of Alzheimer's disease (AD). Participants: A national roundtable of 6 leading professionals involved in treating or advocating for patients with AD was convened on March 14, 2008. This roundtable included 4 leading academic physicians with diverse backgrounds (a geriatric psychiatrist, a neuropsychiatrist, a neurologist, and a geriatrician) from geographically diverse regions of the United States, who were invited on the basis of their national reputation in the field and experience working with minority populations with dementia; the executive director of a national AD advocacy organization; the executive director of a national advocacy organization for caregivers; and a medical correspondent with expertise in interviewing and small group leadership. Evidence: Expert opinion supported by academic literature (search limited to PubMed, English language, 1996–2008, search terms: Alzheimer's disease, primary care, diagnosis, management, caregiver, family, patient-physician relationship). Consensus Process: Moderated dialogue aimed at generating consensus opinion; only statements endorsed by all authors were included in the final article. Conclusions: Diagnosis and management of AD by PCPs, utilizing specialist consultation as needed, may contribute to earlier diagnosis and treatment, improved doctor-patient and doctor-caregiver communication, increased attention to caregiver needs, and better clinical and quality-of-life outcomes for patients and caregivers. A set of expert panel recommendations describing practical strategies for achieving these goals was successfully developed. PMID:20582302

  5. Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts.

    Science.gov (United States)

    Androudi, Sofia; Dastiridou, Anna; Pharmakakis, Nikolaos; Stefaniotou, Maria; Kalogeropoulos, Christos; Symeonidis, Chrysanthos; Charonis, Alexandros; Tsilimbaris, Miltiadis

    2016-05-01

    To propose guidelines for the management of patients with wet age-related macular degeneration (wAMD), taking into account the results of large multicenter studies and clinical experience of retina experts. A team of retina experts developed a consensus paper after three consecutive meetings. The group was focused on guidelines to help clinical decision-making around the definition of successful treatment and the definition of non-response to therapy. Parameters suggestive of a successful response to treatments included: any gain in best corrected visual acuity (BCVA) or vision loss that is less than 5-10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, reduction of central retinal thickness, partial or complete absorption of subretinal fluid (SRF), reduction of intraretinal fluid, reduction of pigment epithelial detachment or restoration of the anatomy of outer retinal layers. Non-response to current treatment was considered in the case of loss of BCVA greater than 10 ETDRS letters, increased retinal edema or increase of SRF as evidenced by optical coherence tomography or new bleeding in biomicroscopy. The introduction of anti-VEGF agents revolutionized the treatment of wAMD. Given the complexity of the disease, the emerging new agents and the difference of cases recruited in clinical trials compared to those appearing in every-day practice, it is essential to individualize treatment options taking into account the results of clinical trials.

  6. Diagnosis and management of acute myeloid leukemia in children and adolescents : recommendations from an international expert panel

    NARCIS (Netherlands)

    Creutzig, Ursula; van den Heuvel-Eibrink, Marry M.; Gibson, Brenda; Dworzak, Michael N.; Adachi, Souichi; de Bont, Eveline; Harbott, Jochen; Hasle, Henrik; Johnston, Donna; Kinoshita, Akitoshi; Lehrnbecher, Thomas; Leverger, Guy; Mejstrikova, Ester; Meshinchi, Soheil; Pession, Andrea; Raimondi, Susana C.; Sung, Lillian; Stary, Jan; Zwaan, Christian M.; Kaspers, Gertjan J. L.; Reinhardt, Dirk

    2012-01-01

    Despite major improvements in outcome over the past decades, acute myeloid leukemia (AML)remains a life-threatening malignancy in children, with current survival rates of similar to 70%. State-of-the-art recommendations in adult AML have recently been published in this journal by Dohner et al. The

  7. Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts.

    Science.gov (United States)

    Calabrese, Emma; Maaser, Christian; Zorzi, Francesca; Kannengiesser, Klaus; Hanauer, Stephen B; Bruining, David H; Iacucci, Marietta; Maconi, Giovanni; Novak, Kerri L; Panaccione, Remo; Strobel, Deike; Wilson, Stephanie R; Watanabe, Mamoru; Pallone, Francesco; Ghosh, Subrata

    2016-05-01

    Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use. Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English. The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent. Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.

  8. 21 CFR 516.141 - Qualified expert panels.

    Science.gov (United States)

    2010-04-01

    ... choose members for the qualified expert panel in accordance with selection criteria listed in paragraph... whether the proposed qualified expert panel meets the selection criteria prior to the panel beginning its... Committee Act, as amended, 5 U.S.C. App. (b) Criteria for the selection of a qualified expert panel. (1) A...

  9. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

    Science.gov (United States)

    Black, Robert E; Taylor, Carl E; Arole, Shobha; Bang, Abhay; Bhutta, Zulfiqar A; Chowdhury, A Mushtaque R; Kirkwood, Betty R; Kureshy, Nazo; Lanata, Claudio F; Phillips, James F; Taylor, Mary; Victora, Cesar G; Zhu, Zonghan; Perry, Henry B

    2017-01-01

    Background The contributions that community–based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health–related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. Methods An Expert Panel convened to guide the review of the effectiveness of community–based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review’s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer–reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). Results The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs – through engagement with

  10. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel.

    Science.gov (United States)

    Black, Robert E; Taylor, Carl E; Arole, Shobha; Bang, Abhay; Bhutta, Zulfiqar A; Chowdhury, A Mushtaque R; Kirkwood, Betty R; Kureshy, Nazo; Lanata, Claudio F; Phillips, James F; Taylor, Mary; Victora, Cesar G; Zhu, Zonghan; Perry, Henry B

    2017-06-01

    The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the

  11. TWRS vadose zone contamination issue expert panel report

    Energy Technology Data Exchange (ETDEWEB)

    Shafer, D.S.

    1997-05-01

    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

  12. TWRS vadose zone contamination issue expert panel status report

    International Nuclear Information System (INIS)

    Shafer, D.S.

    1997-01-01

    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

  13. Teaching statistics to nursing students: an expert panel consensus.

    Science.gov (United States)

    Hayat, Matthew J; Eckardt, Patricia; Higgins, Melinda; Kim, MyoungJin; Schmiege, Sarah J

    2013-06-01

    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.

  14. Osteoporosis in Latin America: panel expert review

    Directory of Open Access Journals (Sweden)

    Patricia Clark

    2013-09-01

    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.

  15. Glyphosate rodent carcinogenicity bioassay expert panel review.

    Science.gov (United States)

    Williams, Gary M; Berry, Colin; Burns, Michele; de Camargo, Joao Lauro Viana; Greim, Helmut

    2016-09-01

    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.

  16. Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel

    Science.gov (United States)

    Fregni, F; Nitsche, MA; Loo, C.K.; Brunoni, AR; Marangolo, P; Leite, J; Carvalho, S; Bolognini, N; Caumo, W; Paik, NJ; Simis, M; Ueda, K; Ekhitari, H; Luu, P; Tucker, DM; Tyler, WJ; Brunelin, J; Datta, A; Juan, CH; Venkatasubramanian, G; Boggio, PS; Bikson, M

    2014-01-01

    The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials. PMID:25983531

  17. How to Meet the Last OIE Expert Surveillance Panel Recommendations on Equine Influenza (EI Vaccine Composition: A Review of the Process Required for the Recombinant Canarypox-Based EI Vaccine

    Directory of Open Access Journals (Sweden)

    Romain Paillot

    2016-11-01

    Full Text Available 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.

  18. Fifth Single-Shell Tank Integrity Project Expert Panel Meeting August 28-29, 2014

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Todd M. [Washington River Protection Solutions, LLC, Richland, WA (United States; Gunter, Jason R. [Washington River Protection Solutions, LLC, Richland, WA (United States); Boomer, Kayle D. [Washington River Protection Solutions, LLC, Richland, WA (United States)

    2015-01-07

    On August 28th and 29th, 2014 the Single-Shell Tank Integrity Project (SSTIP) Expert Panel (Panel) convened in Richland, Washington. This was the Panel’s first meeting since 2011 and, as a result, was focused primarily on updating the Panel on progress in response to the past recommendations (Single-Shell Tank Integrity Expert Panel Report, RPP-RPT-45921, Rev 0, May 2010). This letter documents the Panel’s discussions and feedback on Phase I activities and results.

  19. Application of Delphi expert panel in joint venture projects

    Science.gov (United States)

    Adnan, H.; Rosman, M. R.; Rashid, Z. Z. Ahmad; Mohamad Yusuwan, N.; Bakhary, N. A.

    2018-02-01

    This study was conducted with the aim to identify the application of the Delphi Technique in validating findings obtained from questionnaire surveys and interviews done in- depth on the subject of joint venture projects in Malaysia. The Delphi technique aims to achieve a consensus of opinion amongst expert panellist that were selected on the primary factors in JV projects. To achieve research objectives, a progressive series of questions was designed where a selected panel of expert to confirm and validate the final findings. The rationale, benefits, limitations and recommendations for the use of Delphi were given in this study. From the literature review done, twenty-one factors were identified as critical factors to the making any joint venture project successful. Detail information from contractors were obtained by using the questionnaire survey method and forty-three in-depth interviews were carried out. Trust between partners, mutual understanding, partner selection criteria, agreement of contract, objective compatibility, conflict, and commitment were confirmed by the Delphi panel to be the critical success factors besides another fourteen factors which were found to be the Failure Reduction Criteria. Delphi techniques has proven to successfully assist in recognising the main factors and would be beneficial in supplementing the success of joint venture arrangements application for construction projects in Malaysia.

  20. 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

    DEFF Research Database (Denmark)

    Sidiropoulos, P.I.; Hatemi, G.; Song, I.H.

    2008-01-01

    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 ...... of rheumatologists may improve their dissemination and implementation in daily clinical practice....

  1. Expert panel on hydrogeology; report to AECL Research (1992)

    International Nuclear Information System (INIS)

    Domenico, P.A.; Grisak, G.E.; Schwartz, F.W.

    1995-02-01

    In 1992 AECL Research convened a panel of external hydrogeological experts consisting of P.A. Domenico, G.E. Grisak, and F.W. Schwartz, to review AECL's proposed approach to siting a geological repository in the rocks of the Canadian Shield for the safe disposal of Canada's nuclear fuel wastes. In particular the panel was asked to provide its opinion on 1) the soundness of the technical approach developed to characterize the groundwater flow systems for the purpose of selecting a location for a disposal vault, 2) the validity and effectiveness of the geological case study used to demonstrate the performance assessment methodology based on the hydrogeological conditions observed at the Whiteshell Research Area, and 3) the adequacy of the hydrogeological information that AECL proposes to use in its Environmental Impact Statement (EIS) of the disposal concept. This report presents the findings, conclusions and recommendations of the hydrogeology review panel. The report was submitted to AECL Research in 1992 December. (author). 24 refs., 2 tabs., 4 figs

  2. 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

    Directory of Open Access Journals (Sweden)

    Nelson Spector

    2008-04-01

    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.

  3. Environmental factors and puberty timing: Expert panel research needs

    Science.gov (United States)

    An expert panel reviewed the literature on endocrine disrupting chemicals (EDCs), body size and puberty. The panel concluded that available experimental animal and human data support a possible role of EDCs and body size in relation to alterations in pubertal onset and progressio...

  4. Expert Panel Elicitation of Seismicity Following Glaciation in Sweden

    International Nuclear Information System (INIS)

    Hora, Stephen; Jensen, Mikael

    2005-12-01

    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

  5. Expert Panel Elicitation of Seismicity Following Glaciation in Sweden

    Energy Technology Data Exchange (ETDEWEB)

    Hora, Stephen; Jensen, Mikael (eds.)

    2005-12-15

    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.

  6. Environmental factors and puberty timing: expert panel research needs

    DEFF Research Database (Denmark)

    Louis, G.M. Buck; Jr, L.E. Gray; Marcus, M.

    2008-01-01

    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......, body size, and puberty. The panel concluded that available experimental animal and human data support a possible role of endocrine-disrupting chemicals and body size in relation to alterations in pubertal onset and progression in boys and girls. Critical data gaps prioritized for future research......, and (3) basic research to identify the primary signal(s) for the onset of gonadotropin-releasing hormone-dependent/central puberty and gonadotropin-releasing hormone-independent/peripheral puberty. Prospective studies of couples who are planning pregnancies or pregnant women are needed to capture...

  7. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations.

    Science.gov (United States)

    Urdiales-Gálvez, Fernando; Delgado, Nuria Escoda; Figueiredo, Vitor; Lajo-Plaza, José V; Mira, Mar; Moreno, Antonio; Ortíz-Martí, Francisco; Del Rio-Reyes, Rosa; Romero-Álvarez, Nazaret; Del Cueto, Sofía Ruiz; Segurado, María A; Rebenaque, Cristina Villanueva

    2018-04-01

    Dermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert consensus report is to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance. A multidisciplinary group of experts in esthetic treatments convened to discuss the management of the complications associated with dermal fillers use. A search was performed for English, French, and Spanish language articles in MEDLINE, the Cochrane Database, and Google Scholar using the search terms "complications" OR "soft filler complications" OR "injectable complications" AND "dermal fillers" AND "Therapy". An initial document was drafted by the Coordinating Committee, and it was reviewed and modified by the experts, until a final text was agreed upon and validated. The panel addressed consensus recommendations about the classification of filler complications according to the time of onset and about the clinical management of different complications including bruising, swelling, edema, infections, lumps and bumps, skin discoloration, and biofilm formation. Special attention was paid to vascular compromise and retinal artery occlusion. Clinicians should be fully aware of the signs and symptoms related to complications and be prepared to confidently treat them. Establishing action protocols for emergencies, with agents readily available in the office, would reduce the severity of adverse outcomes associated with injection of hyaluronic acid fillers in the cosmetic setting. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for clinicians who are starting to use dermal fillers. Additionally, this document provides a better understanding about the diagnoses and management of complications if they do occur. This journal requires that authors assign a level of evidence to each

  8. IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

    Directory of Open Access Journals (Sweden)

    Yutskovskaya Y

    2015-06-01

    . 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

  9. 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).

    Science.gov (United States)

    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

    2016-12-01

    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.

  10. Toxicity management of angiogenesis inhibitors: resolution of expert panel

    Directory of Open Access Journals (Sweden)

    Pavel O. Rumiantsev

    2017-12-01

    Full Text Available On 22 June 2017 in St. Petersburg the expert panel was held on the topic “Management of toxicity of angiogenesis inhibitors”, which discussed current issues of systemic therapy of advanced differentiated thyroid cancer resistant to radioactive iodine therapy, advanced kidney cancer and questions of efficacy and safety of new target drugs in the treatment of these diseases. The reports and discussions of experts raised the following questions: 1. Own experience of using lenvatinib in patients with differentiated thyroid cancer refractory to therapy with radioactive iodine and kidney cancer. 2. Profile of efficacy and safety of modern targeted therapy with multikinase inhibitors. 3. Prophylaxis and management of predictable toxicity.

  11. Main findings, conclusions and recommendations of the Ignalina Safety Panel

    International Nuclear Information System (INIS)

    Birkhofer, A.

    1999-01-01

    Ignalina Safety Panel was created to define, monitor and supervise the scope and production of the Ignalina Safety Analysis Report (SAR) and its Review (RSR); to review results of in-depth safety assessment addressing important contradictory statements; to give Lithuanian Government recommendations in view of further licensing process. In this paper General and Specific Recommendations provided by the Panel are presented

  12. Government of Canada response to the report of the Expert Review Panel on medical isotope production

    International Nuclear Information System (INIS)

    Paradis, C.

    2010-01-01

    Recent supply disruptions have highlighted the fragility of the supply chain that delivers essential medical isotopes to patients globally. A new and more reliable way of supplying isotopes to Canadians needs to be found. That is why the Government of Canada established the Expert Review Panel on Medical Isotope Production (the Panel) in June 2009. The Government recognizes the relatively long lead times associated with the development of any new source of medical. isotopes. To ensure that appropriate action is taken now for the long term, the Government tasked the Panel with reporting to the Minister. of Natural Resources on its assessment of the most viable options for securing supplies of technetium-99m (Tc99r) for the Canadian health care system over the medium and long term and the actions that may be required by governments and others to facilitate realization of these options. The Panel reported to the Minister of Natural Resources on November 30, 2009. Since then, the Government has been carefully considering the recommendations of the Panel within the context of the broader nuclear and health care landscape. What follows is the Government's response to the Panel's thoughtful, comprehensive and insightful report, including actions that are planned based on its recommendations. (author)

  13. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II).

    Science.gov (United States)

    Carrascosa, J M; Galán, M; de Lucas, R; Pérez-Ferriols, A; Ribera, M; Yanguas, I

    2016-11-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-07-01

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

  15. Curricular priorities for business ethics in medical practice and research: recommendations from Delphi consensus panels.

    Science.gov (United States)

    DuBois, James M; Kraus, Elena M; Gursahani, Kamal; Mikulec, Anthony; Bakanas, Erin

    2014-11-15

    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.

  16. Exploring the role and function of trial steering committees: results of an expert panel meeting.

    Science.gov (United States)

    Harman, Nicola L; Conroy, Elizabeth J; Lewis, Steff C; Murray, Gordon; Norrie, John; Sydes, Matt R; Lane, J Athene; Altman, Douglas G; Baigent, Colin; Bliss, Judith M; Campbell, Marion K; Elbourne, Diana; Evans, Stephen; Sandercock, Peter; Gamble, Carrol

    2015-12-30

    The independent oversight of clinical trials, which is recommended by the Medical Research Council (MRC) Guidelines for Good Clinical Practice, is typically provided by an independent advisory Data Monitoring Committee (DMC) and an independent executive committee, to whom the DMC makes recommendations. The detailed roles and function of this executive committee, known as the Trial Steering Committee (TSC), have not previously been studied or reviewed since those originally proposed by the MRC in 1998. An expert panel (n = 7) was convened comprising statisticians, clinicians and trial methodologists with prior TSC experience. Twelve questions about the role and responsibilities of the TSC were discussed by the panel at two full-day meetings. Each meeting was transcribed in full and the discussions were summarised. The expert panel reached agreement on the role of the TSC, to which it was accountable, the membership, the definition of independence, and the experience and training needed. The management of ethical issues, difficult/complex situations and issues the TSC should not ask the DMC to make recommendations on were more difficult to discuss without specific examples, but support existed for further work to help share issues and to provide appropriate training for TSC members. Additional topics discussed, which had not been identified by previous work relating to the DMCs but were pertinent to the role of the TSC, included the following: review of data sharing requests, indemnity, lifespan of the TSC, general TSC administration, and the roles of both the Funder and the Sponsor. This paper presents recommendations that will contribute to the revision and update of the MRC TSC terms of reference. Uncertainty remains in some areas due to the absence of real-life examples; future guidance on these issues would benefit from a repository of case studies. Notably, the role of a patient and public involvement (PPI) contributor was not discussed, and further work is

  17. Patient engagement with surgical site infection prevention: an expert panel perspective

    Directory of Open Access Journals (Sweden)

    E. Tartari

    2017-05-01

    Full Text Available Abstract Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

  18. Patient engagement with surgical site infection prevention: an expert panel perspective.

    Science.gov (United States)

    Tartari, E; Weterings, V; Gastmeier, P; Rodríguez Baño, J; Widmer, A; Kluytmans, J; Voss, A

    2017-01-01

    Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

  19. 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

    NARCIS (Netherlands)

    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

    2012-01-01

    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

  20. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

    Science.gov (United States)

    Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

    2017-02-01

    Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. A quick and selected overview of the expert panel on effective ways of investing in health.

    Science.gov (United States)

    Barros, Pedro Pita

    2017-01-01

    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.

  2. PERSON-Personalized Expert Recommendation System for Optimized Nutrition.

    Science.gov (United States)

    Chen, Chih-Han; Karvela, Maria; Sohbati, Mohammadreza; Shinawatra, Thaksin; Toumazou, Christofer

    2018-02-01

    The rise of personalized diets is due to the emergence of nutrigenetics and genetic tests services. However, the recommendation system is far from mature to provide personalized food suggestion to consumers for daily usage. The main barrier of connecting genetic information to personalized diets is the complexity of data and the scalability of the applied systems. Aiming to cross such barriers and provide direct applications, a personalized expert recommendation system for optimized nutrition is introduced in this paper, which performs direct to consumer personalized grocery product filtering and recommendation. Deep learning neural network model is applied to achieve automatic product categorization. The ability of scaling with unknown new data is achieved through the generalized representation of word embedding. Furthermore, the categorized products are filtered with a model based on individual genetic data with associated phenotypic information and a case study with databases from three different sources is carried out to confirm the system.

  3. Comprehensive embryo testing. Experts' opinions regarding future directions: an expert panel study on comprehensive embryo testing.

    Science.gov (United States)

    Hens, Kristien; Dondorp, Wybo J; Geraedts, Joep P M; de Wert, Guido M

    2013-05-01

    What do scientists in the field of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) consider to be the future direction of comprehensive embryo testing? Although there are many biological and technical limitations, as well as uncertainties regarding the meaning of genetic variation, comprehensive embryo testing will impact the IVF/PGD practice and a timely ethical reflection is needed. Comprehensive testing using microarrays is currently being introduced in the context of PGD and PGS, and it is to be expected that whole-genome sequencing will also follow. Current ethical and empirical sociological research on embryo testing focuses on PGD as it is practiced now. However, empirical research and systematic reflection regarding the impact of comprehensive techniques for embryo testing is missing. In order to understand the potential of this technology and to be able to adequately foresee its implications, we held an expert panel with seven pioneers in PGD. We conducted an expert panel in October 2011 with seven PGD pioneers from Belgium, The Netherlands, Germany and the UK. Participants expected the use of comprehensive techniques in the context of PGD. However, the introduction of these techniques in embryo testing requires timely ethical reflection as it involves a shift from choosing an embryo without a particular genetic disease (i.e. PGD) or most likely to result in a successful pregnancy (i.e. PGS) to choosing the best embryo based on a much wider set of criteria. Such ethical reflection should take account of current technical and biological limitations and also of current uncertainties with regard to the meaning of genetic variance. However, ethicists should also not be afraid to look into the future. There was a general agreement that embryo testing will be increasingly preceded by comprehensive preconception screening, thus enabling smart combinations of genetic testing. The group was composed of seven participants from

  4. Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD Expert Meeting.

    Science.gov (United States)

    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

    2013-01-01

    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.

  5. Status report : Terra Nova project environmental assessment panel : recommendations

    International Nuclear Information System (INIS)

    2002-01-01

    An application to the Canada-Newfoundland Offshore Petroleum Board (CNOPB) was submitted by Petro-Canada on August 5, 1996, notifying of its intent to develop the petroleum resources located at the Terra Nova field. The provincial and federal governments jointly appointed the Terra Nova Project Environmental Panel, and the board of the CNOPB referred to it the application documents for review. The environmental effects, considerations of human safety incorporated into the design and operation of the Project, the general approach to the development and exploitation of the petroleum resources, and the employment and industrial benefits expected to be derived from the Project were the issues under review by the Panel. On April 22, 1997, public hearings into the review began, and the final report was submitted to governments and the Board in August 1997. The report included 75 recommendations. The Project was approved in Decision 97.02 in December 1997, and the Board dealt with each of the recommendations. The respective positions of the Governments of Canada and Newfoundland and Labrador with regard to the recommendations that fell outside the jurisdiction of the Board were made public. A status report on every one of the 75 recommendations is provided in the present report. The recommendation is repeated, the verbatim response taken from Decision 97.02 included, followed by the status of the response. The production operations phase of the Project accounts for approximately 65 per cent of the recommendations. January 20, 2002 was the date the Project was begun

  6. Breast carcinoma during pregnancy. International recommendations from an expert meeting.

    Science.gov (United States)

    Loibl, Sibylle; von Minckwitz, Gunter; Gwyn, Karin; Ellis, Paul; Blohmer, Jens U; Schlegelberger, Brigitte; Keller, Monika; Harder, Sebastian; Theriault, Richard L; Crivellari, Diana; Klingebiel, Thomas; Louwen, Frank; Kaufmann, Manfred

    2006-01-15

    Breast carcinoma during pregnancy (BCP) is a difficult clinical situation, as it appears to put the health of the mother in conflict with that of the fetus. An international expert meeting was conducted to form guidelines on how to diagnose and treat women with BCP. The goal for treatment of the pregnant woman with breast carcinoma is the same as that of the nonpregnant breast carcinoma patient: local control of disease and prevention of systemic metastases. However, certain treatment modalities need to be modified because of the potential for adverse effects on the fetus. There is evidence to support the safety of anthracycline-based chemotherapy during the second and third trimesters of pregnancy (Oxford Level of Evidence [LOE] 2b). Because of the lack of evidence, the expert opinion was not to recommend the routine use of newer cytotoxic drugs like the taxanes during pregnancy (LOE 5). The recommendations provided should help to reach informed decision making by the patient. The ongoing prospective collection of data on BCP, such as that at the University of Texas M.D. Anderson Cancer Center (UTMDACC) and that of the German Breast Group/Breast International Group (GBG/BIG), is necessary to further our knowledge regarding the treatment of this unique group of breast carcinoma patients.

  7. Endoscopic Lung Volume Reduction : An Expert Panel Recommendation

    NARCIS (Netherlands)

    Herth, Felix J. F.; Slebos, Dirk-Jan; Rabe, Klaus F.; Shah, Pallav L.

    2016-01-01

    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

  8. Endoscopic Lung Volume Reduction : An Expert Panel Recommendation - Update 2017

    NARCIS (Netherlands)

    Herth, Felix J. F.; Slebos, Dirk-Jan; Criner, Gerard J.; Shah, Pallav L.

    2017-01-01

    Interest in endoscopic lung volume reduction (ELVR) technologies for emphysema is consistently growing. In the last couple of months, several endoscopic options (e.g., endo-or intrabronchial valves, coil implants, and thermal vapor ablation) that have been evaluated in randomized controlled trials

  9. An expert panel approach to support risk-informed decision making

    International Nuclear Information System (INIS)

    Pulkkinen, U.; Simola, K.

    2000-01-01

    The report describes the expert panel methodology developed for supporting risk-informed decision making. The aim of an expert panel is to achieve a balanced utilisation of information and expertise from several disciplines in decision-making including probabilistic safety assessment as one decision criterion. We also summarise the application of the methodology in the STUK's RI-ISI (Risk-Informed In-Service Inspection) pilot study, where the expert panel approach was used to combine the deterministic information on degradation mechanisms and probabilistic information on pipe break consequences. The expert panel served both as a critical review of the preliminary results and as a decision support for the final definition of risk categories of piping. (orig.)

  10. Health Economics of Dengue: A Systematic Literature Review and Expert Panel's Assessment

    Science.gov (United States)

    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.

    2011-01-01

    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

  11. DELPHI expert panel evaluation of Hanford high level waste tank failure modes and release quantities

    Energy Technology Data Exchange (ETDEWEB)

    Dunford, G.L.; Han, F.C.

    1996-09-30

    The Failure Modes and Release Quantities of the Hanford High Level Waste Tanks due to postulated accident loads were established by a DELPHI Expert Panel consisting of both on-site and off-site experts in the field of Structure and Release. The Report presents the evaluation process, accident loads, tank structural failure conclusion reached by the panel during the two-day meeting.

  12. Management of immune thrombocytopenia: Korean experts recommendation in 2017.

    Science.gov (United States)

    Jang, Jun Ho; Kim, Ji Yoon; Mun, Yeung-Chul; Bang, Soo-Mee; Lim, Yeon Jung; Shin, Dong-Yeop; Choi, Young Bae; Yhim, Ho-Young; Lee, Jong Wook; Kook, Hoon

    2017-12-01

    Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.

  13. Expert panel on additional cross subsidisation. Considering arguments and providing expert opinion

    International Nuclear Information System (INIS)

    Faber, J.; Nelissen, D.; Lowe, S.; Mason, A.

    2007-10-01

    market share on markets where they compete directly with EU based airlines by undercutting fares on these markets, subsidising potential losses on these markets by increased prices on routes at which they do not compete with EU airlines, and thus increase their total profits. As part of the project, a panel of experts will be contacted to provide input to the study. This note elaborates the input that we ask for. But first, it provides an analytical background on the study

  14. The healthy food environment policy index: findings of an expert panel in New Zealand.

    Science.gov (United States)

    Vandevijvere, Stefanie; Dominick, Clare; Devi, Anandita; Swinburn, Boyd

    2015-05-01

    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.

  15. Risk Management Post-Marketing Surveillance for the Abuse of Medications Acting on the Central Nervous System: Expert Panel Report

    Science.gov (United States)

    Johanson, Chris-Ellyn; Balster, Robert L.; Henningfield, Jack E.; Schuster, Charles R.; Anthony, James C.; Barthwell, Andrea G.; Coleman, John J.; Dart, Richard C.; Gorodetzky, Charles W.; O’Keeffe, Charles; Sellers, Edward M.; Vocci, Frank; Walsh, Sharon L.

    2010-01-01

    The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October, 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and eleven recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized. PMID:19783383

  16. Poor Agreement Among Expert Witnesses in Bile Duct Injury Malpractice Litigation An Expert Panel Survey

    NARCIS (Netherlands)

    de Reuver, Philip R.; Dijkgraaf, Marcel G. W.; Gevers, Sjef K. M.; Gouma, Dirk J.

    2008-01-01

    Objective: To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. Background Data: Malpractice litigation is an increasing concern in modem surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to

  17. Poor agreement among expert witnesses in bile duct injury malpractice litigation: an expert panel survey.

    NARCIS (Netherlands)

    Reuver, P.R. de; Dijkgraaf, M.G.; Gevers, S.K.; Gouma, D.J.; Bleichrodt, R.P.; Cuesta, M.A.; Erp, W.F. van; Gerritsen, J.; Hesselink, E.J.; Laarhoven, C.J.H.M. van; Lange, J. de; Obertop, H.; Stassen, L.P.; Terpstra, O.T.; Tilanus, H.W.; Vroonhoven, T.J.; Wit, L. de

    2008-01-01

    OBJECTIVE: To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. BACKGROUND DATA: Malpractice litigation is an increasing concern in modern surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to

  18. Environmental factors and puberty timing: expert panel research needs

    DEFF Research Database (Denmark)

    Louis, G.M. Buck; Jr, L.E. Gray; Marcus, M.

    2008-01-01

    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......, body size, and puberty. The panel concluded that available experimental animal and human data support a possible role of endocrine-disrupting chemicals and body size in relation to alterations in pubertal onset and progression in boys and girls. Critical data gaps prioritized for future research...

  19. Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

    Science.gov (United States)

    Wahidi, Momen M; Herth, Felix; Yasufuku, Kazuhiro; Shepherd, Ray Wesley; Yarmus, Lonny; Chawla, Mohit; Lamb, Carla; Casey, Kenneth R; Patel, Sheena; Silvestri, Gerard A; Feller-Kopman, David J

    2016-03-01

    Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

  20. [Consensus statement on the clinical management of non-AIDS defining malignancies. GeSIDA expert panel].

    Science.gov (United States)

    Santos, Jesús; Valencia, Eulalia

    2014-10-01

    This consensus document has been prepared by a panel of experts appointed by GeSIDA. This paper reviews the recommendations on the most important non-AIDS defining malignancies that can affect patients living with AIDS. Lung cancer, hepatocellular carcinoma, anal carcinoma and other less frequent malignancies such as breast, prostate, vagina or colon cancers are reviewed. The aim of the recommendations is to make clinicians who attend to this patients aware of how to prevent, diagnose and treat this diseases. The recommendations for the use of antiretroviral therapy when the patient develops a malignancy are also presented. In support of the recommendations we have used the modified criteria of the Infectious Diseases Society of America. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  1. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts

    NARCIS (Netherlands)

    Vonk Noordegraaf, A.; Huirne, J.A.F.; Brölmann, H.A.M.; van Mechelen, W.; Anema, J.R.

    2011-01-01

    Objective: To generate structured detailed uniform convalescence recommendations after gynaecological surgery by a modified Delphi method amongst experts and a representative group of physicians. Design: Modified Delphi study. Setting: Expert physicians recruited by their respective medical boards

  2. Treatment of Childhood and Adolescent Obesity: An Integrative Review of Recent Recommendations from Five Expert Groups

    Science.gov (United States)

    Kirschenbaum, Daniel S.; Gierut, Kristen

    2013-01-01

    Objective: To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. Method: We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and…

  3. When Patients Write the Guidelines: Patient Panel Recommendations for the Treatment of Rheumatoid Arthritis.

    Science.gov (United States)

    Fraenkel, Liana; Miller, Amy S; Clayton, Kelly; Crow-Hercher, Rachelle; Hazel, Shantana; Johnson, Britt; Rott, Leslie; White, Whitney; Wiedmeyer, Carole; Montori, Victor M; Singh, Jasvinder A; Nowell, W Benjamin

    2016-01-01

    How best to involve patients in the development of clinical practice guideline (CPG) recommendations is not known. We sought to determine the feasibility and value of developing CPG recommendations based on a voting panel composed entirely of patients, with the ultimate goal of comparing the patients' recommendations to ones developed by a physician-dominated voting panel on the same clinical questions. Ten patients with rheumatoid arthritis completed 8 hours of training on evidence-based medicine and guideline development. They constituted a voting panel and, with 2 American College of Rheumatology staff with expertise in CPG development and a physician facilitator, subsequently met at a face-to-face meeting to develop recommendations. They applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to formulate recommendations on 18 questions for which there was evidence warranting moderate or high confidence. The patient panel developed recommendations for 16 of the 18 questions; for the other 2, the panel thought there were insufficient data to support a recommendation. For 13 of the 16 questions, the patient panel recommended the same course of action as did the physician-dominated panel. Differences were due to how the 2 panels valued the balance between benefits and harms. Patient and physician-dominated panels developed the same recommendations for most questions for which there was evidence warranting moderate to high confidence. Additional experiences are necessary to advance the evidence necessary to determine what panel composition is optimal to produce the best guidelines. © 2015, American College of Rheumatology.

  4. Measurements of Radioactivity in Body Organs. Report of a Panel of Experts

    International Nuclear Information System (INIS)

    1970-01-01

    Measurements of radioactivity in body organs in vivo entail physical and other problems which do not arise in measurements of radioactivity in vitro. From 8-12 December 1969 the International Atomic Energy Agency convened at its Headquarters in Vienna a panel of experts to review the existing status of techniques for such measurements

  5. NTP-CERHR EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF AMPHETAMINE AND METHAMPHETAMINE.

    Science.gov (United States)

    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 ...

  6. Sensory analysis of characterizing flavors in tobacco products using a trained expert panel

    Directory of Open Access Journals (Sweden)

    Erna Krüsemann

    2018-03-01

    Using a trained expert panel is a successful example of assessing characterizing flavors in tobacco products. Regulatory decisions should be made on significance level and products representing the reference space, as these directly influence strictness of the method and thus the number of products that imparts a characterizing flavor compared to the reference space.

  7. Curriculum Reform in 3D: A Panel of Experts Discuss the New HPE Curriculum in Australia

    Science.gov (United States)

    Hickey, Chris; Kirk, David; Macdonald, Doune; Penney, Dawn

    2014-01-01

    This paper was developed at the request of the Organising Committee for the 27th Australian Council for Health, Physical Education and Recreation International Conference, in Melbourne, 2013. Its genesis was as a feature forum, wherein a panel of curriculum experts were bought together to discuss the emergence of the Australian Health and Physical…

  8. Establishment of Reference Doses for residues of allergenic foods: Report of the VITAL Expert Panel

    NARCIS (Netherlands)

    Taylor, S.L.; Baumert, J.L.; Kruizinga, A.G.; Remington, B.C.; Crevel, R.W.R.; Brooke-Taylor, S.; Allen, K.J.; Houben, G.

    2014-01-01

    In 2011, an expert panel was assembled to establish appropriate Reference Doses for allergenic food residues as a part of the VITAL (Voluntary Incidental Trace Allergen Labeling) program of The Allergen Bureau of Australia & New Zealand (ABA). These Reference Doses would guide advisory labeling

  9. Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel.

    Science.gov (United States)

    Baugh, Christopher W; Clark, Carol L; Wilson, Jason W; Stiell, Ian G; Kocheril, Abraham G; Luck, Krista K; Myers, Troy D; Pollack, Charles V; Roumpf, Steven K; Tomassoni, Gery F; Williams, James M; Patel, Brian B; Wu, Fred; Pines, Jesse M

    2018-03-10

    Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States. Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways. They are widely used in Canada and other countries but less widely adopted in the United States. In this project, we convened an expert panel to create a practical framework for the process of creating, implementing, and maintaining an outpatient AF pathway for emergency physicians to assess and treat AF patients, safely reduce hospitalization rates, ensure appropriate stroke prophylaxis, and effectively transition patients to longitudinal outpatient treatment settings from the ED and/or observation unit. To support local pathway creation, the panel also reached agreement on a protocol development plan, a sample pathway, consensus recommendations for pathway components, sample pathway metrics, and a structured literature review framework using a modified Delphi technique by a technical expert panel of emergency medicine, cardiology, and other stakeholder groups. © 2018 by the Society for Academic Emergency Medicine.

  10. Microbiological specifications and testing methods for irradiated food. Report of a panel of experts

    International Nuclear Information System (INIS)

    1970-01-01

    In recent years there has been increased interest in the development of food items processed by means of ionizing radiation, wherever that form of preservation might show advantage over other methods. If this method becomes successful, the various items will be commercially exploited; it would then be convenient to have similar legislation in many countries of the world to control this type of processing and to facilitate international trade. To gather information and suggestions in order to devise legislation on irradiated food, a Joint FAO/IAEA/ WHO Expert Committee on the Technical Basis for Legislation on Irradiated Food was held in Rome on 21-28 April 1964. The Committee's report, 'The technical basis for legislation on irradiated food', was published as FAO Atomic Energy Series No.6 and WHO Technical Series No. 316. The Committee's terms of reference were to consider the available evidence on the effect on food of treatment with ionizing radiation in the context of wholesomeness and safety for consumption. Nutritional aspects were taken into account, but microbiological safety and microbiological methods for irradiated food were excluded since these subjects were believed to be too broad for adequate coverage in the working time available at the meeting. However, realizing the importance of radiation microbiology and the need for guidance in formulating regulations in this field, the committee drafted the following recommendation: 'The methods and standards used to ensure the microbiological safety of the irradiated product should, as a matter of urgency, be subject to review by competent international bodies in order that internationally acceptable methods and standards may be agreed upon'. In response to this recommendation an FAO/IAEA Panel on Microbiological Standards and Testing Methods for Irradiated Food was held in Vienna on 22-26 June 1965, in collaboration with the International Association of Microbiological Societies (IAMS). This was a working

  11. Microbiological specifications and testing methods for irradiated food. Report of a panel of experts

    International Nuclear Information System (INIS)

    1971-01-01

    In recent years there has been increased interest in the development of food items processed by means of ionizing radiation, wherever that form of preservation might show advantage over other methods. If this method becomes successful, the various items will be commercially exploited; it would then be convenient to have similar legislation in many countries of the world to control this type of processing and to facilitate international trade. To gather information and suggestions in order to devise legislation on irradiated food, a Joint FAO/IAEA/ WHO Expert Committee on the Technical Basis for Legislation on Irradiated Food was held in Rome on 21-28 April 1964. The Committee's report, 'The technical basis for legislation on irradiated food', was published as FAO Atomic Energy Series No.6 and WHO Technical Series No. 316. The Committee's terms of reference were to consider the available evidence on the effect on food of treatment with ionizing radiation in the context of wholesomeness and safety for consumption. Nutritional aspects were taken into account, but microbiological safety and microbiological methods for irradiated food were excluded since these subjects were believed to be too broad for adequate coverage in the working time available at the meeting. However, realizing the importance of radiation microbiology and the need for guidance in formulating regulations in this field, the committee drafted the following recommendation: 'The methods and standards used to ensure the microbiological safety of the irradiated product should, as a matter of urgency, be subject to review by competent international bodies in order that internationally acceptable methods and standards may be agreed upon'. In response to this recommendation an FAO/IAEA Panel on Microbiological Standards and Testing Methods for Irradiated Food was held in Vienna on 22-26 June 1965, in collaboration with the International Association of Microbiological Societies (IAMS). This was a working

  12. Microbiological specifications and testing methods for irradiated food. Report of a panel of experts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1970-04-01

    In recent years there has been increased interest in the development of food items processed by means of ionizing radiation, wherever that form of preservation might show advantage over other methods. If this method becomes successful, the various items will be commercially exploited; it would then be convenient to have similar legislation in many countries of the world to control this type of processing and to facilitate international trade. To gather information and suggestions in order to devise legislation on irradiated food, a Joint FAO/IAEA/ WHO Expert Committee on the Technical Basis for Legislation on Irradiated Food was held in Rome on 21-28 April 1964. The Committee's report, 'The technical basis for legislation on irradiated food', was published as FAO Atomic Energy Series No.6 and WHO Technical Series No. 316. The Committee's terms of reference were to consider the available evidence on the effect on food of treatment with ionizing radiation in the context of wholesomeness and safety for consumption. Nutritional aspects were taken into account, but microbiological safety and microbiological methods for irradiated food were excluded since these subjects were believed to be too broad for adequate coverage in the working time available at the meeting. However, realizing the importance of radiation microbiology and the need for guidance in formulating regulations in this field, the committee drafted the following recommendation: 'The methods and standards used to ensure the microbiological safety of the irradiated product should, as a matter of urgency, be subject to review by competent international bodies in order that internationally acceptable methods and standards may be agreed upon'. In response to this recommendation an FAO/IAEA Panel on Microbiological Standards and Testing Methods for Irradiated Food was held in Vienna on 22-26 June 1965, in collaboration with the International Association of Microbiological Societies (IAMS). This was a working

  13. May one conquer a radiation. Recommendations of experts

    International Nuclear Information System (INIS)

    Zhukovskaya, O.V.; Kovalev, S.D.; Stavrov, A.I.; Rolevich, I.V.; Antsipov, G.V.; Borovikov, A.N.; Baraboshkin, A.V.; Basalaeva, Z.N.

    1996-01-01

    The brief recommendations for the population living on radionuclides contaminated territories on prophylactic feed, agricultural work, keeping of the animals, preparation of food products to use, bee keeping, fishing and hunt, use of production of a forest, hygiene of labour and etc. The recommendations permit to ensure conditions of safe living and activity on contaminated territories. 4 refs., 8 tabs., 1 fig

  14. Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels.

    Science.gov (United States)

    Tran, Diem; Hall, Linda McGillis; Davis, Aileen; Landry, Michel D; Burnett, Dawn; Berg, Katherine; Jaglal, Susan

    2008-12-09

    Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development.

  15. Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

    Directory of Open Access Journals (Sweden)

    Landry Michel D

    2008-12-01

    Full Text Available Abstract Background Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1 to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2 to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. Methods A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. Results A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Conclusion Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional

  16. [Isolated primary nocturnal enuresis: international evidence based management. Consensus recommendations by French expert group].

    Science.gov (United States)

    Aubert, D; Berard, E; Blanc, J-P; Lenoir, G; Liard, F; Lottmann, H

    2010-05-01

    The causes and treatment of isolated primary nocturnal enuresis (PNE) are the subject of ongoing controversy. We are proposing consensus practical recommendations, based on a formalised analysis of the literature and validated by a large panel of experts. A task force of six experts based its work on the guide for literature analysis and recommendations and recommendation grading of the French Haute Autorité de Santé (formalized consensus process methodological guidelines) to evaluate the level of scientific proof (grade of 1 to 4) and the strength of the recommendations (grade A, B, C) of the publications on PNE. As a result of this, 223 articles from 2003 on were identified, of which only 127 (57 %) have an evaluable level of proof. This evaluation was then reviewed by a 19-member rating group. Several recommendations, poorly defined by the literature, had to be proposed by a professional agreement resulting from a consultation between the members of the task force and those of the rating group. For its final validation, the document was submitted to a reading group of 21 members working in a wide range of specialist areas and practices but all involved in PNE. The definition of PNE is very specific: intermittent incontinence during sleep, from the age of 5, with no continuous period of continence longer than 6 months, with no other associated symptom, particularly during the day. Its diagnosis is clinical by the exclusion of all other urinary pathologies. Two factors must be identified during the consultation: nocturnal polyuria promoted by excessive fluid intake, inverse secretion of vasopressin, snoring and sleep apnoea. It is sensitive to desmopressin; small bladder capacity evaluated according to a voiding diary and the ICCS formula. It may be associated with diurnal hyperactivity of the detrusor (30 %). It is resistant to desmopressin. Problems associated with PNE are: abnormal arousal threshold, attention deficit hyperactivity disorder (ADHD) (10 %), low

  17. Key considerations for preventing suicide in older adults: consensus opinions of an expert panel

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Nordentoft, Merete; Conwell, Yeates

    2011-01-01

    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...

  18. Expert system verification and validation survey. Delivery 3: Recommendations

    Science.gov (United States)

    1990-01-01

    The purpose is to determine the state-of-the-practice in Verification and Validation (V and V) of Expert Systems (ESs) on current NASA and Industry applications. This is the first task of a series which has the ultimate purpose of ensuring that adequate ES V and V tools and techniques are available for Space Station Knowledge Based Systems development. The strategy for determining the state-of-the-practice is to check how well each of the known ES V and V issues are being addressed and to what extent they have impacted the development of ESs.

  19. Lynch Syndrome: A Primer for Urologists and Panel Recommendations.

    Science.gov (United States)

    Mork, Maureen; Hubosky, Scott G; Rouprêt, Morgan; Margulis, Vitaly; Raman, Jay; Lotan, Yair; O'Brien, Timothy; You, Nancy; Shariat, Shahrokh F; Matin, Surena F

    2015-07-01

    Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, is a common genetic disease. The predisposition of patients with Lynch syndrome to urological cancer, particularly upper tract urothelial carcinoma, is underappreciated. Urologists may be involved in several aspects of care involving Lynch syndrome, including identifying undiagnosed patients, surveillance of those with established Lynch syndrome or screening family members, in addition to treating patients with Lynch syndrome in whom upper tract urothelial carcinoma develops. We sought to increase awareness in the urological community about Lynch syndrome and provide some guidance where little currently exists. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement we reviewed the available published literature and guidelines from 1998 to 2014 on Lynch syndrome and its association with upper tract urothelial carcinoma. Recommendations based on the literature and the consensus of expert opinion are provided. No randomized or prospective study has been done to evaluate Lynch syndrome in the setting of urological cancer. All data were based on retrospective studies. Lynch syndrome is an autosomal dominant genetic disease caused by germline mutations in 4 mismatch repair genes, leading to the accumulation of DNA errors in microsatellite regions. Upper tract urothelial carcinoma develops in up to 28% of patients with known Lynch syndrome. The diagnosis of Lynch syndrome is established by clinical criteria, tumor tissue testing and genetic evaluation. Urologists should suspect Lynch syndrome when a patient with upper tract urothelial carcinoma presents before age 60 years or meets the 3-2-1 rule. Screening patients with Lynch syndrome for upper tract urothelial carcinoma presents a particular challenge. While no ideal screening test exists, at a minimum routine urinalysis is recommended using the American Urological Association guideline of 3 or more red

  20. Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel.

    Science.gov (United States)

    deKleijn, Miriam; Lagro-Janssen, Antoine L M; Canelo, Ismelda; Yano, Elizabeth M

    2015-04-01

    Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. Modified Delphi expert panel process. Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.

  1. Breaking Bad News: Different Approaches in Different Countries of Iran and Germany- an Expert Panel

    Directory of Open Access Journals (Sweden)

    Carl Eduard Scheidt

    2017-10-01

    Full Text Available In this expert panel report which was held in Isfahan, Iran, the participants were Carl Eduard Scheidt, Alexander Wunsch, Hamid Afshar, Farzad Goli, Azadeh Malekian, Mohammad Reza Sharbafchi, Masoud Ferdosi, Farzad Taslimi, and Mitra Molaeinezhad. Professor Scheidt was the facilitator and coordinator of the discussion. Therefore, he started it with a brief introduction. After all is said and done, he ended the discussion with a conclusion.

  2. Sensory analysis of characterising flavours: evaluating tobacco product odours using an expert panel.

    Science.gov (United States)

    Krüsemann, Erna J Z; Lasschuijt, Marlou P; de Graaf, C; de Wijk, René A; Punter, Pieter H; van Tiel, Loes; Cremers, Johannes W J M; van de Nobelen, Suzanne; Boesveldt, Sanne; Talhout, Reinskje

    2018-05-23

    Tobacco flavours are an important regulatory concept in several jurisdictions, for example in the USA, Canada and Europe. The European Tobacco Products Directive 2014/40/EU prohibits cigarettes and roll-your-own tobacco having a characterising flavour. This directive defines characterising flavour as 'a clearly noticeable smell or taste other than one of tobacco […]'. To distinguish between products with and without a characterising flavour, we trained an expert panel to identify characterising flavours by smelling. An expert panel (n=18) evaluated the smell of 20 tobacco products using self-defined odour attributes, following Quantitative Descriptive Analysis. The panel was trained during 14 attribute training, consensus training and performance monitoring sessions. Products were assessed during six test sessions. Principal component analysis, hierarchical clustering (four and six clusters) and Hotelling's T-tests (95% and 99% CIs) were used to determine differences and similarities between tobacco products based on odour attributes. The final attribute list contained 13 odour descriptors. Panel performance was sufficient after 14 training sessions. Products marketed as unflavoured that formed a cluster were considered reference products. A four-cluster method distinguished cherry-flavoured, vanilla-flavoured and menthol-flavoured products from reference products. Six clusters subdivided reference products into tobacco leaves, roll-your-own and commercial products. An expert panel was successfully trained to assess characterising odours in cigarettes and roll-your-own tobacco. This method could be applied to other product types such as e-cigarettes. Regulatory decisions on the choice of reference products and significance level are needed which directly influences the products being assessed as having a characterising odour. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use

  3. Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel.

    Science.gov (United States)

    Wirrell, Elaine C; Laux, Linda; Donner, Elizabeth; Jette, Nathalie; Knupp, Kelly; Meskis, Mary Anne; Miller, Ian; Sullivan, Joseph; Welborn, Michelle; Berg, Anne T

    2017-03-01

    To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process. An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies

  4. Expert panel evaluation of health information technology effects on adverse events.

    Science.gov (United States)

    Abramson, Erika L; Kern, Lisa M; Brenner, Samantha; Hufstader, Meghan; Patel, Vaishali; Kaushal, Rainu

    2014-08-01

    Adverse events (AEs) among hospitalized patients occur frequently and result in significant sequelae. Federal policy is incentivizing health information technology (HIT) use, although research demonstrating safety benefits from HIT is mixed. Our objective was to evaluate the potential effects of HIT on reducing 21 different inpatient AEs. Identifying AEs most likely to be reduced by HIT can inform the design of future studies evaluating its effectiveness. We conducted a modified Delphi panel of national experts in HIT and safety. We conducted a focused literature review to inform the experts. Using a novel framework, experts rated each AE as 'definitely reduced by health IT,' 'possibly reduced by health IT' and 'not likely to be reduced by health IT'. From our panel discussion, experts identified six AEs as 'definitely reduced by health IT': (1) adverse drug events (ADEs) associated with digoxin; (2) ADE associated with IV heparin; (3) ADE associated with hypoglycaemic agents; (4) ADE associated with low molecular weight heparin and factor Xa inhibitor; (5) contrast nephropathy associated with catheter angiography; and (6) ADE hospital-acquired antibiotic-associated Clostridium difficile. Understanding the effects of HIT on patient outcomes will be essential to ensuring that the significant federal investment results in anticipated improvements. This study serves as an important early step in helping with the design of future work evaluating level of HIT infrastructure and rates of inpatient AEs. © 2014 John Wiley & Sons, Ltd.

  5. Expert Opinion Is Necessary: Delphi Panel Methodology Facilitates a Scientific Approach to Consensus.

    Science.gov (United States)

    Hohmann, Erik; Brand, Jefferson C; Rossi, Michael J; Lubowitz, James H

    2018-02-01

    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.

  6. Expert panels as a reference standard in orthodontic research: An assessment of published methods and reporting.

    Science.gov (United States)

    Lempesi, Evangelia; Toulia, Electra; Pandis, Nikolaos

    2017-04-01

    The aim of this study was to investigate the expert panel methodology applied in orthodontics and its reporting quality. Additionally, the relationship between the reporting quality and a range of variables was explored. PubMed was searched for orthodontic studies in which the final diagnosis or assessment was made by 2 or more experts published up to March 16, 2015. Reporting quality assessment was conducted using an established modified checklist. The relationship between potential predictors and the total score was assessed using univariable linear regression. We identified 237 studies with a mean score of 9.97 (SD, 1.12) out of a maximum of 15. Critical information about panel methodology was missing in all studies. The panel composition differed substantially across studies, ranging from 2 to 646 panel members, with large variations in the expertise represented. Only 17 studies (7.2%) reported sample size calculations to justify the panel size. Panel members were partly blinded in 65 (27.4%) studies. Most studies failed to report which statistic was used to compute intrarater (65.8%) and interrater (66.2%) agreements. Journal type (nonorthodontic: β, 0.23; 95% CI, -0.07 to 0.54 compared with orthodontic), publication year (β, 0; 95% CI, -0.02 to 0.02 for each additional year), number of authors (1-3: β, 0.30; 95% CI, -0.13 to 0.74 compared with at least 6; 4-5: β, 0.18; 95% CI, -0.29 to 0.33 compared with at least 6), and number of centers involved (single: β, 0.20; 95% CI, -0.14 to 0.54 compared with multicenter) were not significant predictors of improved reporting. Studies published in Asia and Australia had significantly lower scores compared with those published in Europe (β, -0.54; 95% CI, -0.92 to -0.17). Formal guidelines on methodology and reporting of studies involving expert panels are required. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  7. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts.

    Science.gov (United States)

    Raurell-Torredà, M; Romero-Collado, A; Rodríguez-Palma, M; Farrés-Tarafa, M; Martí, J D; Hurtado-Pardos, B; Peñarrubia-San Florencio, L; Saez-Paredes, P; Esquinas, A M

    In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet ® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  8. SERDP/ESTCP Expert Panel Workshop on Research and Development Needs for Cleanup of Chlorinated Solvent Sites

    National Research Council Canada - National Science Library

    2001-01-01

    ...) 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...

  9. Identification of component performance degradations caused by ageing using expert panels

    International Nuclear Information System (INIS)

    Nitoi, Mirela; Cristea, Dumitru; Pavelescu, Margarit

    2008-01-01

    Since the component ageing can be considered as one of the important causes of operating events reported, the identification of ageing effects and implementation of appropriate methods for mitigation of these effects represent an important preoccupation of many organizations and research activities. In the process of identification of ageing manifestation we can use either analysis of operational data or expert opinions, each of the methods having specific advantages and disadvantages. A reasonable combination of statistical, structural reliability and expert panel methods would be an appropriate approach in the failure probability assessments. In case when there are not enough operational data, the expert judgments represent the only viable alternative in the effort dedicated to identification of components and systems vulnerability to ageing. The panel use judgments to analyse the degradation produced by ageing, to score the components based on specific criteria and to rank them relative to one another. The paper presents the approach developed, including evaluation criteria and assigning indices for assessment of particular types of ageing degradation (the case of secondary system of TRIGA reactor). (authors)

  10. NTP-CERHR expert panel report on the developmental toxicity of soy infant formula.

    Science.gov (United States)

    McCarver, Gail; Bhatia, Jatinder; Chambers, Christina; Clarke, Robert; Etzel, Ruth; Foster, Warren; Hoyer, Patricia; Leeder, J Steven; Peters, Jeffrey M; Rissman, Emilie; Rybak, Michael; Sherman, Claire; Toppari, Jorma; Turner, Katie

    2011-10-01

    Soy infant formula contains soy protein isolates and is fed to infants as a supplement to or replacement for human milk or cow milk. Soy protein isolates contains estrogenic isoflavones (phytoestrogens) that occur naturally in some legumes, especially soybeans. Phytoestrogens are nonsteroidal, estrogenic compounds. In plants, nearly all phytoestrogens are bound to sugar molecules and these phytoestrogen-sugar complexes are not generally considered hormonally active. Phytoestrogens are found in many food products in addition to soy infant formula, especially soy-based foods such as tofu, soy milk, and in some over-the-counter dietary supplements. Soy infant formula was selected for National Toxicology Program (NTP) evaluation because of (1) the availability of large number of developmental toxicity studies in laboratory animals exposed to the isoflavones found in soy infant formula (namely, genistein) or other soy products, as well as few studies on human infants fed soy infant formula, (2) the availability of information on exposures in infants fed soy infant formula, and (3) public concern for effects on infant or child development. On October 2, 2008 (73 FR 57360), the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR) announced its intention to conduct an updated review of soy infant formula to complete a previous evaluation that was initiated in 2005. Both the current and previous evaluations relied on expert panels to assist the NTP in developing its conclusions on the potential developmental effects associated with the use of soy infant formula, presented in the NTP Brief on Soy Infant Formula. The initial expert panel met on March 15 to 17, 2006, to reach conclusions on the potential developmental and reproductive toxicities of soy infant formula and its predominant isoflavone constituent genistein. The expert panel reports were released for public comment on May 5, 2006 (71 FR 28368). On November 8, 2006 (71 FR 65537), CERHR staff released

  11. Genotoxicity Expert Panel review: weight of evidence evaluation of the genotoxicity of glyphosate, glyphosate-based formulations, and aminomethylphosphonic acid.

    Science.gov (United States)

    Brusick, David; Aardema, Marilyn; Kier, Larry; Kirkland, David; Williams, Gary

    2016-09-01

    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.

  12. Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

    Science.gov (United States)

    Miller, Dave P.; O'Shaughnessy, Kathryn F.; Wood, Susan A.; Castellino, Ronald A.

    2004-05-01

    Comparative evaluations of reader performance using different modalities, e.g. CT with computer-aided detection (CAD) vs. CT without CAD, generally require a "truth" definition based on a gold standard. There are many situations in which a true invariant gold standard is impractical or impossible to obtain. For instance, small pulmonary nodules are generally not assessed by biopsy or resection. In such cases, it is common to use a unanimous consensus or majority agreement from an expert panel as a reference standard for actionability in lieu of the unknown gold standard for disease. Nonetheless, there are three major concerns about expert panel reference standards: (1) actionability is not synonymous with disease (2) it may be possible to obtain different conclusions about which modality is better using different rules (e.g. majority vs. unanimous consensus), and (3) the variability associated with the panelists is not formally captured in the p-values or confidence intervals that are generally produced for estimating the extent to which one modality is superior to the other. A multi-reader-multi-case (MRMC) receiver operating characteristic (ROC) study was performed using 90 cases, 15 readers, and a reference truth based on 3 experienced panelists. The primary analyses were conducted using a reference truth of unanimous consensus regarding actionability (3 out of 3 panelists). To assess the three concerns noted above: (1) additional data from the original radiology reports were compared to the panel (2) the complete analysis was repeated using different definitions of truth, and (3) bootstrap analyses were conducted in which new truth panels were constructed by picking 1, 2, or 3 panelists at random. The definition of the reference truth affected the results for each modality (CT with CAD and CT without CAD) considered by itself, but the effects were similar, so the primary analysis comparing the modalities was robust to the choice of the reference truth.

  13. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

    Science.gov (United States)

    Uhlenhuth, E H; Balter, M B; Ban, T A; Yang, K

    1999-01-01

    To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years. A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997. This report focuses on the experts' responses to questions about therapeutic options relevant to seven vignettes describing typical cases of different anxiety disorders. The preferred initial treatment strategy in 1992 was a combination of medication with a psychological therapy for all vignettes except simple phobia, where a psychological procedure alone was favored. There was little change in 1997, primarily some decrease in the choice of psychological therapy and some increase in the choice of medication for social phobia. Experts recommending a medication in 1992 most often chose as first-line treatment a benzodiazepine anxiolytic (BZ) for panic disorder (PD), generalized anxiety disorder (GAD), simple phobia, and adjustment disorder. They recommended a beta-blocker most often for social phobia and a tricyclic anti-depressant (TCA) for agoraphobia and obsessive-compulsive disorder (OCD). Nearly a fourth chose a combination of medications, usually a TCA plus a BZ. In 1997, the expert panel's most frequent recommendation for agoraphobia, PD, and OCD changed to a specific serotonin reuptake inhibitor (SSRI); and they also recommended these compounds more often for GAD, social phobia, and simple phobia. Fewer experts chose BZs or TCAs. However, in 1997 many again chose a combination of medications, often a BZ plus a SSRI, so that, overall, there was only a small decline in recommendations for BZs. As second-line medications (1997 only), the experts recommended SSRIs most often for most vignettes, but a TCA for PD and

  14. The Design and Implementation of an Intelligent Apparel Recommend Expert System

    Directory of Open Access Journals (Sweden)

    A. H. Dong

    2013-01-01

    Full Text Available Now with the rapid development of information science and technology, intelligent apparel recommend has drawn wide attention in apparel retail industry. Intelligent management and effective recommend are two issues of crucial importance for the retail store to enhance its corporate influence and increase its economic benefits. This paper proposes an intelligent recommend system design scheme for apparel retail which is based on expert system. By comprehensive utilization of database management and expert system technology, the proposed system provides a solid solution in improving the customer shopping experience. This paper presents a kind of object-oriented blackboard structure, which is applied in the apparel recommend expert system and establishes expert rule on the basis of apparel characteristic elements. Through the establishment of the rule base, the system generates personal recommend list by positive rule reasoning mechanism engine. The proposed method thus gives dress collocation scheme for the customer through the human-machine interaction from the point of view of the apparel experts. This design scheme avails the customers to experience targeted service with intellectualization, and personalization and it has certain reference significance for promoting apparel retail intelligence development.

  15. 'Energy for a sustainable society'. Recommendations of the Panel

    International Nuclear Information System (INIS)

    1997-10-01

    On June 18 and 19, 1997, The Norwegian Research Council arranged a series of national conferences on sustainable development. A panel has followed up the conferences with the present report. The priority is on issues of importance for the development of policies and political means in the climate area. This is because the climate challenges are essential for a sustainable global development. Without doubt, it takes long for the temperature of the atmosphere to stabilise after a change in the CO 2 content, several decades. Greatly reduced anthropogenic emissions of greenhouse gases cannot prevent a delayed temperature increase, which calls for precautionary measures. Norwegian policy should be based on the assumption that the emission negotiations will lead to emission restrictions for most of the industrialised countries. However, one-sided focus on national emission goals may lead to unwanted increase in other countries' emissions following Norwegian decreases. The panel suggests that Norwegian measures should be oriented along the following: (1) Energy efficiency, (2) Social planning, (3) Renewable energy sources, (4) De-carbonisation of fossil energy carriers

  16. Analysis of core damage frequency from internal events: Expert judgment elicitation. Part 1: Expert panel results. Part 2: Project staff results

    Energy Technology Data Exchange (ETDEWEB)

    Wheeler, T A; Cramond, W R [Sandia National Laboratories, Albuquerque, NM (United States); Hora, S C [University of Hawii at Hilo (United States); Unwin, S D [Brookhaven National Laboratory (United States)

    1989-04-01

    Quantitative modeling techniques have limitations as to the resolution of important issues in probabilistic risk assessment (PRA). Not all issues can be resolved via the existing set of methods such as fault trees, event trees, statistical analyses, data collection, and computer simulation. Therefore, an expert judgment process was developed to address issues perceived as important to risk in the NUREG-1150 analysis but which could not be resolved with existing techniques. This process was applied to several issues that could significantly affect the internal event core damage frequencies of the PRAs performed on six light water reactors. Detailed descriptions of these issues and the results of the expert judgment elicitation are reported here, as well as an explanation of the methodology used and the procedure followed in performing the overall elicitation task. The process is time-consuming and expensive. However, the results are very useful, and represent an improvement over the draft NUREG-1150 analysis in the areas of expert selection, elicitation training, issue selection and presentation, elicitation of judgment and aggregation of results. The results are presented in two parts. Part documents the expert panel elicitations, where the most important issues were presented to a panel of experts convened from throughout the nuclear power risk assessment community. Part 2 documents the process by which the project staff performed expert judgment on other important issues, using the project staff as panel members. (author)

  17. Sensory evaluation of irradiated hake (Merluccius merluccius hubbsi) by an expert trade panel

    International Nuclear Information System (INIS)

    Lescano, G.

    1989-01-01

    Commercial high quality hake (Merluccius merluccius hubbsi) scaled, headless and eviscerated, caught in the South Atlantic Ocean, was analyzed by an expert testing panel. The samples were the following: one lot vacuum packed, another lot previously dipped in 10% sodium poliphosphate, both irradiated with 3.3 kGy and then stored at 0deg C±1deg C, and a third lot, air-packed, frozen, kept at -20deg C±2 deg C, and used as control. The analysis was made on day 36 after catch. The evaluations were performed by a panel of 5 experts in buying fish to export. The following attributes were analyzed: on raw fish: external appearance, muscle elasticity, shine, bone adhesion, muscle cohesion, odor, natural odor, unpleasant odor and purchase acceptability. On oven cooked samples: odor, natural odor, unpleasant odor, flavor, natural flavor, unpleasant flavor, oral texture and general acceptability. Data were analyzed by student test (p ≤ 0.05). The results showed that the raw irradiated fish (with and without dip in polyphosphate) were generally significantly better than the raw frozen hake; and cooked frozen hake was better than the irradiated one but not significantly different. An undesirable off odor on cooked irradiated samples was detected, that would be an irradiation effect. It could be minimized with a lower dose. The polyphosphate dip did not modify the amount of drip loss. (Author) [es

  18. What is case management in palliative care? An expert panel study

    Directory of Open Access Journals (Sweden)

    van der Plas Annicka G M

    2012-06-01

    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.

  19. Tracheotomy in the intensive care unit: guidelines from a French expert panel.

    Science.gov (United States)

    Trouillet, Jean Louis; Collange, Olivier; Belafia, Fouad; Blot, François; Capellier, Gilles; Cesareo, Eric; Constantin, Jean-Michel; Demoule, Alexandre; Diehl, Jean-Luc; Guinot, Pierre-Grégoire; Jegoux, Franck; L'Her, Erwan; Luyt, Charles-Edouard; Mahjoub, Yazine; Mayaux, Julien; Quintard, Hervé; Ravat, François; Vergez, Sebastien; Amour, Julien; Guillot, Max

    2018-03-15

    Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques 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 tracheotomy in adult 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) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.

  20. Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion

    Energy Technology Data Exchange (ETDEWEB)

    Baere, Thierry de, E-mail: thierry.debaere@gustaveroussy.fr [Gustave Roussy, Department of Interventional Radiology (France); Arai, Yasuaki, E-mail: arai-y3111@mvh.biglobe.ne.jp [National Cancer Center, Department of Diagnostic Radiology (Japan); Lencioni, Riccardo, E-mail: riccardo.lencioni@med.unipi.it [Pisa University School of Medicine, Division of Diagnostic Imaging and Intervention (R.L.) (Italy); Geschwind, Jean-Francois, E-mail: jfg@jhmi.edu [The Johns Hopkins Hospital, Vascular and Interventional Radiology (United States); Rilling, William, E-mail: wrilling@mcw.edu [Medical College of Wisconsin, Division of Vascular and Interventional Radiology Rm2803 (United States); Salem, Riad, E-mail: r-salem@northwestern.edu [Northwestern University, Department of Radiology (United States); Matsui, Osamu, E-mail: matsuio@med.kanazawa-u.ac.jp [Kanazawa University Graduate School of Medical Sciences, Department of Advanced Medical Imaging (Japan); Soulen, Michael C., E-mail: michael.soulen@uphs.upenn.edu [University of Pennsylvania, Division of Interventional Radiology (MCS) (United States)

    2016-03-15

    Transarterial chemoembolization with Lipiodol (Lipiodol TACE), also called conventional TACE, was developed in the early 1980s and widely adopted worldwide after randomized control trials and meta-analysis demonstrated superiority of Lipiodol TACE to best supportive care. Presently, there is no level one evidence that other TACE techniques are superior to Lipiodol TACE for intermediate stage hepatocellular carcinoma (HCC), which includes patients with preserved liver function and nonsurgical large or multinodular HCC without distant metastases. In addition, TACE is part of the treatment for progressive or symptomatic liver metastases from gastroenteropancreatic neuroendocrine tumors. When injected into the hepatic artery, Lipiodol has the unique property of selective uptake and retention in hyperarterialyzed liver tumors. Lipiodol/drug emulsion followed by particle embolization has been demonstrated to improve the pharmacokinetic of the drug and tumor response. Radio opacity of Lipiodol helps to monitor treatment delivery, with retention of Lipiodol serving as an imaging biomarker for tumor response. For 30 years, Lipiodol TACE has been inconsistently referenced in many publications with various levels of details for the method of preparation and administration, with reported progressive outcomes following improvements in the technique and the devices used to deliver the treatment and better patient selection. Consequently, there is no consensus on the standard method of TACE regarding the use of anticancer agents, embolic material, technical details, and the treatment schedule. In order to develop an internationally validated technical recommendation to standardize the Lipiodol TACE procedure, a worldwide panel of experts participated in a consensus meeting held on May 10, 2014.

  1. Risk management and post-marketing surveillance for the abuse of medications acting on the central nervous system: expert panel report.

    Science.gov (United States)

    Johanson, Chris-Ellyn; Balster, Robert L; Henningfield, Jack E; Schuster, Charles R; Anthony, James C; Barthwell, Andrea G; Coleman, John J; Dart, Richard C; Gorodetzky, Charles W; O'Keeffe, Charles; Sellers, Edward M; Vocci, Frank; Walsh, Sharon L

    2009-12-01

    The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and 11 recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized.

  2. Recommendations for the performance rating of flat plate terrestrial photovoltaic solar panels

    Science.gov (United States)

    Treble, F. C.

    1976-01-01

    A review of recommendations for standardizing the performance rating of flat plate terrestrial solar panels is given to develop an international standard code of practice for performance rating. Required data to characterize the performance of a solar panel are listed. Other items discussed are: (1) basic measurement procedures; (2) performance measurement in natural sunlight and simulated sunlight; (3) standard solar cells; (4) the normal incidence method; (5) global method and (6) definition of peak power.

  3. Recommendations for Longitudinal Post-Tensioning in Full-Depth Precast Concrete Bridge Deck Panels

    OpenAIRE

    Bowers, Susan Elizabeth

    2007-01-01

    Full-depth precast concrete panels offer an efficient alternative to traditional cast-in-place concrete for replacement or new construction of bridge decks. Research has shown that longitudinal post-tensioning helps keep the precast bridge deck in compression and avoid problems such as leaking, cracking, spalling, and subsequent rusting on the beams at the transverse panel joints. Current design recommendations suggest levels of initial compression for precast concrete decks in a very limit...

  4. Indonesian dengue burden estimates: review of evidence by an expert panel.

    Science.gov (United States)

    Wahyono, T Y M; Nealon, J; Beucher, S; Prayitno, A; Moureau, A; Nawawi, S; Thabrany, H; Nadjib, M

    2017-08-01

    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.

  5. Treatment of severe psoriasis in children: recommendations of an Italian expert group.

    Science.gov (United States)

    Fortina, Anna Belloni; Bardazzi, Federico; Berti, Samantha; Carnevale, Claudia; Di Lernia, Vito; El Hachem, Maya; Neri, Iria; Gelmetti, Carlo Mario; Lora, Viviana; Mazzatenta, Carlo; Milioto, Mirella; Moretta, Gaia; Patrizi, Annalisa; Peris, Ketty; Villani, Alberto

    2017-10-01

    This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up

  6. Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation.

    Science.gov (United States)

    Waller, J; Macedo, A; von Wagner, C; Simon, A E; Jones, C; Hammersley, V; Weller, D; Wardle, J; Campbell, C

    2012-12-04

    Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50-80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.

  7. Targeted temperature management in the ICU: guidelines from a French expert panel.

    Science.gov (United States)

    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

    2017-12-01

    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

  8. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report.

    Science.gov (United States)

    Tarlo, Susan M; Altman, Kenneth W; Oppenheimer, John; Lim, Kaiser; Vertigan, Anne; Prezant, David; Irwin, Richard S

    2016-10-01

    In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  9. International Linear Collider Steering Committee issues charge to Technology Recommendation Panel

    CERN Multimedia

    2003-01-01

    "Following its November 19 meeting in Paris, the International Linear Collider Steering Committee, a subcommittee of the International Committee for Future Accelerators, has published the charge http://www.fnal.gov/directorate/icfa/ITRP_Charge.pdf to the International Technology Recommendation Panel appointed by ICFA" (2 paragraphs).

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  11. Royal Society of Canada expert panel report : environmental and health impacts of Canada's oil sands industry

    International Nuclear Information System (INIS)

    Gosselin, P.; Hrudey, S.E.; Naeth, M.A.; Plourde, A.; Therrien, R.; Laval Univ., Quebec City, PQ; Van Der Kraak, G.; Guelph Univ., ON; Xu, Z.

    2010-12-01

    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.

  12. NTP-CERHR expert panel report on the reproductive anddevelopmental toxicity of hydroxyurea

    Energy Technology Data Exchange (ETDEWEB)

    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.

    2007-01-01

    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.

  13. Using Expert Panel Data to Guide Youth Agricultural Safety and Health Training Resources in the US

    Directory of Open Access Journals (Sweden)

    Andrew J. Mann

    2017-01-01

    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.

  14. Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland—Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies—2018 Update

    Directory of Open Access Journals (Sweden)

    Agnieszka Rusińska

    2018-05-01

    Full Text Available IntroductionVitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency.MethodsA systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations.ResultsThe updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care.ConclusionVitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there

  15. Treating rheumatoid arthritis to target: Revision of the 2014 International Expert Group Recommendations

    Directory of Open Access Journals (Sweden)

    N. T. Vatutin

    2016-01-01

    Full Text Available The paper presents a new edition (2014 of basic approaches to therapy of rheumatoid arthritis (RA based on the principle of «Treat to target », which has been elaborated by the experts of the European League Against Rheumatism (EULAR and the American College of Rheumatology (ACR. The revised recommendations consider the results of numerous randomized controlled and cohort studies, as well as the data of an extensive systematic review of the literature. The new 2014 version contains 4 basic principles and 10 recommendations for the management of patients with RA. When making the updated recommendations, the experts took into account particularly issues, such as criteria for defining a remission, the need to minimize comorbidities in patients with RA and to individualize its therapy, as well as their working ability. The basic principles in the management of patients with RA, by using a treat-to-target strategy, are discussed in detail and the rewording of the main points of the 2010 recommendations and their new edition are substantiated.

  16. ACR Appropriateness Criteria on Induction and Adjuvant Therapy for Stage N2 Non-Small-Cell Lung Cancer: Expert Panel on Radiation Oncology-Lung

    International Nuclear Information System (INIS)

    Gopal, Ramesh S.; Dubey, Sarita; Rosenzweig, Kenneth E.; Chang, Joe Yujiao; Decker, Roy; Gewanter, Richard M.; Kong Fengming; Lally, Brian E.; Langer, Corey J.; Lee, Hoon Ku; Movsas, Benjamin M.D.

    2010-01-01

    'The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.'

  17. Parents of preschoolers: expert media recommendations and ratings knowledge, media-effects beliefs, and monitoring practices.

    Science.gov (United States)

    Funk, Jeanne B; Brouwer, Jason; Curtiss, Kathleen; McBroom, Evan

    2009-03-01

    Given the increase in screen media targeted at the very young, the purpose of this study was to examine preschooler parents' knowledge about expert recommendations for young children's screen media experience, their knowledge of specific screen media ratings, their beliefs about screen media effects, and actual monitoring practices. Parents of 94 children education, age and gender of child, and parents' perceptions of their child's favorite television show and favorite video or computer game. Eleven multiple-choice questions assessed the respondent's knowledge of expert recommendations for screen media for preschoolers and the meaning of television and video game content ratings. Fourteen questions addressed the typical amount of their preschooler's screen media exposure, parental rules regarding screen media use, and parents' beliefs about appropriate use of screen media for preschoolers. Preschoolers were exposed to an average of approximately 12 hours of screen media in a typical week. Parents believe that media do have either short- or long-term effects on preschoolers. Performance on factual questions was poor (mean score: 2.83 of 11). In particular, only 34% of the parents correctly identified the expert recommendation for children >2 years of age. Parents should continue to be educated about the need for preschoolers to participate in activities that promote language development, socialization, imagination, and physical activity. Although professionals should work to improve the ratings, and ultimately to implement a universal ratings system for all screen media, parents need to be encouraged to improve their understanding of current recommendations for screen media exposure and television and video game ratings.

  18. End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making.

    Science.gov (United States)

    Schüklenk, Udo; van Delden, Johannes J M; Downie, Jocelyn; McLean, Sheila A M; Upshur, Ross; Weinstock, Daniel

    2011-11-01

    This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. © 2011 Blackwell Publishing Ltd.

  19. Establishing global policy recommendations: the role of the Strategic Advisory Group of Experts on immunization.

    Science.gov (United States)

    Duclos, Philippe; Okwo-Bele, Jean-Marie; Salisbury, David

    2011-02-01

    The vaccine landscape has changed considerably over the last decade with many new vaccines and technological developments, unprecedented progress in reaching out to children and the development of new financing mechanisms. At the same time, there are more demands and additional expectations of national policy makers, donors and other interested parties for increased protection through immunization. The Global Immunization Vision and Strategy (GIVS), which broadens the previous scope of immunization efforts, sets a number of goals to be met by countries. The WHO has recently reviewed and adjusted both its policy making structure and processes for vaccines and immunization to include an enlarged consultation process to generate evidence-based recommendations, thereby ensuring the transparency of the decision making process and improving communications. This article describes the process of development of immunization policy recommendations at the global level and some of their impacts. It focuses on the roles and modes of operating of the Strategic Advisory Group of Experts on immunization, which is the overarching advisory group involved with the issuance of policy recommendations, monitoring and facilitating the achievement of the GIVS goals. The article also describes the process leading to the publication of WHO vaccine position papers, which provide WHO recommendations on vaccine use. WHO vaccine-related recommendations have become a necessary step in the pathway to the introduction and use of vaccines, especially in developing countries and, consequently, have a clear and significant impact.

  20. DOD Financial Management: Continued Actions Needed to Address Congressional Committee Panel Recommendations

    Science.gov (United States)

    2015-09-01

    which was intended to fundamentally transform DOD’s financial management operations and achieve clean financial 12GAO-15-290. 13GAO-15-290. 14Pub...Actions to Implement the Panel on Defense Financial Management and Auditability Reform Recommendations valuations for these assets. For example, DOD’s...governance, the department is managing its business systems, including ERP systems, as portfolios of investments . The goal is to aggregate data from

  1. Biofuels and Food Security. A report by the High Level Panel of Experts on Food Security and Nutrition

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    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 around the following five axes

  2. Biofuels and Food Security. A report by the High Level Panel of Experts on Food Security and Nutrition

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    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

  3. Obesity prevention, screening, and treatment: practices of pediatric providers since the 2007 expert committee recommendations.

    Science.gov (United States)

    Rausch, John Conrad; Perito, Emily Rothbaum; Hametz, Patricia

    2011-05-01

    This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.

  4. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region.

    Science.gov (United States)

    Breymann, Christian; Bian, Xu-Ming; Blanco-Capito, Lourdes R; Chong, Christopher; Mahmud, Ghazala; Rehman, Rakhshanda

    2011-03-01

    Anemia during pregnancy and the postpartum period is commonly caused by iron deficiency and is a significant worldwide issue with severe consequences for both mother and developing fetus. From a worldwide perspective, iron-deficiency anemia (IDA) during pregnancy is highest in the Asia-Pacific region; however, there has been little guidance in this region for safe and effective treatment. An expert panel was convened to develop a concise and informative set of recommendations for the treatment of IDA in pregnant and postpartum women in the Asia-Pacific region. This manuscript provides these recommendations and aims to reduce the morbidity and mortality associated with IDA in pregnant and postpartum women in the Asia-Pacific region. The consensus recommendations define anemia as a hemoglobin (Hb) level iron, intravenous iron or red blood cell transfusion.

  5. Speaking to experts and patients: Recommendations for improving antiretroviral therapy (ART adherence

    Directory of Open Access Journals (Sweden)

    Janice Frank

    2009-06-01

    Full Text Available This article reports on the findings of a study that aimed to explore experts’ and patients’ opinions and recommendations regarding adherence to antiretroviral medication. This study was prompted firstly by the lack of existing local research on adherence to antiretroviral therapy (ART and secondly by the importance of adherence, given the recent introduction of ART to the public health sector. Four experts and seven patients were interviewed. The experts had worked within the HIV/AIDS field for at least two years while the patients (chosen from public antiretroviral roll-out programmes had been on ART for at least six months. These interviews were transcribed and analysed using thematic content analysis. This article focuses specifically on the recommendations for improving adherence that emerged from the experts' and patients' interviews. While the experts and patients generated two fairly distinct sets of recommendations (clearly informed by their different experiences and knowledge, both groups emphasised the importance of the mediating effects of social support and the healthcare provider–patient relationship in adherence to ART medication. Opsomming Gesprekke met kundiges en pasiënte: Aanbevelings ter verbetering van ART-nakoming. Hierdie artikel doen verslag oor die bevindinge van ’n studie wat kundiges en pasiënte se menings en aanbevelings ten opsigte van die nakoming van antiretrovirale medikasievoorskrifte ondersoek het. Die studie is in die eerste plek uitgevoer na aanleiding van die gebrek aan bestaande plaaslike navorsing oor die nakoming van antiretrovirale terapie (ART en in die tweede plek na aanleiding van die belangrikheid van nakoming in die lig van die onlangse bekendstelling van ART in die openbaregesondheidsektor. Onderhoude is met vier kundiges en sewe pasiënte gevoer. Die kundiges het vir ten minste twee jaar binne die MIV/Vigs-omgewing gewerk en die pasiënte (wat uit die openbare antiretrovirale

  6. Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations.

    Science.gov (United States)

    Black, Joyce; Clark, Michael; Dealey, Carol; Brindle, Christopher T; Alves, Paulo; Santamaria, Nick; Call, Evan

    2015-08-01

    The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  7. Recommendations for probabilistic seismic hazard analysis: Guidance on uncertainty and use of experts

    International Nuclear Information System (INIS)

    Budnitz, R.J.; Apostolakis, G.; Boore, D.M.

    1997-04-01

    Probabilistic Seismic Hazard Analysis (PSHA) is a methodology that estimates the likelihood that various levels of earthquake-caused ground motion will be exceeded at a given location in a given future time period. Due to large uncertainties in all the geosciences data and in their modeling, multiple model interpretations are often possible. This leads to disagreement among experts, which in the past has led to disagreement on the selection of ground motion for design at a given site. In order to review the present state-of-the-art and improve on the overall stability of the PSHA process, the U.S. Nuclear Regulatory Commission (NRC), the U.S. Department of Energy (DOE), and the Electric Power Research Institute (EPRI) co-sponsored a project to provide methodological guidance on how to perform a PSHA. The project has been carried out by a seven-member Senior Seismic Hazard Analysis Committee (SSHAC) supported by a large number other experts. The SSHAC reviewed past studies, including the Lawrence Livermore National Laboratory and the EPRI landmark PSHA studies of the 1980's and examined ways to improve on the present state-of-the-art. The Committee's most important conclusion is that differences in PSHA results are due to procedural rather than technical differences. Thus, in addition to providing a detailed documentation on state-of-the-art elements of a PSHA, this report provides a series of procedural recommendations. The role of experts is analyzed in detail. Two entities are formally defined-the Technical Integrator (TI) and the Technical Facilitator Integrator (TFI)--to account for the various levels of complexity in the technical issues and different levels of efforts needed in a given study

  8. Recommendations for probabilistic seismic hazard analysis: Guidance on uncertainty and use of experts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    Probabilistic Seismic Hazard Analysis (PSHA) is a methodology that estimates the likelihood that various levels of earthquake-caused ground motion will be exceeded at a given location in a given future time period. Due to large uncertainties in all the geosciences data and in their modeling, multiple model interpretations are often possible. This leads to disagreement among experts, which in the past has led to disagreement on the selection of ground motion for design at a given site. In order to review the present state-of-the-art and improve on the overall stability of the PSHA process, the U.S. Nuclear Regulatory Commission (NRC), the U.S. Department of Energy (DOE), and the Electric Power Research Institute (EPRI) co-sponsored a project to provide methodological guidance on how to perform a PSHA. The project has been carried out by a seven-member Senior Seismic Hazard Analysis Committee (SSHAC) supported by a large number other experts. The SSHAC reviewed past studies, including the Lawrence Livermore National Laboratory and the EPRI landmark PSHA studies of the 1980`s and examined ways to improve on the present state-of-the-art. The Committee`s most important conclusion is that differences in PSHA results are due to procedural rather than technical differences. Thus, in addition to providing a detailed documentation on state-of-the-art elements of a PSHA, this report provides a series of procedural recommendations. The role of experts is analyzed in detail. Two entities are formally defined-the Technical Integrator (TI) and the Technical Facilitator Integrator (TFI)--to account for the various levels of complexity in the technical issues and different levels of efforts needed in a given study.

  9. Expert group study on recommended practices for wind turbine testing and evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Ljunggren, S; Gustafsson, A; Trenka, A R

    1984-01-01

    The major goal of this documents is to facilitate comparisons of noise measurements made in different countries by different investigators. The secondary goal is to provide an engineering data base for the development and validation of analytical acoustic prediction techniques. The evaluation of wind turbines must encompass all aspects of a Wind Energy Conversion System (WECS) ranging from: energy production, quality of power, reliability, durability and safety, through to cost effectiveness or economics, noise characteristics, impact on the environment and electromagnetic interference. The development of internationally agreements on evaluation procedures for each of these areas is needed now to aid in the development of the industry, while strengthening confidence and preventing chaos in the market. It is the purpose of the proposed recommendatons for wind turbine testing to address the development of internationally agreed upon test procedures which deal with each of the above noted aspects for characteizing WECS. The IEA expert committee will pursue this procedures in each of the following areas, power performance, cost of energy from WECS, fatigue evaluation, acountics, electromagnetic interference, safety and reliability and quality of power. This paper addresses the forth item - Acoustics. The expert committee will seek to gain approval of the procedures in each member country through the IEA agreements. The recommendations shall be regularly reviewed and areas in need of further investigation shall be identified. (AB).

  10. Cognitive and Physical Demands of Activities of Daily Living in Older Adults: Validation of Expert Panel Ratings.

    Science.gov (United States)

    Fong, Tamara G; Gleason, Lauren J; Wong, Bonnie; Habtemariam, Daniel; Jones, Richard N; Schmitt, Eva M; de Rooij, Sophia E; Saczynski, Jane S; Gross, Alden L; Bean, Jonathan F; Brown, Cynthia J; Fick, Donna M; Gruber-Baldini, Ann L; O'Connor, Margaret; Tabloski, Patrica A; Marcantonio, Edward R; Inouye, Sharon K

    2015-07-01

    Difficulties with performance of functional activities may result from cognitive and/or physical impairments. To date, there has not been a clear delineation of the physical and cognitive demands of activities of daily living. To quantify the relative physical and cognitive demands required to complete typical functional activities in older adults. Expert panel survey. Web-based platform. Eleven experts from 8 academic medical centers and 300 community-dwelling elderly adults age 70 and older scheduled for elective noncardiac surgery from 2 academic medical centers. Sum scores of expert ratings were calculated and then validated against objective data collected from a prospective longitudinal study. Correlation between expert ratings and objective neuropsychologic tests (memory, language, complex attention) and physical measures (gait speed and grip strength) for performance-based tasks. Managing money, self-administering medications, using the telephone, and preparing meals were rated as requiring significantly more cognitive demand, whereas walking and transferring, moderately strenuous activities, and climbing stairs were assessed as more physically demanding. Largely cognitive activities correlated with objective neuropsychologic performance (r = 0.13-0.23, P cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment. This additional information may significantly influence decisions about rehabilitation, postacute care needs, treatment plans, and caregiver education. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts

    DEFF Research Database (Denmark)

    Deprez, P H; Bergman, J J; Meisner, S

    2010-01-01

    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...

  12. How to Choose Appropriate Experts for Peer Review: An Intelligent Recommendation Method in a Big Data Context

    Directory of Open Access Journals (Sweden)

    Duanduan Liu

    2015-05-01

    Full Text Available The rapid development of the internet has led to the accumulation of massive amounts of data, and thus we find ourselves entering the age of big data. Obtaining useful information from these big data is a crucial issue. The aim of this article is to solve the problem of recommending experts to provide peer reviews for universities and other scientific research institutions. Our proposed recommendation method has two stages. An information filtering method is first offered to identify proper experts as a candidate set. Then, an aggregation model with various constraints is suggested to recommend appropriate experts for each applicant. The proposed method has been implemented in an online research community, and the results exhibit that the proposed method is more effective than existing ones.

  13. Developing a Standard Definition of Whole-Grain Foods for Dietary Recommendations: Summary Report of a Multidisciplinary Expert Roundtable Discussion12

    Science.gov (United States)

    Ferruzzi, Mario G.; Jonnalagadda, Satya S.; Liu, Simin; Marquart, Len; McKeown, Nicola; Reicks, Marla; Riccardi, Gabriele; Seal, Chris; Slavin, Joanne; Thielecke, Frank; van der Kamp, Jan-Willem; Webb, Densie

    2014-01-01

    Although the term “whole grain” is well defined, there has been no universal standard of what constitutes a “whole-grain food,” creating challenges for researchers, the food industry, regulatory authorities, and consumers around the world. As part of the 2010 Dietary Guidelines for Americans, the U.S. Dietary Guidelines Technical Advisory Committee issued a call to action to develop definitions for whole-grain foods that could be universally accepted and applied to dietary recommendations and planning. The Committee’s call to action, and the lack of a global whole-grain food definition, was the impetus for the Whole Grain Roundtable held 3–5 December 2012 in Chicago, Illinois. The objective was to develop a whole-grain food definition that is consistent with the quartet of needs of science, food product formulation, consumer behavior, and label education. The roundtable’s expert panel represented a broad range of expertise from the United States and Europe, including epidemiology and dietary intervention researchers, consumer educators, government policy makers, and food and nutrition scientists from academia and the grain food industry. Taking into account the totality, quality, and consistency of available scientific evidence, the expert panel recommended that 8 g of whole grain/30 g serving (27 g/100 g), without a fiber requirement, be considered a minimum content of whole grains that is nutritionally meaningful and that a food providing at least 8 g of whole grains/30-g serving be defined as a whole-grain food. Having an established whole-grain food definition will encourage manufacturers to produce foods with meaningful amounts of whole grain, allow consistent product labeling and messaging, and empower consumers to readily identify whole-grain foods and achieve whole-grain dietary recommendations. PMID:24618757

  14. Practical issues of management of patients with chronic migraine. Recommendations from Russian experts

    Directory of Open Access Journals (Sweden)

    N. V. Latysheva

    2015-01-01

    Full Text Available The world medicine has achieved considerable advances over the last years in understanding of causes and pathogenesis as well as in specification of diagnostics criteria and studies of therapeutic approaches at chronic migraine (CM. Meantime this widespread disease is badly recognized by the physicians and diagnosed seldom. In addition, there is no generally accepted document, regulating the treatment of patients with CM, who are peculiar by their express deadaptation due to high frequency of severe attacks of the headache (HA, co-morbid psychic and somatic disorders, frequent abuse of analgetic drugs and low adherence to preventive therapy. The specialists of our country, like in other countries, gained their own unique expertise in management of such patients, who are hard to cure, including by botulinum A toxin – representative of the state-of-the-art generation of the registered drugs with the proven efficiency against CM. The article sets out the Recommendation from the Russian specialists as to management of the patients with CM, approved by the meeting of CM Expert Board (on November 12, 2014, Moscow, including with respect to time of treatment, rules of withdrawal and replacement of drugs and some other features, in compliance with modern world concepts on pathogenesis and treatment of such disease and expertise gained in managing patientswith CM in our country.

  15. Recommendations on the use of expert judgment in safety and reliability engineering studies. Two offshore case studies

    International Nuclear Information System (INIS)

    Hokstada, Per; Oien, Knut; Reinertsen, Rune

    1998-01-01

    This paper provides guidance on the process of establishing input data to safety and reliability engineering analyses when no or little field data exist, and expert judgment is required. Some recommendations are directly related to a discussion of basic requirements for scientific work. Further, two case studies are discussed in order to highlight some actual problem areas that are experienced when using expert judgment, and some recommendations for handling these problems are given. The first case describes how expert judgment was used to analyse the safe operation of an umbilical on a semisubmersible drilling rig, and the second case is related to establishing generic failure rates/probabilities for components of offshore safety systems

  16. Implementation intention and planning interventions in Health Psychology : Recommendations from the Synergy Expert Group for research and practice

    NARCIS (Netherlands)

    Hagger, M.S.; Luszczynska, A.; de Wit, J.; Benyamini, Y.; Burkert, S.; Chamberland, P.-E.; Chater, A.; Dombrowski, S.U.; van Dongen, A.; French, D.P.; Gauchet, A.; Hankonen, N.; Karekla, M.; Kinney, A.Y.; Kwasnicka, D.; Lo, S.H.; López-Roig, S.; Meslot, C.; Marques, M.M.; Neter, E.; Plass, A.M.; Potthoff, S.; Rennie, L.; Scholz, U.; Stadler, G.; Stolte, E.; ten Hoor, G.; Verhoeven, A.A.C.; Wagner, M.; Oettingen, G.; Sheeran, P.; Gollwitzer, P.M.

    2016-01-01

    The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural

  17. Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice

    NARCIS (Netherlands)

    Hagger, M.S.; Luszczynska, A.; de Wit, J.; Benyamini, Y.; Burkert, S.; Chamberland, P.E.; Chater, A.; Dombrowski, S.U.; van Dongen, A.; French, D.P.; Gauchet, A.; Hankonen, N.; Karekla, M.; Kinney, A.Y.; Kwasnicka, D.; Lo, S.H.; López-Roig, S.; Meslot, C.; Marques, M.M.; Neter, E.; Plass, A.M.; Potthoff, S.; Rennie, L.; Scholz, U; Stadler, G.; Stolte, E.; Ten Hoor, G.; Verhoeven, A.; Wagner, M.; Oettingen, G.; Sheeran, P.; Gollwitzer, P.M.

    2016-01-01

    The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural

  18. Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines.

    Science.gov (United States)

    Velligan, Dawn I; Weiden, Peter J; Sajatovic, Martha; Scott, Jan; Carpenter, Daniel; Ross, Ruth; Docherty, John P

    2010-01-01

    Poor adherence to medication treatment can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article concerning assessment of adherence are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey contained 39 questions (521 options) that asked about defining nonadherence, extent of adherence problems in schizophrenia and bipolar disorder, risk factors for nonadherence, assessment methods, and interventions for specific types of adherence problems. The survey was completed by 41 (85%) of the 48 experts to whom it was sent. When evaluating adherence, the experts considered it important to assess both behavior and attitude, although they considered actual behavior most important. They also noted the importance of distinguishing patients who are not willing to take medication from those who are willing but not able to take their medication as prescribed due to forgetfulness, misunderstanding of instructions, or financial or environmental problems, since this will affect the type of intervention needed. Although self- and physician report are most commonly used to clinically assess adherence, they are often inaccurate and may underestimate nonadherence. The experts believe that more accurate information will be obtained by asking about any problems patients are having or anticipate having taking medication rather than if they have been taking their medication; They also recommended speaking with family or caregivers, if the patient gives permission, as well as using more objective measures (e.g., pill counts, pharmacy records, smart pill containers if available, and, when appropriate, medication plasma levels). Use of a validated self-report scale may also help improve accuracy. For patients who appear adherent to medication, the experts recommended monthly assessments for

  19. Panel: Current Status of Knowledge and Recommendations for Further Related Activities

    International Nuclear Information System (INIS)

    Caldarola, L.; Costa, J.; Fauske, Hans K.; Jakeman, D.; Mizuta, H.; Wright, R.W.; Stadie, K.B.

    1976-01-01

    This Panel consists of two parts, in the first part the participants attempt to summarise their views on the current status and knowledge of SFI and its importance for the LMFBR safety case and in the second part they try to agree on recommendations for future actions. The first question tackled was: what progress has been made since the Ispra meeting which was a little over two years ago - in answering the question: 'what role does SFI play in LMFBR safety'? The second question approached was: 'Is it possible to identify SFI areas which are not yet covered by the present research and development programme? Finally 4 recommendations were proposed: 1. to have another meeting of the same nature as this one and the previous ones in two years' time; 2. to create a group dealing with the fundamental science with a view to further the safety of the LMFBR. This group would meet more regularly and would not require, and that is the important thing, approval from-CSNI every time it meets; 3. to discontinue the group on calculational models; 4. to publish at least one to two newsletters between this SFI meeting and the next SFI meeting in two years

  20. Recent advances in acute lymphoblastic leukemia in children and adolescents: an expert panel discussion.

    Science.gov (United States)

    Asselin, Barbara L; Gaynon, Paul; Whitlock, James A

    2013-12-01

    Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia, representing 75% to 80% of cases of acute leukemia among children. Dramatic improvements in the cure rates and survival outcomes for children with ALL have been seen over the past several decades; currently the 5-year survival rate for childhood ALL is more than 80%. These improvements have come about because of advances in the understanding of the molecular genetics and pathogenesis of the disease, incorporation of risk-adapted therapy, and the advent of new targeted agents. Scientific advances have provided new insights into leukemogenesis, drug resistance, and host pharmacogenomics, identified novel subtypes of leukemia, and suggested potential targets for therapy. At the same time novel monoclonal antibodies, small molecule inhibitors, chemotherapeutics, and cell-based treatment strategies have been developed and investigated. In this article, experts will discuss some of the current challenges and future directions in the treatment of pediatric ALL. The authors will offer expert guidance to practicing oncologists on how to best incorporate newer treatment approaches into the care of children and adolescents with ALL. The most important ongoing clinical trials in the area will also be reviewed.

  1. Final report of the Cosmetic Ingredient Review Expert Panel amended safety assessment of Calendula officinalis-derived cosmetic ingredients.

    Science.gov (United States)

    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

    2010-01-01

    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.

  2. Probability encoding of hydrologic parameters for basalt: Elicitation of expert opinions from a panel of five consulting hydrologists

    International Nuclear Information System (INIS)

    Davis, J.D.

    1984-01-01

    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 flow top and flow interior and the vertical-to-horizontal hydraulic conductivity, or anisotropy ratio, of the Cohassett flow interior. Site-specific data for these hydrologic parameters are currently inadequate. To obtain credible, auditable, and independently derived estimates of the specified hydrologic parameters for the purpose of preliminary assessment of candidate repository performance, 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. 210 refs., 12 figs., 5 tabs

  3. Developing a HACCP-like system for improving animal health and welfare in organic egg production - based on an expert panel analysis

    DEFF Research Database (Denmark)

    Hegelund, Lene; Sørensen, Jan Tind

    2007-01-01

    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...

  4. A review of the carcinogenic potential of glyphosate by four independent expert panels and comparison to the IARC assessment.

    Science.gov (United States)

    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

    2016-09-01

    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.

  5. Probability encoding of hydrologic parameters for basalt. Elicitation of expert opinions from a panel of five consulting hydrologists

    International Nuclear Information System (INIS)

    Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.

    1984-11-01

    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

  6. Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel

    Science.gov (United States)

    Allison, Kimberly H; Reisch, Lisa M; Carney, Patricia A; Weaver, Donald L; Schnitt, Stuart J; O’Malley, Frances P; Geller, Berta M; Elmore, Joann G

    2015-01-01

    Aims To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon. Methods and results In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists’ opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases. Conclusions Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability. PMID:24511905

  7. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis.

    Science.gov (United States)

    Fritz, Julie M; Rundell, Sean D; Dougherty, Paul; Gentili, Angela; Kochersberger, Gary; Morone, Natalia E; Naga Raja, Srinivasa; Rodriguez, Eric; Rossi, Michelle I; Shega, Joseph; Sowa, Gwendolyn; Weiner, Debra K

    2016-03-01

    . To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. . 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 illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR). . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care. . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations

    Science.gov (United States)

    Sommers, Juultje; Engelbert, Raoul HH; Dettling-Ihnenfeldt, Daniela; Gosselink, Rik; Spronk, Peter E; Nollet, Frans; van der Schaaf, Marike

    2015-01-01

    Objective: To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. Methods: We used the EBRO method, as recommended by the ‘Dutch Evidence Based Guideline Development Platform’ to develop an ‘evidence statement for physiotherapy in the intensive care unit’. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. Results: Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. Conclusions: These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014. PMID:25681407

  9. Maintenance treatment of advanced non-small-cell lung cancer: results of an international expert panel meeting of the Italian association of thoracic oncology.

    Science.gov (United States)

    Gridelli, Cesare; de Marinis, Filippo; Di Maio, Massimo; Ardizzoni, Andrea; Belani, Chandra P; Cappuzzo, Federico; Ciardiello, Fortunato; Fidias, Panagiotis; Paz-Ares, Luis; Perrone, Francesco; Pirker, Robert; De Petris, Luigi; Stahel, Rolf

    2012-06-01

    Several randomized trials have recently investigated the role of maintenance treatment for patients with advanced non-small-cell lung cancer (NSCLC) with responding or stable disease after completion of first-line chemotherapy. Maintenance strategy has relevant implications in terms of potential toxicity, logistics and costs, and all of these aspects should be taken into account, together with the magnitude of benefit for the patient. In order to assess the strengths and limitations of available evidence, to help clinical practice, and to suggest priorities for future clinical research, the Italian Association of Thoracic Oncology (AIOT) organized an International Experts Panel Meeting on maintenance treatment of advanced NSCLC, which took place in Sperlonga (Italy) in May 2011. Based on the available evidence, panelists agreed that maintenance therapy represents a treatment option in advanced NSCLC. Maintenance should be discussed with patients not progressed after 4-6 cycles of first-line chemotherapy, who are fit (performance status 0-1) and without persistent chemotherapy-induced toxicity. Patients need to be well informed about potential advantages and disadvantages of accepting additional therapy without a "treatment-free period". Two different strategies, switch or continuation maintenance, are supported by available evidence. At the moment, there is no direct comparison between switch maintenance and continuation maintenance. For future trials, the panel recommends the use of overall survival as the primary endpoint, with pre-defined second-line treatment. Translational research is essential to identify predictive factors, and should be performed, whenever feasible, in order to achieve treatment optimization with proper patient selection. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.

    Science.gov (United States)

    Günthard, Huldrych F; Saag, Michael S; Benson, Constance A; del Rio, Carlos; Eron, Joseph J; Gallant, Joel E; Hoy, Jennifer F; Mugavero, Michael J; Sax, Paul E; Thompson, Melanie A; Gandhi, Rajesh T; Landovitz, Raphael J; Smith, Davey M; Jacobsen, Donna M; Volberding, Paul A

    2016-07-12

    New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and

  11. The UN panel of governmental experts on small arms: a Canadian perspective on their report

    International Nuclear Information System (INIS)

    DeClerq, D.G.

    1998-01-01

    After the end of the Cold War, the United Nations, some individual governments, non-govermental research organizations and academia began to focus increased attention on light weapons as an arms control proliferation issue particularly within the context of intrastate warfare and destabilizing criminal activities. In 1995 the Secretary-General to the Security Council in a report entitled, An Agenda for Peace stressed the need for 'practical disarmament in the context of the conflicts that the UN is actually dealing with and of the weapons most of them light weapons, that are actually killing people in the hundreds of thousands. Light weapons and small arms have been the subject of some 12 UN resolutions and documents among them, UN Resolution 49175M which addressed illicit arms trafficking and Annex I of UN Document A151142 which provided 'Guidelines for International Arms Transfers.' Within a different context, the UN Commission on Crime Prevention and Criminal Justice in Vienna recently made recommendations on the impact of small arms, primarily within the framework of criminal activities, accidents and suicides, illicit firearms trafficking, and domestic, regional and interregional firearms regulations. On 12 December 1995, Japan introduced Resolution 50/01/70 B which was the first attempt by the UN to clearly address small arms and light weapons as an arms control issue. (author)

  12. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel.

    Science.gov (United States)

    Cicero, Arrigo F G; Colletti, Alessandro; Bajraktari, Gani; Descamps, Olivier; Djuric, Dragan M; Ezhov, Marat; Fras, Zlatko; Katsiki, Niki; Langlois, Michel; Latkovskis, Gustavs; Panagiotakos, Demosthenes B; Paragh, Gyorgy; Mikhailidis, Dimitri P; Mitchenko, Olena; Paulweber, Bernhard; Pella, Daniel; Pitsavos, Christos; Reiner, Željko; Ray, Kausik K; Rizzo, Manfredi; Sahebkar, Amirhossein; Serban, Maria-Corina; Sperling, Laurence S; Toth, Peter P; Vinereanu, Dragos; Vrablík, Michal; Wong, Nathan D; Banach, Maciej

    2017-09-01

    In recent years, there has been growing interest in the possible use of nutraceuticals to improve and optimize dyslipidemia control and therapy. Based on the data from available studies, nutraceuticals might help patients obtain theraputic lipid goals and reduce cardiovascular residual risk. Some nutraceuticals have essential lipid-lowering properties confirmed in studies; some might also have possible positive effects on nonlipid cardiovascular risk factors and have been shown to improve early markers of vascular health such as endothelial function and pulse wave velocity. However, the clinical evidence supporting the use of a single lipid-lowering nutraceutical or a combination of them is largely variable and, for many of the nutraceuticals, the evidence is very limited and, therefore, often debatable. The purpose of this position paper is to provide consensus-based recommendations for the optimal use of lipid-lowering nutraceuticals to manage dyslipidemia in patients who are still not on statin therapy, patients who are on statin or combination therapy but have not achieved lipid goals, and patients with statin intolerance. This statement is intended for physicians and other healthcare professionals engaged in the diagnosis and management of patients with lipid disorders, especially in the primary care setting. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  13. Caring for Our Future: The Content of Prenatal Care. A Report of the Public Health Service Expert Panel on the Content of Prenatal Care.

    Science.gov (United States)

    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…

  14. An expert panel approach to assessing potential effects of bull trout reintroduction on federally listed salmonids in the Clackamas River, Oregon

    Science.gov (United States)

    Bruce G. Marcot; Chris S. Allen; Steve Morey; Dan Shively; Rollie. White

    2012-01-01

    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...

  15. Ethical acceptability of research on human-animal chimeric embryos: summary of opinions by the Japanese Expert Panel on Bioethics.

    Science.gov (United States)

    Mizuno, Hiroshi; Akutsu, Hidenori; Kato, Kazuto

    2015-01-01

    Human-animal chimeric embryos are embryos obtained by introducing human cells into a non-human animal embryo. It is envisaged that the application of human-animal chimeric embryos may make possible many useful research projects including producing three-dimensional human organs in animals and verification of the pluripotency of human ES cells or iPS cells in vivo. The use of human-animal chimeric embryos, however, raises several ethical and moral concerns. The most fundamental one is that human-animal chimeric embryos possess the potential to develop into organisms containing human-derived tissue, which may lead to infringing upon the identity of the human species, and thus impairing human dignity. The Japanese Expert Panel on Bioethics in the Cabinet Office carefully considered the scientific significance and ethical acceptability of the issue and released its "Opinions regarding the handling of research using human-animal chimeric embryos". The Panel proposed a framework of case-by-case review, and suggested that the following points must be carefully reviewed from the perspective of ethical acceptability: (a) Types of animal embryos and types of animals receiving embryo transfers, particularly in dealing with non-human primates; (b) Types of human cells and organs intended for production, particularly in dealing with human nerve or germ cells; and (c) Extent of the period required for post-transfer studies. The scientific knowledge that can be gained from transfer into an animal uterus and from the production of an individual must be clarified to avoid unnecessary generation of chimeric animals. The time is ripe for the scientific community and governments to start discussing the ethical issues for establishing a global consensus.

  16. Expert Meeting. Recommended Approaches to Humidity Control in High Performance Homes

    Energy Technology Data Exchange (ETDEWEB)

    Rudd, Armin [Building Science Corporation (BSC), Somerville, MA (United States)

    2013-07-01

    This meeting was held on October 16, 2012, in Westford, MA, and brought together experts in the field of residential humidity control to address modeling issues for dehumidification. The presentations and discussions centered on computer simulation and field experience with these systems, with the goal of developing foundational information to support the development of a Building America Measure Guideline on this topic.

  17. Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.

    Science.gov (United States)

    Velligan, Dawn I; Weiden, Peter J; Sajatovic, Martha; Scott, Jan; Carpenter, Daniel; Ross, Ruth; Docherty, John P

    2010-09-01

    Poor adherence to medication can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey (39 questions, 521 options) on adherence problems in schizophrenia and bipolar disorder was completed by 41 experts in 2008. This article first reviews the literature on interventions aimed at improving adherence. It then presents the experts' recommendations for targeting factors that can contribute to nonadherence and relates them to the literature. The following psychosocial/programmatic and pharmacologic interventions were rated first line for specific problems that can lead to nonadherence: ongoing symptom/ side-effect monitoring for persistent symptoms or side effects; services targeting logistic problems; medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) for lack of routines or cognitive deficits; and adjusting the dose or switching to a different oral antipsychotic for persistent side effects (also high second-line for persistent symptoms). Among pharmacologic interventions, the experts gave high second-line ratings to switching to a long-acting antipsychotic when lack of insight, substance use, persistent symptoms, logistic problems, lack of routines, or lack of family/ social support interfere with adherence and to simplifying the treatment regimen when logistic problems, lack of routines, cognitive deficits, or lack of family/social support interfere with adherence. Psychosocial/programmatic interventions that received high second-line ratings in a number of situations included medication monitoring/environmental supports, patient psychoeducation, more frequent and/or longer visits if possible, cognitive behavioral therapy (CBT), family-focused therapy

  18. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

    Science.gov (United States)

    Zhang, W; Moskowitz, R W; Nuki, G; Abramson, S; Altman, R D; Arden, N; Bierma-Zeinstra, S; Brandt, K D; Croft, P; Doherty, M; Dougados, M; Hochberg, M; Hunter, D J; Kwoh, K; Lohmander, L S; Tugwell, P

    2008-02-01

    To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and

  19. Geochemistry Review Panel report on the SRP geochemistry program and draft geochemistry summary program plan (May, 1986) and discussion of panel recommendations

    International Nuclear Information System (INIS)

    1986-12-01

    The Geochemistry Review Panel (GRP) was established by the Salt Repository Project Office (SRPO) to help evaluate geochemistry-related issues in the US Department of Energy's nuclear waste repository program. The May 1986 meeting of the GRP reviewed the Salt Repository Program (SRP) geochemistry program developed by the Office of Nuclear Waste Isolation (ONWI). This program is described in the Draft Geochemistry Plan of April 9, 1986. This report documents the GRP's comments and recommendations on this subject and the ONWI responses to the specific points raised by the GRP

  20. Developing a HACCP-like system for improving animal health and welfare in organic egg production - based on an expert panel analysis.

    Science.gov (United States)

    Hegelund, L; Sørensen, J T

    2007-08-01

    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

  1. ESPEN expert group recommendations for action against cancer-related malnutrition.

    Science.gov (United States)

    Arends, J; Baracos, V; Bertz, H; Bozzetti, F; Calder, P C; Deutz, N E P; Erickson, N; Laviano, A; Lisanti, M P; Lobo, D N; McMillan, D C; Muscaritoli, M; Ockenga, J; Pirlich, M; Strasser, F; de van der Schueren, M; Van Gossum, A; Vaupel, P; Weimann, A

    2017-10-01

    Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  2. Thyroid cancer in children living near Chernobyl. Expert panel report on the consequences of the Chernobyl accident

    International Nuclear Information System (INIS)

    Williams, D.; Karaoglou, A.; Chadwick, K.H.

    1993-01-01

    In January 1992, the Radiation Protection Research Action formed a panel of thyroid experts in order to evaluate the current situation concerning reported increased rates of thyroid cancer in children living in the neighbourhood of Chernobyl, where the reactor accident occurred on April 26 1986 and resulted in widespread radioactive contamination over large areas of Belarus, Russia, Ukraine. Studies of the Atom Bomb survivors in Japan have revealed that the incidence of leukemia starts to increase some five years after exposure. For Chernobyl accident health consequences are now becoming evident. Thyroid cancer has already been observed in children. Iodine 131 was seen to pose a specific hazard because it is taken up by the body and concentrated in the thyroid gland. At a dose of 5 Gy to the childhood thyroid about 4000 thyroid cancers per 100000 children exposed can be anticipated. An essential component of the verification of this observation is the study of the pathology of the lesions, which derived from four cell types: follicular cells, C cells, lymphoid cells and connective tumor cells. All distant metastases are lung metastases. Measures to be considered for the prevention of the development of thyroid cancer in a radiation-exposed population include correction of iodine deficiency by iodine prophylaxis and suppression of TSH. There are three methods of diagnosis: ultrasound imaging, thyroid scanning, fine needle aspiration performed by skilled personnel. For the therapy total or near-total thyroidectomy is regarded as the treatment of choice. Radioactive iodine can be used to treat lymph node and distant metastases which take up iodine after a total thyroidectomy. Thyroid hormone replacement should be carried out with TSH suppressive doses of L-Thyroxine. 45 refs., 1 annexe

  3. Sem-Fit: a semantic based expert system to provide recommendations in the tourism domain

    OpenAIRE

    García-Crespo, Ángel; López-Cuadrado, José Luis; Colomo-Palacios, Ricardo; González-Carrasco, Israel; Ruiz-Mezcua, Belén

    2011-01-01

    The hotel industry is one of the leading stakeholders in the tourism sector. In order to reduce the trav eler’s cost of seeking accommodations, enforce the return ratio efficiency of guest rooms and enhance total operating performance, evaluating and selecting a suitable hotel location has become one of the most critical issues for the hotel industry. In this scenario, recommender services are increasingly emerg ing which employ intelligent agents and artificial intelligence to ‘‘cut through’...

  4. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.

    Science.gov (United States)

    Piltcher, Otávio Bejzman; Kosugi, Eduardo Macoto; Sakano, Eulalia; Mion, Olavo; Testa, José Ricardo Gurgel; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Sá, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin

    Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  5. A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings from a Systematic Review and Expert Panel

    OpenAIRE

    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.

    2013-01-01

    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 ...

  6. Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

    Science.gov (United States)

    Pirrello, Rosene D.; Hirst, Jeremy M.; Buckholz, Gary T.; Ferris, Frank D.

    2013-01-01

    Abstract Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes. PMID:23480299

  7. Implementing and expanding HIV testing in immigrant populations in Europe: Comparing guideline's recommendations and expert's opinions.

    Science.gov (United States)

    Álvarez-Del Arco, Débora; Monge, Susana; Rivero-Montesdeoca, Yaiza; Burns, Fiona; Noori, Teymur; Del Amo, Julia

    2017-01-01

    Immigrant populations, especially those from endemic countries, living in the European Union (EU) suffer a disproportionate burden of HIV, delayed diagnosis and poorer access to antiretroviral treatment. While International Organisations are developing recommendations aimed at increasing the uptake of HIV testing, the feasibility and real outcomes of these measures remain unexplored. The aim of this review was, firstly to identify the recommendations of the main International Organisations (IO) on HIV testing in immigrants. Secondly, to describe the challenges for implementing and expanding HIV testing and counselling interventions targeting immigrants by interviewing key informants. The importance of HIV testing in immigrants is discussed, along with the appropriateness of universal HIV testing approaches vs most at risk targeted approaches. Also addressed is, pre- and post-HIV test counselling characteristics and community initiatives suitable to reach this population and, finally the legal issues regarding access to treatment for illegal immigrants. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  8. The DELPHI expert process of the German umbrella project AUGE as basis for recommendations to CO2 storage in Germany

    Science.gov (United States)

    Pilz, Peter; Schoebel, Birgit; Liebscher, Axel

    2016-04-01

    Within the GEOTECHNOLOGIEN funding scheme for geological CO2 storage by the Federal Ministry of Education and Research (BMBF) in Germany 33 projects (135 subprojects) have been funded with a total budget of 58 Mio € (excluding industry funds) from 2005 to 2014. In 2012, the German parliament passed the transposition of the EU CCS Directive 2009/31/EG into the national "Carbon Dioxide Storage Law" (KSpG). Annex 1 of the KSpG provides a description of criteria for the characterization and assessment of a potential CO2 storage site. Annex 2 describes the expected monitoring system of a CO2 storage site. The criteria given in the appendices are of general nature, which reflects (1) that the CO2 storage technology is still being developed and (2) that site specific aspects needs to be considered. In 2012 an umbrella project called AUGE has been launched in order to compile and summarize the results of the GEOTECHNOLOGIEN projects to underpin the two Annexes scientifically. By integration of the individual project results AUGE aims at derive recommendations for the review and implementation of the KSpG. The recommendations shall be drafted based on a common ground of science, public authorities and industry. Therefore, the AUGE project includes a Delphi expert process as an essential part. It is realized in cooperation with the company COMPARE Consulting, Göppingen. The implementation of the Delphi-Process is organized in three steps: • After the technical preparation of a standardized questionnaire (2014/2015) it was sent to 129 experts from science, industry and public authorities in Germany. After a few weeks of consideration time, 40 persons (30 %) had decided to participate actively in this inquiry. • Following the results of the first interrogation campaign, the second survey campaign started at the end of 2015. The same list of questions was used, complemented with the results of the first inquiry campaign. The intention is reduce the variance of the

  9. Leveraging geospatial data, technology, and methods for improving the health of communities: priorities and strategies from an expert panel convened by the CDC.

    Science.gov (United States)

    Elmore, Kim; Flanagan, Barry; Jones, Nicholas F; Heitgerd, Janet L

    2010-04-01

    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.

  10. The National Nanotechnology Initiative: Second Assessment and Recommendations of the National Nanotechnology Advisory Panel

    Science.gov (United States)

    2008-04-01

    Council on Bioethics . NNI member agencies and the National Nanotechnology Coordination Office (NNCO) also provided valuable information. The NNAP...societal aspects of nanotechnology. In consultation with the President’s Council on Bioethics , the panel concluded that at present, nanotechnology...biomarker. One is a magnetic particle probe that captures the target from complex media . The other is a gold nanoparticle probe that is specific to the

  11. Energy from gas hydrates - assessing the opportunities and challenges for Canada: report of the expert panel on gas hydrates

    International Nuclear Information System (INIS)

    2008-09-01

    Gas hydrates form when water and natural gas combine at low temperatures and high pressures in regions of permafrost and in marine subseafloor sediments. Estimates suggest that the total amount of natural gas bound in hydrate form may exceed all conventional gas resources, or even the amount of all combined hydrocarbon energy. Gas from gas hydrate could provide a potentially vast new source of energy to offset declining supplies of conventional natural gas in North America and to provide greater energy security for countries such as Japan and India that have limited domestic sources. However, complex issues would need to be addressed if gas hydrate were to become a large part of the energy future of Canada. Natural Resources Canada asked the Council of Canadian Academies to assemble a panel of experts to examine the challenges for an acceptable operational extraction of gas hydrates in Canada. This report presented an overview of relevant contextual background, including some basic science; the medium-term outlook for supply and demand in markets for natural gas; broad environmental issues related to gas hydrate in its natural state and as a fuel; and an overview of Canada's contribution to knowledge about gas hydrate in the context of ongoing international research activity. The report also presented current information on the subject and what would be required to delineate and quantify the resource. Techniques for extracting gas from gas hydrate were also outlined. The report also addressed safety issues related to gas hydrate dissociation during drilling operations or release into the atmosphere; the environmental issues associated with potential leakage of methane into the atmosphere and with the large volumes of water produced during gas hydrate dissociation; and jurisdictional and local community issues that would need to be resolved in order to proceed with the commercial exploitation of gas hydrate. It was concluded that there does not appear to be

  12. 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

    NARCIS (Netherlands)

    Klok, F. A.; Schreiber, K.; Stach, K.; Ageno, W.; Middeldorp, S.; Eichinger, S.; Delluc, A.; Blondon, M.; Ay, C.

    2017-01-01

    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. 10

  13. 1. Introduction. 2. Laboratory experiments. 3. Field experiments. 4. Integrated field-laboratory experiments. 5. Panel recommendations

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    Some recommendations for the design of laboratory and field studies in marine radioecology are formulated. The difficulties concerning the comparability of various experimental methods used to measure the fluxes of radionuclides through marine organisms and ecosystems, and also the use of laboratory results to make predictions for the natural environment are discussed. Three working groups were established during the panel meeting, to consider laboratory experiments, field studies, and the design and execution of integrated laboratory and field studies respectively. A number of supporting papers dealing with marine radioecological experiments were presented

  14. Secondary prophylaxis with rFVIIa in hemophilia and inhibitors: Recommendations from an Experts Committee from Argentina

    Directory of Open Access Journals (Sweden)

    Raúl Pérez Bianco

    2010-06-01

    Full Text Available Secondary prophylaxis with rFVIIa has been the subject of several publications in the past few years. However, there is no general consensus on how this treatment should be put into practice, as publications have been very heterogeneous in the dosing schedule they report. Furthermore, the mechanism of action of rFVIIa and its short half life have been used as arguments against its role in prophylaxis. There have been a series of recent publications that show that rFVIIa can traffic through the intact endothelium and be stored in the subendothelium of several organs for a prolonged period of time. In order to consensuate the role of rFVIIa in prophylaxis, a group of experts from Argentina, resumed available information regarding pharmacology and clinical experience with this treatment, and developed a series of recommendations to use this drug in the prophylaxis setting.

  15. Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.

    Science.gov (United States)

    Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O

    2012-06-01

    It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), psystems in any application domain. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Energy for a sustainable society. Recommendations of the Panel; Energi for et baerekraftig samfunn. Panelets anbefalinger

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-10-01

    On June 18 and 19, 1997, The Norwegian Research Council arranged a series of national conferences on sustainable development. A panel has followed up the conferences with the present report. The priority is on issues of importance for the development of policies and political means in the climate area. This is because the climate challenges are essential for a sustainable global development. Without doubt, it takes long for the temperature of the atmosphere to stabilise after a change in the CO{sub 2} content, several decades. Greatly reduced anthropogenic emissions of greenhouse gases cannot prevent a delayed temperature increase, which calls for precautionary measures. Norwegian policy should be based on the assumption that the emission negotiations will lead to emission restrictions for most of the industrialised countries. However, one-sided focus on national emission goals may lead to unwanted increase in other countries' emissions following Norwegian decreases. The panel suggests that Norwegian measures should be oriented along the following: (1) Energy efficiency, (2) Social planning, (3) Renewable energy sources, (4) De-carbonisation of fossil energy carriers.

  17. Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

    Science.gov (United States)

    Wilkes, Michael; Srinivasan, Malathi; Cole, Galen; Tardif, Richard; Richardson, Lisa C; Plescia, Marcus

    2013-11-01

    Shared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men. In July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians. Two-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes. Sixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations). Panelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified. Highly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing

  18. Recommendations to the Technical Steering Panel regarding approach for estimating individual radiation doses resulting from releases of radionuclides to the Columbia River

    International Nuclear Information System (INIS)

    Brothers, A.J.; Napier, B.A.

    1992-08-01

    At the direction of the Technical Steering Panel (TSP) of the Hanford Environmental Dose Reconstruction (HEDR) Project, Battelle staff have reviewed and analyzed available data regarding possible historical radiation doses to individuals resulting from radionuclide releases to the Columbia River. The objective of this review was to recommend to the TSP the spatial and temporal scope and level of effort on Columbia River work to most effectively extend work performed in Phase I of the project to meet the project objectives. Four stretches of the Columbia River and adjacent Pacific coastal waters were defined and investigated for four time periods. Radiation doses arising from ten potentially major exposure pathways were evaluated for each of the time/location combinations, and several alternative methods were defined for estimating the doses from each pathway. Preliminary cost estimates were also developed for implementing dose estimation activities for each of the possible combinations. The number of combinations of the alternatives is obviously very large. A ''value of information'' (VOI) decision analysis tool was developed and applied to the problem of selecting a few ''optimal'' sets of alternatives to consider. This VOI analysis relies on both available data and the judgement of technical experts. Input data and the algorithms used are described

  19. Final recommendations of the Peer Review Panel on the use of seismic methods for characterizing Yucca Mountain and vicinity

    International Nuclear Information System (INIS)

    1991-01-01

    The Peer Review Panel was charged with deciding whether seismic methods, which had been utilized at Yucca Mountain with mixed results in the past, could provide useful information about the Tertiary structure in the Yucca Mountain area. The objectives of using seismic methods at Yucca Mountain are to: (a) obtain information about the structural character of the Paleozoic-Tertiary (Pz-T) contact, and (b) obtain information about the structural and volcanic details within the Tertiary and Quaternary section. The Panel recommends that a four part program be undertaken to test the utility of seismic reflection data for characterizing the structural setting of the Yucca Mountain area. The Panel feels strongly that all four parts of the program must be completed in order to provide the highest probability of success. The four parts of the program are: (a) drill or extend a deep hole in Crater Flat to provide depth control and allow for the identification of seismic reflectors in an area where good quality seismic reflection data are expected; (b) undertake a full seismic noise test in Crater Flat, test 2D receiver arrays as well as linear arrays; perform an expanding spread test using both P and S wave sources to obtain a quick look at the reflection quality in the area and see if shear wave reflections might provide structural information in areas of unsaturated rock; (c) acquire a P wave seismic reflection profile across Crater Flat through the deep control well, across Yucca Mountain, and continuing into Jackass Flats; and (d) acquire a standard VSP (vertical seismic profiling) in the deep control well to tie the seismic data into depth and to identify reflectors correctly

  20. Do textbooks used in university reading education courses conform to the instructional recommendations of the national reading panel?

    Science.gov (United States)

    Malatesha Joshi, R; Binks, Emily; Graham, Lori; Ocker-Dean, Emily; Smith, Dennie L; Boulware-Gooden, Regina

    2009-01-01

    Two reasons may be responsible for the poor grasp of the linguistic concepts related to literacy acquisition by preservice and in-service teachers: a lack of attention given to such concepts by teacher educators (college faculty members) and a lack of relevant information provided in the textbooks used in college courses. In an earlier study, the authors found that many teacher educators involved in the training of preservice and in-service teachers were not well acquainted with these concepts. In this study, the authors examined the extent to which textbooks used in reading education courses contain the information about the five components of literacy instruction (phonemic awareness, phonics, fluency, vocabulary, and text comprehension) recommended by the National Reading Panel. Such scrutiny shows that many textbooks do not adequately cover these five components and the related instructional procedures for teaching them. In addition to the paucity of information about teaching the five components, some textbooks present inaccurate information.

  1. Endobronchial Valves for Endoscopic Lung Volume Reduction : Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction

    NARCIS (Netherlands)

    Slebos, Dirk-Jan; Shah, Pallav L.; Herth, Felix J. F.; Valipour, Arschang

    Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in

  2. Use of questionnaires and an expert panel to judge the environmental consequences of chemical spills for the development of an environment-accident index.

    Science.gov (United States)

    Andersson, Asa Scott; Stjernström, Olof; Fängmark, Ingrid

    2005-05-01

    Assessing the environmental consequences of a chemical accident is a complex task. To date, the methods used to evaluate the environmental effects of an acute release of a chemical have often been based on measurements of chemical and physical variables deemed to be important, such as the concentration of the chemical. However, a broader strategy is needed to predict the environmental consequences of potential accidents during the planning process. An Environment-Accident Index (EAI), a simple tool based on such a strategy, has been developed to facilitate the consideration of a multitude of influential variables. The objectives of this study were to evaluate whether questionnaire-based expert panel's judgements could provide useful data on the environmental consequences of chemical spills, and an effective basis for further development of the EAI. As expected, the judgements did not agree perfectly, but they do give rough indications of the environmental effects, and highlight consistent trends that should be useful inputs for planning, prevention and decontamination processes. The different accidents were also judged to have caused everything from minor to very major effects in the environment, implying that a wide range of accident scenarios were represented in the material and covered by the EAI. Therefore, questionnaires and expert panel judgements can be used to collect useful data for estimating the likely environmental consequences of chemical accidents and for further development of the EAI.

  3. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine.

    Science.gov (United States)

    Trouillet, Jean-Louis; Collange, Olivier; Belafia, Fouad; Blot, François; Capellier, Gilles; Cesareo, Eric; Constantin, Jean-Michel; Demoule, Alexandre; Diehl, Jean-Luc; Guinot, Pierre-Grégoire; Jegoux, Franck; L'Her, Erwan; Luyt, Charles-Edouard; Mahjoub, Yazine; Mayaux, Julien; Quintard, Hervé; Ravat, François; Vergez, Sébastien; Amour, Julien; Guillot, Max

    2018-06-01

    Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques 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 tracheotomy in adult 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) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  4. Improved inter-observer agreement of an expert review panel in an oncology treatment trial--Insights from a structured interventional process.

    Science.gov (United States)

    Nestle, Ursula; Rischke, Hans Christian; Eschmann, Susanne Martina; Holl, Gabriele; Tosch, Marco; Miederer, Matthias; Plotkin, Michail; Essler, Markus; Puskas, Cornelia; Schimek-Jasch, Tanja; Duncker-Rohr, Viola; Rühl, Friederike; Leifert, Anja; Mix, Michael; Grosu, Anca-Ligia; König, Jochem; Vach, Werner

    2015-11-01

    Oncologic imaging is a key for successful cancer treatment. While the quality assurance (QA) of image acquisition protocols has already been focussed, QA of reading and reporting offers still room for improvement. The latter was addressed in the context of a prospective multicentre trial on fluoro-deoxyglucose (FDG)-positron-emission tomography (PET)/CT-based chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). An expert panel was prospectively installed performing blinded reviews of mediastinal NSCLC involvement in FDG-PET/CT. Due to a high initial reporting inter-observer disagreement, the independent data monitoring committee (IDMC) triggered an interventional harmonisation process, which overall involved 11 experts uttering 6855 blinded diagnostic statements. After assessing the baseline inter-observer agreement (IOA) of a blinded re-review (phase 1), a discussion process led to improved reading criteria (phase 2). Those underwent a validation study (phase 3) and were then implemented into the study routine. After 2 months (phase 4) and 1 year (phase 5), the IOA was reassessed. The initial overall IOA was moderate (kappa 0.52 CT; 0.53 PET). After improvement of reading criteria, the kappa values improved substantially (kappa 0.61 CT; 0.66 PET), which was retained until the late reassessment (kappa 0.71 CT; 0.67 PET). Subjective uncertainty was highly predictive for low IOA. The IOA of an expert panel was significantly improved by a structured interventional harmonisation process which could be a model for future clinical trials. Furthermore, the low IOA in reporting nodal involvement in NSCLC may bear consequences for individual patient care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Intergovernmental Conference of Experts on the Scientific Basis for Rational Use and Conservation of the Resources of the Biosphere (Paris, France, September 4-13, 1968), Recommendations.

    Science.gov (United States)

    United Nations Educational, Scientific, and Cultural Organization, Paris (France).

    This document contains twenty recommendations put forth at the Intergovernmental Conference of Experts on the Scientific Basis for Rational Use and Conservation of the Resources of the Biosphere under the direction of UNESCO (United Nations Educational, Scientific and Cultural Organization). The conference was held at the UNESCO House, Paris,…

  6. Can fire safety in hotels be improved? Results from the survey of a panel of experts in Spain.

    Science.gov (United States)

    Rubio-Romero, Juan Carlos; Márquez-Sierra, Francisco; Suárez-Cebador, Manuel

    2016-06-08

    The hotel industry is an important driver of the European labour market with over 250,000 hotels employing some 2 million people. In Spain, 240 workers were injured by fires in hotels from 2004 to 2008. Fire is considered to be the most important risk in the hotel industry, but the lack of an EU-wide data recording system for hotels makes it difficult to give exact figures for fire events. We analysed the state of fire prevention systems in hotels in Spain with the aim of proposing strategies to improve fire safety. A 10-item questionnaire was administered from 2007 to 2009 to 15 Spanish experts in fire safety. The questions were measured using a Likert scale and classified into 4 sections: current state of installations, influence of establishment characteristics, application of regulations and priority ranking of actions. Descriptive statistics summarized the data and t-tests evaluated the agreement foreach statement in the questionnaire. The statistical analysis showed homogeneity in the responses by the experts in all four categories: current state of fire safety installations, influence of establishment characteristics, application of regulations, and priority of actions. There was consensus among the experts over the necessity to improve the enforcement of regulations and also regarding the existence of an association between the hotel category (in Spain they are ranked using a 1 to 5 "star" rating system) and the level of fire safety; hotels with a higher category had higher levels of safety. There is a need to identify ways to apply fire safety standards to older hotels so that they comply with new regulations, to standardize regulations for different regions and countries, to improve the maintenance of installations and equipment, to increase the effectiveness of inspections conducted by government bodies, and to raise the general awareness of stakeholders involved in hotel fire prevention.

  7. Advancing the future of physical activity guidelines in Canada: an independent expert panel interpretation of the evidence

    DEFF Research Database (Denmark)

    Kesäniemi, Antero; Riddoch, Chris J; Reeder, Bruce

    2010-01-01

    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...... to review the background materials and systematic reviews; listen to the presentations and discussions at the expert meeting; ask for clarification; and produce the present paper representing their interpretation of the evidence including grading of the evidence and their identification of needs for future...

  8. Upstream fish migration. Report of the hydro power panel of experts; Fischaufstieg. Bericht aus der Expertengruppe Wasserkraft

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2013-10-01

    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.)

  9. Report on how to handle the recommendations in expert reports and statements of views on the demonstration of the nuclear waste disposal programme. Technical report 08-02

    International Nuclear Information System (INIS)

    2008-10-01

    In the process of evaluating the Opalinus Clay project demonstrating the feasibility of disposing of spent fuel, vitrified high-level waste and long-lived intermediate-level waste in Switzerland, the authorities and their experts made numerous recommendations regarding future procedures and activities to be implemented in the disposal programme. Nagra analysed these reviews and expert opinions and took the recommendations into consideration when preparing its future work programme. In 2006, the Federal Council decided that the feasibility of disposing of these waste categories had been demonstrated successfully, but called on the waste producers to prepare a report that systematically addresses the open questions and recommendations and shows how these will be dealt with in a timely and technically appropriate manner. In the present report, Nagra fulfils this requirement on behalf of the waste producers. The report sets out the recommendations made by the authorities and explains how they will be handled. In many cases, the work required has already begun; in other cases plans are already in place. To facilitate the discussion in the report, the recommendations and the responses of Nagra in each case are divided into topical areas. The main part of the report provides a summary discussion, which also addresses time-related aspects of implementing the recommendations. An appendix to the report provides a detailed overview, in the form of a table, of all the recommendations and the associated responses of Nagra. (author)

  10. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

    Science.gov (United States)

    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

    2012-05-15

    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.

  11. Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

    Science.gov (United States)

    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

    2012-01-01

    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

  12. Estimates of the solubilities of waste element radionuclides in waste isolation pilot plant brines: A report by the expert panel on the source term

    Energy Technology Data Exchange (ETDEWEB)

    Hobart, D.E. [Sandia National Labs., Albuquerque, NM (United States)]|[Glenn T. Seaborg Inst. for Transactinium Science, Livermore, CA (United States); Bruton, C.J. [Sandia National Labs., Albuquerque, NM (United States)]|[Lawrence Livermore National Lab., CA (United States). Earth Sciences Dept.; Millero, F.J. [Sandia National Labs., Albuquerque, NM (United States)]|[Univ. of Miami, FL (United States). Rosenstiel School of Marine and Atmospheric Science; Chou, I.M. [Sandia National Labs., Albuquerque, NM (United States)]|[Geological Survey, Reston, VA (United States); Trauth, K.M.; Anderson, D.R. [Sandia National Labs., Albuquerque, NM (United States)

    1996-05-01

    Evaluation of the long-term performance of the WIPP includes estimation of the cumulative releases of radionuclide elements to the accessible environment. Nonradioactive lead is added because of the large quantity expected in WIPP wastes. To estimate the solubilities of these elements in WIPP brines, the Panel used the following approach. Existing thermodynamic data were used to identify the most likely aqueous species in solution through the construction of aqueous speciation diagrams. Existing thermodynamic data and expert judgment were used to identify potential solubility-limiting solid phases. Thermodynamic data were used to calculate the activities of the radionuclide aqueous species in equilibrium with each solid. Activity coefficients of the radionuclide-bearing aqueous species were estimated using Pitzer`s equations. These activity coefficients were then used to calculate the concentration of each radionuclide at the 0.1 and 0.9 fractiles. The 0.5 fractile was chosen to represent experimental data with activity coefficient corrections as described above. Expert judgment was used to develop the 0.0, 0.25, 0.75, and 1.0 fractiles by considering the sensitivity of solubility to the potential variability in the composition of brine and gas, and the extent of waste contaminants, and extending the probability distributions accordingly. The results were used in the 1991 and 1992 performance assessment calculations. 68 refs.

  13. Estimates of the solubilities of waste element radionuclides in waste isolation pilot plant brines: A report by the expert panel on the source term

    International Nuclear Information System (INIS)

    Hobart, D.E.; Bruton, C.J.; Trauth, K.M.; Anderson, D.R.

    1996-05-01

    Evaluation of the long-term performance of the WIPP includes estimation of the cumulative releases of radionuclide elements to the accessible environment. Nonradioactive lead is added because of the large quantity expected in WIPP wastes. To estimate the solubilities of these elements in WIPP brines, the Panel used the following approach. Existing thermodynamic data were used to identify the most likely aqueous species in solution through the construction of aqueous speciation diagrams. Existing thermodynamic data and expert judgment were used to identify potential solubility-limiting solid phases. Thermodynamic data were used to calculate the activities of the radionuclide aqueous species in equilibrium with each solid. Activity coefficients of the radionuclide-bearing aqueous species were estimated using Pitzer's equations. These activity coefficients were then used to calculate the concentration of each radionuclide at the 0.1 and 0.9 fractiles. The 0.5 fractile was chosen to represent experimental data with activity coefficient corrections as described above. Expert judgment was used to develop the 0.0, 0.25, 0.75, and 1.0 fractiles by considering the sensitivity of solubility to the potential variability in the composition of brine and gas, and the extent of waste contaminants, and extending the probability distributions accordingly. The results were used in the 1991 and 1992 performance assessment calculations. 68 refs

  14. [ANALYSIS USING AN EXPERT PANEL OF ACTIVITIES AND COMPETENCIES WHICH NURSING CLINICAL PRACTICE TUTORS IN THE COMUNIDAD AUTÓNOMA DE MADRID SHOULD POSSESS].

    Science.gov (United States)

    Argüello López, María Teresa; Palmar Santos, Ana María; Sellán Soto, Carmen

    2015-01-01

    Although practical training has always been important in Nursing, it has reached a new dimension in the European Higher Education Area. This has involved adapting the syllabus, where one of the new features is considering clinical practice as an independent subject and also including the concept of competence as a result of the students' learning. The figure of the tutor becomes one of the key factors and therefore their activities and competencies must be defined. To enumerate and prioritize, by agreement, the main activities and competences by the tutor of clinical practices in the Comunidad Autónoma de Madrid should posses. METHODOLOGY. Quantitative focus, analysis by group of experts between 2010 and 2013. RESULTS. A total of 510 nurses have participated, 17 panels of experts have met and consensus has been reached on 22 competencies and 12 activities. The description of activities and competencies can be extremely useful for selecting, evaluating and developing nursing clinical practice tutors, becoming a baseline and reducing the subjectivity in the development of tutors according to the new demands of the European Higher Education Area.

  15. Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis.

    Science.gov (United States)

    Herman, Patricia M; Coulter, Ian D

    2016-09-01

    The purpose of this project was to examine the policy implications of politically defining complementary and alternative medicine (CAM) professions by their treatment modalities rather than by their full professional scope. This study used a 2-stage exploratory grounded approach. In stage 1, we identified how CAM is represented (if considered as professions vs modalities) across a purposely sampled diverse set of policy topic domains using exemplars to describe and summarize each. In stage 2 we convened 2 stakeholder panels (12 CAM practitioners and 9 health policymaker representatives), and using the results of stage 1 as a starting point and framing mechanism, we engaged panelists in a discussion of how they each see the dichotomy and its impacts. Our discussion focused on 4 licensed CAM professions: acupuncture and Oriental medicine, chiropractic, naturopathic medicine, and massage. Workforce policies affected where and how members of CAM professions could practice. Licensure affected whether a CAM profession was recognized in a state and which modalities were allowed. Complementary and alternative medicine research examined the effectiveness of procedures and modalities and only rarely the effectiveness of care from a particular profession. Treatment guidelines are based on research and also focus on procedures and modalities. Health plan reimbursement policies address which professions are covered and for which procedures/modalities and conditions. The policy landscape related to CAM professions and modalities is broad, complex, and interrelated. Although health plan reimbursement tends to receive the majority of attention when CAM health care policy is discussed, it is clear, given the results of our study, that coverage policies cannot be addressed in isolation and that a wide range of stakeholders and social institutions will need to be involved. Copyright © 2016. Published by Elsevier Inc.

  16. Centers for Disease Control review panel's recommendations on health effects and epidemiological studies of operations at the Savannah River Plant, Aiken, South Carolina. Public comment and meeting report

    International Nuclear Information System (INIS)

    1985-05-01

    Based on the request of the US Department of Energy, the Centers for Disease Control of the US Department of Health and Human Services organized a panel to review the feasibility and usefulness of conducting further epidemiologic studies of delayed health effects around the Department of Energy's Savannah River Plant. The review and recommendations of the panel were documented in a report entitled Epidemiologic Projects Considered Possible to Undertake in Populations Around the Savannah River Plant. On November 30, 1984, the Department of Energy announced in the Federal Register (49 FR 47095) the conduct of a public meeting and a 30-day public comment period between December 1 and December 30, 1984, on the recommendations of the review panel. Based on the requests of individuals and representatives of organizations attending the December 18, 1984, public meetings, the Department of Energy subsequently announced in the Federal Register on December 31, 1984 (49 FR 50767) an extension of the public comment period to January 31, 1985. This report documents the public meeting and comment process, and provides responses to the public comments that were submitted during this process. In addition, this report contains the Department of Energy's position based on the recommendations of the Centers for Disease Control review panel and the public comments. 23 refs., 16 tabs

  17. Final report of the cosmetic ingredient review expert panel on the safety assessment of Polyisobutene and Hydrogenated Polyisobutene as used in cosmetics.

    Science.gov (United States)

    2008-01-01

    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

  18. Prevention and treatment of pressure ulcers by newest recommendations from European Pressure Ulcer Advisory Panel (EPUAP: practical reference guide for GPs

    Directory of Open Access Journals (Sweden)

    Jakub Taradaj

    2017-03-01

    Full Text Available The guideline titled “Prevention and treatment of pressure ulcers: clinical practice guideline” is the result of a collaborative effort between the National Pressure Ulcer Advisory Panel (NPUAP, European Pressure Ulcer Advisory Panel (EPUAP and Pan Pacific Pressure Injury Alliance (PPPIA. A comprehensive literature review was conducted on pressure ulcer prevention and treatment. Rigorous scientific methodology was used to appraise available research and make evidence-based recommendations for the prevention and treatment of pressure ulcers. Draft guidelines were made available to 986 invited individual stakeholders and organizations or societies, and the feedback of the stakeholders was taken under consideration by the developers of the guideline. The guideline includes 575 explicit recommendations and/or research summaries for multidisciplinary pressure ulcer topics.

  19. Maximizing the Utility of the Serum Repository With Current Technologies and Recommendations to Meet Future Needs: Report of the Technical Panel.

    Science.gov (United States)

    Baird, Coleen P

    2015-10-01

    The Department of Defense Serum Repository (DoDSR) of the Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, has over 55 million specimens. Over 80% of these specimens are linked to individual health data. In response to Congressional and Department of Defense (DoD) concern about toxic exposures of deployed Service members and rapidly developing laboratory capabilities that may identify those exposed, the AFHSC hosted two panels in 2013. The first, the Needs Panel, focused on assessing the needs of the DoD that may be met using the current DoDSR and an enhanced repository. The second panel, the Technical Panel, focused on identifying the emerging laboratory technologies that are or will be available to DoD public health workers and researchers. This report summarizes the recommendations of the Technical Panel, to include identified gaps in the ability of the current DoDSR to address questions of interest to the DoD, the availability of laboratory technology to address these needs, and the types and quality of specimens required from Service members possibly exposed. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  20. Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone

    Directory of Open Access Journals (Sweden)

    Anido J

    2017-10-01

    Full Text Available Javier Anido,1 Daniel Arenas,2 Cristina Arruabarrena,3 Alfonso Domínguez-Gil,4 Carlos Fajardo,5 Mar Mira,6 Javier Murillo,7 Natalia Ribé,8 Helga Rivera,9 Sofia Ruiz del Cueto,6 Helder Silvestre,10 Marisa Tirado11 1A-Clinic, Madrid, 2Hospital Cruz Roja, Madrid, 3Clinic Cristina Arruabarrena, San Sebastiá, 4Salamanca University, Salamanca, 5Clinic Fajardo, Malaga, 6Clinic Mira+Cueto, Madrid, 7Clinic CIR, Seville, 8Institute Natalia Ribé, Barcelona, 9Clinic Helga Rivera, Vigo, Spain; 10Clinic Europa, Lisbon, Portugal; 11Clinic Derma Alemar, Castellón, Spain Background: Facial lines and wrinkles are strongly influenced by individual differences in anatomy and muscle activity and no single injection protocol will suit all patients. However, there is only limited information in the published literature on how to develop a tailored approach to botulinum toxin treatment.Methods: An expert panel of physicians was convened to establish a consensus on developing an individualized approach to treatment of the forehead with incobotulinumtoxinA. Separate treatment protocols were developed for men and women and subdivided by background level of muscle activity: kinetic, hyperkinetic, and hypertonic. Each muscle tone category was then further subdivided to take account of individual characteristics that can influence treatment.Results: Consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is described for men and women with a wide range of forehead presentations. For each presentation, units of toxin as well as the precise location of injection points were defined by creating a 12-zone map of the forehead.Conclusion: These recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and

  1. Microbiological specifications and testing methods for irradiated food. Report of a panel of experts; Specifications et methodes d'analyse microbiologiques des aliments irradies. Rapport d'un groupe d'etude

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1971-09-01

    In recent years there has been increased interest in the development of food items processed by means of ionizing radiation, wherever that form of preservation might show advantage over other methods. If this method becomes successful, the various items will be commercially exploited; it would then be convenient to have similar legislation in many countries of the world to control this type of processing and to facilitate international trade. To gather information and suggestions in order to devise legislation on irradiated food, a Joint FAO/IAEA/ WHO Expert Committee on the Technical Basis for Legislation on Irradiated Food was held in Rome on 21-28 April 1964. The Committee's report, 'The technical basis for legislation on irradiated food', was published as FAO Atomic Energy Series No.6 and WHO Technical Series No. 316. The Committee's terms of reference were to consider the available evidence on the effect on food of treatment with ionizing radiation in the context of wholesomeness and safety for consumption. Nutritional aspects were taken into account, but microbiological safety and microbiological methods for irradiated food were excluded since these subjects were believed to be too broad for adequate coverage in the working time available at the meeting. However, realizing the importance of radiation microbiology and the need for guidance in formulating regulations in this field, the committee drafted the following recommendation: 'The methods and standards used to ensure the microbiological safety of the irradiated product should, as a matter of urgency, be subject to review by competent international bodies in order that internationally acceptable methods and standards may be agreed upon'. In response to this recommendation an FAO/IAEA Panel on Microbiological Standards and Testing Methods for Irradiated Food was held in Vienna on 22-26 June 1965, in collaboration with the International Association of Microbiological Societies (IAMS). This was a working

  2. Amikacin Dosing and Monitoring in Spinal Cord Injury Patients: Variation in Clinical Practice Between Spinal Injury Units and Differences in Experts' Recommendations

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available The objective of this article was to determine the current practice on amikacin dosing and monitoring in spinal cord injury patients from spinal cord physicians and experts. Physicians from spinal units and clinical pharmacologists were asked to provide protocol for dosing and monitoring of amikacin therapy in spinal cord injury patients. In a spinal unit in Poland, amikacin is administered usually 0.5 g twice daily. A once-daily regimen of amikacin is never used and amikacin concentrations are not determined. In Belgium, Southport (U.K., Spain, and the VA McGuire Medical Center (Richmond, Virginia, amikacin is given once daily. Whereas peak and trough concentrations are determined in Belgium, only trough concentration is measured in Southport. In both these spinal units, modification of the dose is not routinely done with a nomogram. In Spain and the VA McGuire Medical Center, monitoring of serum amikacin concentration is not done unless a patient has renal impairment. In contrast, the dose/interval of amikacin is adjusted according to pharmacokinetic parameters at the Edward Hines VA Hospital (Hines, Illinois, where amikacin is administered q24h or q48h, depending on creatinine clearance. Spinal cord physicians from Denmark, Germany, and the Kessler Institute for Rehabilitation (West Orange, New Jersey state that they do not use amikacin in spinal injury patients. An expert from Canada does not recommend determining serum concentrations of amikacin, but emphasizes the value of monitoring ototoxicity and nephrotoxicity. Experts from New Zealand recommend amikacin in conventional twice- or thrice-daily dosing because of the theoretical increased risk of neuromuscular blockade and apnea with larger daily doses in spinal cord injury patients. On the contrary, experts from Greece, Israel, and the U.S. recommend once-daily dosing and determining amikacin pharmacokinetic parameters for each patient. As there is considerable variation in clinical

  3. PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain.

    Science.gov (United States)

    Neugebauer, E A M; Wilkinson, R C; Kehlet, H; Schug, S A

    2007-07-01

    Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

  4. Mental health system funding of cognitive enhancement interventions for schizophrenia: summary and update of the New York Office of Mental Health expert panel and stakeholder meeting.

    Science.gov (United States)

    McGurk, Susan R; Mueser, Kim T; Covell, Nancy H; Cicerone, Keith D; Drake, Robert E; Silverstein, Steven M; Medialia, Alice; Myers, Robert; Bellack, Alan S; Bell, Morris D; Essock, Susan M

    2013-09-01

    A growing research literature indicates that cognitive enhancement (CE) interventions for people with schizophrenia can improve cognitive functioning and may benefit psychosocial functioning (e.g., competitive employment, quality of social relationships). Debate continues regarding the strength of evidence for CE and related policy implications, such as the appropriateness of funding CE services. This paper summarizes and updates a meeting of experts and stakeholders convened in 2008 by the New York Office of Mental Health to review evidence on the impact of CE for people with schizophrenia and other serious mental illnesses, and addresses whether the evidence base for CE interventions is sufficient to warrant funding. Specific recommendations based on the extant literature are provided regarding the structure and components of CE programs that should be present in order to improve cognitive and psychosocial outcomes and therefore merit consideration of funding. These recommendations may serve as a starting point in developing standards for CE programs. Establishing evidence-based practice standards for implementing CE interventions for people with serious mental illnesses may facilitate dissemination of programs that have the greatest potential for improving individuals' functional outcomes while minimizing incremental costs associated with providing CE services. Important open questions include how the performance of CE programs should be monitored and which individuals might be expected to benefit from CE as evidenced by improved functioning in their everyday lives. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  5. Treatment of non muscle invasive bladder tumor related to the problem of bacillus Calmette-Guerin availability. Consensus of a Spanish expert's panel. Spanish Association of Urology.

    Science.gov (United States)

    Fernández-Gómez, J M; Carballido-Rodríguez, J; Cozar-Olmo, J M; Palou-Redorta, J; Solsona-Narbón, E; Unda-Urzaiz, J M

    2013-01-01

    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.

  6. Experience with citizens panels

    International Nuclear Information System (INIS)

    Selwyn, J.

    2002-01-01

    In May 1999, 200 delegates attended a four-day UK Consensus Conference on radioactive waste management, which was organised by the UK Centre for Economic and Environmental Development (UK CEED) and supported by the government, industry and environmental groups. The event brought together a Citizens' Panel of fifteen people, randomly selected to represent a cross section of the British public, together with the major players in the debate. The four-day conference saw the panel cross-examine expert witnesses from organisations such as NIREX, British Nuclear Fuels Limited, the Ministry of Defence, Greenpeace and Friends of the Earth. The findings of their investigations were put together in a report containing detailed recommendations for government and industry and presented to the Minister on the final day. (author)

  7. A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel.

    Science.gov (United States)

    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

    2013-09-13

    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

  8. A review of traditional and novel treatments for seizures in autism spectrum disorder: Findings from a systematic review and expert panel.

    Directory of Open Access Journals (Sweden)

    Richard Eugene Frye

    2013-09-01

    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

  9. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    DEFF Research Database (Denmark)

    Trenkwalder, Claudia; Chaudhuri, K Ray; García Ruiz, Pedro J

    2015-01-01

    practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuous infusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment...... and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose...

  10. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services.

    Science.gov (United States)

    Barlow, S E; Dietz, W H

    1998-09-01

    The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families

  11. Expert System analysis of non-fuel assembly hardware and spent fuel disassembly hardware: Its generation and recommended disposal

    International Nuclear Information System (INIS)

    Williamson, D.A.

    1991-01-01

    Almost all of the effort being expended on radioactive waste disposal in the United States is being focused on the disposal of spent Nuclear Fuel, with little consideration for other areas that will have to be disposed of in the same facilities. one area of radioactive waste that has not been addressed adequately because it is considered a secondary part of the waste issue is the disposal of the various Non-Fuel Bearing Components of the reactor core. These hardware components fall somewhat arbitrarily into two categories: Non-Fuel Assembly (NFA) hardware and Spent Fuel Disassembly (SFD) hardware. This work provides a detailed examination of the generation and disposal of NFA hardware and SFD hardware by the nuclear utilities of the United States as it relates to the Civilian Radioactive Waste Management Program. All available sources of data on NFA and SFD hardware are analyzed with particular emphasis given to the Characteristics Data Base developed by Oak Ridge National Laboratory and the characterization work performed by Pacific Northwest Laboratories and Rochester Gas ampersand Electric. An Expert System developed as a portion of this work is used to assist in the prediction of quantities of NFA hardware and SFD hardware that will be generated by the United States' utilities. Finally, the hardware waste management practices of the United Kingdom, France, Germany, Sweden, and Japan are studied for possible application to the disposal of domestic hardware wastes. As a result of this work, a general classification scheme for NFA and SFD hardware was developed. Only NFA and SFD hardware constructed of zircaloy and experiencing a burnup of less than 70,000 MWD/MTIHM and PWR control rods constructed of stainless steel are considered Low-Level Waste. All other hardware is classified as Greater-ThanClass-C waste

  12. The role of the Technical Review Panel of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: an analysis of grant recommendations.

    Science.gov (United States)

    Schmidt-Traub, Guido

    2018-04-01

    The independent Technical Review Panel (TRP) of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria is a unique mechanism to review funding proposals and to provide recommendations on their funding. Its functioning and performance have received little attention in the scientific literature. We aimed to identify predictors for TRP recommendations, whether these were in line with the Global Fund's ambition to give priority to countries most in need, and whether they correlated with grant performance. We combined data on proposals and applications under the Rolling Continuation Channel, TRP recommendations and grant implementation during the rounds-based mechanism (2002-2010) with country characteristics. Ordered logistic and OLS regressions were used to identify predictors for per-capita funding requests, TRP recommendations, Global Fund funding and grant performance ratings. We tested for financial suppression of large funding proposals and whether fragile or English-speaking countries performed differently from other countries. We found that funding requests and TRP recommendations were consistent with disease burden, but independent of other country characteristics. Countries with larger populations requested less funding per capita, but there is no evidence of financial suppression by the TRP. Proposals from fragile countries were as likely to be recommended as proposals from other countries, and resulting grants performed equally well except for lower performance of HIV/AIDS grants. English-speaking countries obtained more funding for TB and malaria than other countries. In conclusion, the independent TRP acted in line with the guiding principles of the Global Fund to direct funding to countries most in need without ex ante country allocation. The Global Fund appears to have promoted learning on how to design and implement large-scale programs in fragile and non-fragile countries. Other pooled financing mechanisms may consider TRP operating principles to

  13. Survey of expert opinions and related recommendations regarding bridging therapy using hypomethylating agents followed by allogeneic transplantation for high-risk MDS.

    Science.gov (United States)

    Sohn, Sang Kyun; Moon, Joon Ho

    2015-08-01

    According to current guidelines on therapeutic strategies for myelodysplastic syndrome (MDS), cytoreductive therapies before allogeneic stem cell transplantation (SCT) are not widely recommended for patients with high-risk MDS or refractory anemia with excess blasts (RAEB) who are eligible for allogeneic SCT because of controversial evidence on the role of such therapies. Yet, while treatment with hypomethylating agents (HMAs) has a critical limitation in eradicating MDS clones, the use of HMA treatment as a bridge to allogeneic SCT has become a focus with the hope of improving the SCT outcome based on the chance of achieving complete remission or reducing the blast percentage safely and effectively before allogeneic SCT. However, a consensus needs to be established on the use of HMAs as a bridging therapy for high-risk MDS or RAEB. Thus, the Korean AML/MDS working party group surveyed 34 Korean MDS experts on their bridging therapies for high-risk MDS. Accordingly, this paper presents the survey questionnaire and resulting data, along with a summary of the consensus and related recommendations regarding strategies using HMA treatment and allogeneic SCT based on reported studies and the current survey results. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. NCATE's Blue Ribbon Panel Report and NAPDS: Working Together

    Science.gov (United States)

    Van Scoy, Irma J.

    2012-01-01

    An expert panel including representatives from schools/districts, teacher education, and professional education associations was convened by the National Council for the Accreditation of Teacher Education (NCATE) to make recommendations regarding clinical preparation in teacher education. This article presents an analysis of how the ten design…

  15. Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel.

    Science.gov (United States)

    Miller, J Michael; Astles, Rex; Baszler, Timothy; Chapin, Kimberle; Carey, Roberta; Garcia, Lynne; Gray, Larry; Larone, Davise; Pentella, Michael; Pollock, Anne; Shapiro, Daniel S; Weirich, Elizabeth; Wiedbrauk, Danny

    2012-01-06

    Prevention of injuries and occupational infections in U.S. laboratories has been a concern for many years. CDC and the National Institutes of Health addressed the topic in their publication Biosafety in Microbiological and Biomedical Laboratories, now in its 5th edition (BMBL-5). BMBL-5, however, was not designed to address the day-to-day operations of diagnostic laboratories in human and animal medicine. In 2008, CDC convened a Blue Ribbon Panel of laboratory representatives from a variety of agencies, laboratory organizations, and facilities to review laboratory biosafety in diagnostic laboratories. The members of this panel recommended that biosafety guidelines be developed to address the unique operational needs of the diagnostic laboratory community and that they be science based and made available broadly. These guidelines promote a culture of safety and include recommendations that supplement BMBL-5 by addressing the unique needs of the diagnostic laboratory. They are not requirements but recommendations that represent current science and sound judgment that can foster a safe working environment for all laboratorians. Throughout these guidelines, quality laboratory science is reinforced by a common-sense approach to biosafety in day-to-day activities. Because many of the same diagnostic techniques are used in human and animal diagnostic laboratories, the text is presented with this in mind. All functions of the human and animal diagnostic laboratory--microbiology, chemistry, hematology, and pathology with autopsy and necropsy guidance--are addressed. A specific section for veterinary diagnostic laboratories addresses the veterinary issues not shared by other human laboratory departments. Recommendations for all laboratories include use of Class IIA2 biological safety cabinets that are inspected annually; frequent hand washing; use of appropriate disinfectants, including 1:10 dilutions of household bleach; dependence on risk assessments for many activities

  16. Consensus panel's assessment and recommendations on the use of 3 botulinum toxin type A products in facial aesthetics.

    Science.gov (United States)

    Lorenc, Z Paul; Kenkel, Jeffrey M; Fagien, Steven; Hirmand, Haideh; Nestor, Mark S; Sclafani, Anthony P; Sykes, Jonathan M; Waldorf, Heidi A

    2013-03-01

    In this summary article, the authors discuss the characteristics of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA. With 3 neuromodulators available in the US market, comparisons between and among products will invariably be made, so arguments for the most effective facial aesthetic uses of each neuromodulator are presented. Topics addressed in this article include patient expectations, toxin reconstitution and preparation, patient positioning, differences among products, the role of complexing proteins, and dosing and injection strategies. Recommendations are also provided by treatment area.

  17. Recommendations to the Technical Steering Panel regarding approach for estimating individual radiation doses resulting from releases of radionuclides to the Columbia River

    International Nuclear Information System (INIS)

    Napier, B.A.; Brothers, A.J.

    1992-07-01

    At the direction of the Technical Steering Panel (TSP) of the Hanford Environmental Dose Reconstruction (HEDR) Project, Battelle staff have reviewed and analyzed available data regarding possible historical radiation doses to individuals resulting from radionuclide releases to the Columbia River. The objective of this review was to recommend to the TSP the spatial and temporal scope and level of effort on Columbia River work to most effectively extend work performed in Phase I of the project (PNL 1991a, PNL 1991b) to meet the project objectives. A number of options were analyzed. Four stretches of the Columbia River and adjacent Pacific coastal waters were defined and investigated for four time periods. Radiation doses arising from ten potentially major exposure pathways were evaluated for each of the time/location combinations, and several alternative methods were defined for estimating the doses from each pathway. Preliminary cost estimates were also developed for implementing dose estimation activities for each of the possible combinations

  18. Waldenström macroglobulinemia: Progress in evidence-based medicine and updates of consensus panel recommendation

    Directory of Open Access Journals (Sweden)

    Jian HOU

    2013-09-01

    Full Text Available Waldenström macroglobulinemia (WM is a distinct B-cell lymphoproliferative disorder primarily characterized by infiltration of lymphoplasmacytic cells into the bone marrow, along with demonstration of monoclonal immunoglobulinemia M(IgM. Recent studies have demonstrated the MYD88 L265P somatic mutation contributes to the pathogenesis of WM. Mutated MYD88 activates NF-κB through a series of signals, which results in abnormal propagation of B cells. Clinical manifestation mainly consisted of tissue injuries attributable to tissue infiltration and monoclonal IgM. WM should be differentiated from lymphomas producing monoclonal IgM, and detection of MYD88 L265P mutation provides a new way to differentiate WM from other similar diseases. At present recommended treatments for WM include alkylating agents, nucleoside analogues, bortezomib, rituximab etc.

  19. An evaluation of the International Society for Animal Genetics recommended parentage and identification panel for the domestic pigeon (Columba livia domestica).

    Science.gov (United States)

    de Groot, M; van Haeringen, W A

    2017-08-01

    In this study, the International Society for Animal Genetics (ISAG) recommended panel for the identification of the domestic pigeon (Columba livia domestica) is characterized based on commonly used statistical parameters. The marker panel is based on 16 short tandem repeat (STR) loci (PIGN15, PIGN10, PIGN57, PIGN26, CliμD16, CliμD19, PIGN12, CliμD17, CliμT17, PIGN04, CliμD01, CliμD11, CliμD35, CliμT02, CliμT13, CliμT43). The alleles of the 16 loci consist of a mixture of tri-, tetra-, penta- and hexameric repeat patterns. A sex determination marker was included in the multiplex for quality control. The repeat sequence of the PIGN markers was previously unpublished and therefore sequenced to reveal the sequence pattern. In total, 1421 pigeons were genotyped on 16 STR loci to generate allele frequency data for each locus. For all 16 markers combined, a PE1 (combined non-exclusion probability, first parent) of 0.9986 and PE2 (combined non-exclusion probability, second parent) of >0.9999 was observed. Comparing the alleged father and mother, a PE value of >0.9999 was observed. Two of the markers, CliμD19 and PIGN12, were found to have relatively high Hardy-Weinberg equilibrium and F(null) values. Therefore these markers may be considered to be replaced by other STRs. Another point of discussion may be to add a gender identification marker to the recommended ISAG panel. Not only can this serve as an extra identification marker, but this can also confirm the sex of a sample, because it is challenging to determine the sex based on phenotypical characteristics, especially for chicks. In conclusion, the set of 16 STR markers can be used in routine parentage verification and the identification of individuals. © 2017 Stichting International Foundation for Animal Genetics.

  20. Choosing Wisely: The Top-5 Recommendations from the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children.

    Science.gov (United States)

    Chiappini, Elena; Bortone, Barbara; Di Mauro, Giuseppe; Esposito, Susanna; Galli, Luisa; Landi, Massimo; Novelli, Andrea; Marchisio, Paola; Marseglia, Gian Luigi; Principi, Nicola; de Martino, Maurizio

    2017-03-01

    With the aim to reduce waste in the health care system and avoid risks associated with unnecessary treatment, the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children joined the Choosing Wisely initiative. An ad hoc Choosing Wisely task force was selected to develop a candidate list of items for the top-5 list on pharyngitis medicine. Through a process of literature review and consensus, the final list of 5 items was chosen. Drafted recommendations were formulated and then reviewed by the task force members until a final consensus was reached. The 5 recommendations approved are: blood exams should not be performed; antibiotics should not be administrated unless microbiologic confirmation of streptococcal infection has been carried out; if a throat culture is performed, susceptibility tests on isolates should not be executed; antibiotic course should not be shortened; because penicillin V is not available in Italy, amoxicillin (50 mg/kg/d in 2-3 doses orally) for 10 days is the first choice treatment; and steroids should not be administered for the risk of masking possible underlying severe condition. This top-5 list can be a novel tool to spread the key messages of guidelines and to avoid unnecessary diagnostic procedures, and to promote a rational use of antibiotics in children. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  1. Probability encoding of hydrologic parameters for basalt. Elicitation of expert opinions from a panel of three basalt waste isolation project staff hydrologists

    International Nuclear Information System (INIS)

    Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.

    1984-11-01

    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

  2. Expert Cold Structure Development

    Science.gov (United States)

    Atkins, T.; Demuysere, P.

    2011-05-01

    The EXPERT Program is funded by ESA. The objective of the EXPERT mission is to perform a sub-orbital flight during which measurements of critical aero- thermodynamic phenomena will be obtained by using state-of-the-art instrumentation. As part of the EXPERT Flight Segment, the responsibility of the Cold Structure Development Design, Manufacturing and Validation was committed to the Belgian industrial team SONACA/SABCA. The EXPERT Cold Structure includes the Launcher Adapter, the Bottom Panel, the Upper Panel, two Cross Panels and the Parachute Bay. An additional Launcher Adapter was manufactured for the separation tests. The selected assembly definition and manufacturing technologies ( machined parts and sandwich panels) were dictated classically by the mass and stiffness, but also by the CoG location and the sensitive separation interface. Used as support for the various on-board equipment, the Cold Structure is fixed to but thermally uncoupled from the PM 1000 thermal shield. It is protect on its bottom panel by a thermal blanket. As it is a protoflight, analysis was the main tool for the verification. Low level stiffness and modal analysis tests have also been performed on the Cold Structure equipped with its ballast. It allowed to complete its qualification and to prepare SONACA/SABCA support for the system dynamic tests foreseen in 2011. The structure was finally coated with a thermal control black painting and delivered on time to Thales Alenia Space-Italy end of March 201.

  3. An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings.

    Science.gov (United States)

    Smits, M J; Loots, C M; van Wijk, M P; Bredenoord, A J; Benninga, M A; Smout, A J P M

    2015-05-01

    Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard. Twenty-one experts from 10 countries were asked to mark GER presence for adult and pediatric pH-I patterns in an online pre-assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER. Majority consensus was reached for 35/79 episodes in the online pre-assessment (interrater κ = 0.332). Mean agreement between pre-assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH-I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard. Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter 'retrograde propagation pattern' is an indicator of GER in difficult pH-I patterns. © 2015 John Wiley & Sons Ltd.

  4. Integrated thermal treatment systems study. Internal review panel report

    International Nuclear Information System (INIS)

    Cudahy, J.; Escarda, T.; Gimpel, R.

    1995-04-01

    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

  5. Centers for Disease Control review panel's recommendations on health effects and epidemiological studies of operations at the Savannah River Plant, Aiken, South Carolina. Public comment and meeting report

    Energy Technology Data Exchange (ETDEWEB)

    1985-05-01

    Based on the request of the US Department of Energy, the Centers for Disease Control of the US Department of Health and Human Services organized a panel to review the feasibility and usefulness of conducting further epidemiologic studies of delayed health effects around the Department of Energy's Savannah River Plant. The review and recommendations of the panel were documented in a report entitled Epidemiologic Projects Considered Possible to Undertake in Populations Around the Savannah River Plant. On November 30, 1984, the Department of Energy announced in the Federal Register (49 FR 47095) the conduct of a public meeting and a 30-day public comment period between December 1 and December 30, 1984, on the recommendations of the review panel. Based on the requests of individuals and representatives of organizations attending the December 18, 1984, public meetings, the Department of Energy subsequently announced in the Federal Register on December 31, 1984 (49 FR 50767) an extension of the public comment period to January 31, 1985. This report documents the public meeting and comment process, and provides responses to the public comments that were submitted during this process. In addition, this report contains the Department of Energy's position based on the recommendations of the Centers for Disease Control review panel and the public comments. 23 refs., 16 tabs.

  6. Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

    Science.gov (United States)

    Thompson, Melanie A.; Mugavero, Michael J.; Amico, K. Rivet; Cargill, Victoria A.; Chang, Larry W.; Gross, Robert; Orrell, Catherine; Altice, Frederick L.; Bangsberg, David R.; Bartlett, John G.; Beckwith, Curt G.; Dowshen, Nadia; Gordon, Christopher M.; Horn, Tim; Kumar, Princy; Scott, James D.; Stirratt, Michael J.; Remien, Robert H.; Simoni, Jane M.; Nachega, Jean B.

    2014-01-01

    Description After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. Methods A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. Recommendations Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided. PMID:22393036

  7. 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.

    Science.gov (United States)

    McCullough, Amanda R; Ryan, Cristín; O'Neill, Brenda; Bradley, Judy M; Elborn, J Stuart; Hughes, Carmel M

    2015-08-22

    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

  8. Key implications of the new ICRP recommendations: contribution of the C.R.P.P.H. expert group on the implications of ICRP recommendations (E.G.I.R.)

    International Nuclear Information System (INIS)

    Lazo, T.

    2003-01-01

    The International Commission of Radiological Protection (ICRP) has embarked on a broad programme of consultation in order to collect concepts, ideas and views regarding how radiological protection should be managed at the start of the 21 st century. The results of this consultation will be a new set of comprehensive ICRP recommendations, updating and consolidating ICRP publication 60 and all subsequent ICRP recommendations. It is expected that the new ICRP general recommendations will be published in 2005 with additional more detailed building block recommendations being published in subsequent years. (N.C.)

  9. Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe)

    International Nuclear Information System (INIS)

    Nanni, Cristina; Rambaldi, Ilaria; Fanti, Stefano; Zamagni, Elena; Cavo, Michele; Versari, Annibale; Chauvie, Stephane; Bianchi, Andrea; Rensi, Marco; Bello, Marilena; Gallamini, Andrea; Patriarca, Francesca; Gay, Francesca; Gamberi, Barbara

    2016-01-01

    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

  10. Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe)

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2016-03-15

    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

  11. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.

    Science.gov (United States)

    Boyce, Joshua A; Assa'ad, Amal; Burks, A Wesley; Jones, Stacie M; Sampson, Hugh A; Wood, Robert A; Plaut, Marshall; Cooper, Susan F; Fenton, Matthew J; Arshad, S Hasan; Bahna, Sami L; Beck, Lisa A; Byrd-Bredbenner, Carol; Camargo, Carlos A; Eichenfield, Lawrence; Furuta, Glenn T; Hanifin, Jon M; Jones, Carol; Kraft, Monica; Levy, Bruce D; Lieberman, Phil; Luccioli, Stefano; McCall, Kathleen M; Schneider, Lynda C; Simon, Ronald A; Simons, F Estelle R; Teach, Stephen J; Yawn, Barbara P; Schwaninger, Julie M

    2010-12-01

    Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research. Published by Mosby, Inc.

  12. Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel.

    Science.gov (United States)

    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.

  13. An evidence-based recommendation on bed head elevation for mechanically ventilated patients

    OpenAIRE

    Ni?l-Weise, Barbara S; Gastmeier, Petra; Kola, Axel; Vonberg, Ralf P; Wille, Jan C; van den Broek, Peterhans J

    2011-01-01

    Introduction A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based ...

  14. The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment.

    Directory of Open Access Journals (Sweden)

    Abraham Morgentaler

    2016-11-01

    Full Text Available Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism and testosterone therapy was held in Prague (Czech Republic on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.

  15. Clinical relevance of molecular diagnostics in gastrointestinal (GI) cancer: European Society of Digestive Oncology (ESDO) expert discussion and recommendations from the 17th European Society for Medical Oncology (ESMO)/World Congress on Gastrointestinal Cancer, Barcelona.

    Science.gov (United States)

    Baraniskin, Alexander; Van Laethem, Jean-Luc; Wyrwicz, Lucjan; Guller, Ulrich; Wasan, Harpreet S; Matysiak-Budnik, Tamara; Gruenberger, Thomas; Ducreux, Michel; Carneiro, Fatima; Van Cutsem, Eric; Seufferlein, Thomas; Schmiegel, Wolff

    2017-11-01

    In the epoch of precision medicine and personalised oncology, which aims to deliver the right treatment to the right patient, molecular genetic biomarkers are a topic of growing interest. The aim of this expert discussion and position paper is to review the current status of various molecular tests for gastrointestinal (GI) cancers and especially considering their significance for the clinical routine use. Opinion leaders and experts from diverse nationalities selected on scientific merit were asked to answer to a prepared set of questions about the current status of molecular diagnostics in different GI cancers. All answers were then discussed during a plenary session and reported here in providing a well-balanced reflection of both clinical expertise and updated evidence-based medicine. Preselected molecular genetic biomarkers that are described and disputed in the current medical literature in different GI cancers were debated, and recommendations for clinical routine practice were made whenever possible. Furthermore, the preanalytical variations were commented and proposals for quality controls of biospecimens were made. The current article summarises the recommendations of the expert committee regarding prognostic and predictive molecular genetic biomarkers in different entities of GI cancers. The briefly and comprehensively formulated guidelines should assist clinicians in the process of decision making in daily clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Recommendations of the Panel on Clinical Practices for Treatment of HIV.

    Science.gov (United States)

    Dybul, Mark; Fauci, Anthony S; Bartlett, John G; Kaplan, Jonathan E; Pau, Alice K

    2002-05-17

    The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC. Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR 1998;47[RR-5]:1-41). This report, which updates the 1998 guidelines, addresses 1) using testing for plasma HIV ribonucleic acid levels (i.e., viral load) and CD4+ T cell count; 2) using testing for antiretroviral drug resistance; 3) considerations for when to initiate therapy; 4) adherence to antiretroviral therapy; 5) considerations for therapy among patients with advanced disease; 6) therapy-related adverse events; 7) interruption of therapy; 8) considerations for changing therapy and available therapeutic options; 9) treatment for acute HIV infection; 10) considerations for antiretroviral therapy among adolescents; 11) considerations for antiretroviral therapy among pregnant women; and 12) concerns related to transmission of HIV to others. Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance because of nonadherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions is critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. Treatment should

  17. Waste disposal experts meet

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1959-01-15

    Problems connected with the disposal into the sea of radioactive wastes from peaceful uses of atomic energy are being examined by a panel of experts, convened by the International Atomic Energy Agency. These experts from eight different countries held a first meeting at IAEA headquarters in Vienna from 4-9 December 1958, under the chairmanship of Dr. Harry Brynielsson, Director General of the Swedish Atomic Energy Company. The countries represented are: Canada, Czechoslovakia, France, Japan, Netherlands, United Kingdom and United States. The group will meet again in 1959. (author)

  18. Expert systems

    International Nuclear Information System (INIS)

    Haldy, P.A.

    1988-01-01

    The definitions of the terms 'artificial intelligence' and 'expert systems', the methodology, areas of employment and limits of expert systems are discussed. The operation of an expert system is described, especially the presentation and organization of knowledge as well as interference and control. Methods and tools for expert system development are presented and their application in nuclear energy are briefly addressed. 7 figs., 2 tabs., 6 refs

  19. Expert Systems

    OpenAIRE

    Lucas, P.J.F.

    2005-01-01

    Expert systems mimic the problem-solving activity of human experts in specialized domains by capturing and representing expert knowledge. Expert systems include a knowledge base, an inference engine that derives conclusions from the knowledge, and a user interface. Knowledge may be stored as if-then rules, orusing other formalisms such as frames and predicate logic. Uncertain knowledge may be represented using certainty factors, Bayesian networks, Dempster-Shafer belief functions, or fuzzy se...

  20. Concluding report by the committee of experts on the Brunsbuettel and Kruemmel nuclear power stations. Vattenfall to implement the set of measures and all recommendations

    International Nuclear Information System (INIS)

    Hassa, R.

    2007-01-01

    The independent Committee of Experts appointed by Vattenfall Europe after the events of June 28, 2007 in the Brunsbuettel and Kruemmel nuclear power stations concluded its investigations. The Committee had been asked to investigate and evaluate the situation associated with the events, and to elaborate proposals for improvement on this basis. The analysis by the Committee of Experts boils down to the finding that the Brunsbuettel and Kruemmel nuclear power stations represent a modern standard as far as design concepts and technical safety features are concerned. Besides technical preconditions, also the administrative features are in place for safe plant oepration. No indications were found of any deficits in safety culture which would justify doubt about the reliability of the operator or the staff responsible under the Atomic Energy Act, nor is there any doubt about the level of technical expertise. Vattenfall directly ordered the findings to be implemented by applying, for part of the technical measures, for implementation with the Kiel State Ministry for Social Affairs as the competent regulatory agency. The Vattenfall Group is going to establish a new safety organization and safety controlling for the nuclear power plants operated by the company. These measures are to ensure an optimum safety level and the highest safety standards. With Vattenfall, safety enjoys top priority. (orig.)

  1. Interim report of the JHPS expert committee on radiation protection of the lens of the eye (1). Overview of the lens, radiogenic cataract, and equivalent dose limit for the lens newly recommended by the ICRP

    International Nuclear Information System (INIS)

    Akahane, Keiichi; Tatsuzaki, Hideo; Iimoto, Takeshi; Ichiji, Takeshi; Hamada, Nobuyuki; Fujimichi, Yuki; Iwai, Satoshi; Ohguchi, Hiroyuki; Ohno, Kazuko; Yamauchi, Chiyo; Tsujimura, Norio; Hotta, Yutaka; Yamasaki, Tadashi; Yokoyama, Sumi

    2014-01-01

    In April 2011, the International Commission on Radiological Protection (ICRP) issued the statement on tissue reactions. This stimulated interest in many countries. The Expert Committee on Radiation Protection of the Lens of the Eye was established in the Japanese Health Physics Society, and in April 2013, started discussion about the international developments and recent studies related to the dosimetry of the lens of the eye. This committee now publishes the interim report consisting of parts I-VI. Of these, this Part I overviews the structure of the eye and lens, cataract types and the scientific evidence of its new dose threshold and equivalent dose limit newly recommended by the ICRP. (author)

  2. Recommendations on the Nature and Level of U.S. Participation in the International Thermonuclear Experimental Reactor Extension of the Experimental Reactor Extension of the Engineering Design Activities. Panel Report To Fusion Energy Sciences Advisory Committee (FESAC)

    International Nuclear Information System (INIS)

    1998-01-01

    The DOE Office of Energy Research chartered through the Fusion Energy Sciences Advisory Committee (FESAC) a panel to 'address the topic of U. S. participation in an ITER construction phase, assuming the ITER Parties decide to proceed with construction.' (Attachment 1: DOE Charge, September 1996). Given that there is expected to be a transition period of three to five years between the conclusion of the Engineering Design Activities (EDA) and the possible construction start, the DOE Office of Energy Research expanded the charge to 'include the U.S. role in an interim period between the EDA and construction.' (Attachment 2: DOE Expanded Charge, May 1997). This panel has heard presentations and received input from a wide cross-section of parties with an interest in the fusion program. The panel concluded it could best fulfill its responsibility under this charge by considering the fusion energy science and technology portion of the U.S. program in its entirety. Accordingly, the panel is making some recommendations for optimum use of the transition period considering the goals of the fusion program and budget pressures.

  3. Do the Washington Panel recommendations hold for europe inversigating the relation between quality of life versus work-status, absenteeism and presenteeism

    NARCIS (Netherlands)

    S. Knies (Saskia); A. Boonen (Annelies); J.L. Severens (Hans)

    2014-01-01

    markdownabstract__Abstract__ Background: The question of how to value lost productivity in economic evaluations has been subject of debate in the past twenty years. According to the Washington panel, lost productivity influences health-related quality of life and should thus be considered a

  4. A Patch Density Recommendation based on Convergence Studies for Vehicle Panel Vibration Response resulting from Excitation by a Diffuse Acoustic Field

    Science.gov (United States)

    Smith, Andrew; LaVerde, Bruce; Jones, Douglas; Towner, Robert; Waldon, James; Hunt, Ron

    2013-01-01

    Producing fluid structural interaction estimates of panel vibration from an applied pressure field excitation are quite dependent on the spatial correlation of the pressure field. There is a danger of either over estimating a low frequency response or under predicting broad band panel response in the more modally dense bands if the pressure field spatial correlation is not accounted for adequately. It is a useful practice to simulate the spatial correlation of the applied pressure field over a 2d surface using a matrix of small patch area regions on a finite element model (FEM). Use of a fitted function for the spatial correlation between patch centers can result in an error if the choice of patch density is not fine enough to represent the more continuous spatial correlation function throughout the intended frequency range of interest. Several patch density assumptions to approximate the fitted spatial correlation function are first evaluated using both qualitative and quantitative illustrations. The actual response of a typical vehicle panel system FEM is then examined in a convergence study where the patch density assumptions are varied over the same model. The convergence study results illustrate the impacts possible from a poor choice of patch density on the analytical response estimate. The fitted correlation function used in this study represents a diffuse acoustic field (DAF) excitation of the panel to produce vibration response.

  5. Comparison of CpG island methylator phenotype (CIMP frequency in colon cancer using different probe- and gene-specific scoring alternatives on recommended multi-gene panels.

    Directory of Open Access Journals (Sweden)

    Marianne Berg

    Full Text Available BACKGROUND: In colorectal cancer a distinct subgroup of tumours demonstrate the CpG island methylator phenotype (CIMP. However, a consensus of how to score CIMP is not reached, and variation in definition may influence the reported CIMP prevalence in tumours. Thus, we sought to compare currently suggested definitions and cut-offs for methylation markers and how they influence CIMP classification in colon cancer. METHODS: Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA, with subsequent fragment analysis, was used to investigate methylation of tumour samples. In total, 31 CpG sites, located in 8 different genes (RUNX3, MLH1, NEUROG1, CDKN2A, IGF2, CRABP1, SOCS1 and CACNA1G were investigated in 64 distinct colon cancers and 2 colon cancer cell lines. The Ogino gene panel includes all 8 genes, in addition to the Weisenberger panel of which only 5 of the 8 genes included were investigated. In total, 18 alternative combinations of scoring of CIMP positivity on probe-, gene-, and panel-level were analysed and compared. RESULTS: For 47 samples (71%, the CIMP status was constant and independent of criteria used for scoring; 34 samples were constantly scored as CIMP negative, and 13 (20% consistently scored as CIMP positive. Only four of 31 probes (13% investigated showed no difference in the numbers of positive samples using the different cut-offs. Within the panels a trend was observed that increasing the gene-level stringency resulted in a larger difference in CIMP positive samples than increasing the probe-level stringency. A significant difference between positive samples using 'the most stringent' as compared to 'the least stringent' criteria (20% vs 46%, respectively; p<0.005 was demonstrated. CONCLUSIONS: A statistical significant variation in the frequency of CIMP depending on the cut-offs and genes included in a panel was found, with twice as many positives samples by least compared to most stringent definition

  6. Comparison of CpG island methylator phenotype (CIMP) frequency in colon cancer using different probe- and gene-specific scoring alternatives on recommended multi-gene panels.

    Science.gov (United States)

    Berg, Marianne; Hagland, Hanne R; Søreide, Kjetil

    2014-01-01

    In colorectal cancer a distinct subgroup of tumours demonstrate the CpG island methylator phenotype (CIMP). However, a consensus of how to score CIMP is not reached, and variation in definition may influence the reported CIMP prevalence in tumours. Thus, we sought to compare currently suggested definitions and cut-offs for methylation markers and how they influence CIMP classification in colon cancer. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA), with subsequent fragment analysis, was used to investigate methylation of tumour samples. In total, 31 CpG sites, located in 8 different genes (RUNX3, MLH1, NEUROG1, CDKN2A, IGF2, CRABP1, SOCS1 and CACNA1G) were investigated in 64 distinct colon cancers and 2 colon cancer cell lines. The Ogino gene panel includes all 8 genes, in addition to the Weisenberger panel of which only 5 of the 8 genes included were investigated. In total, 18 alternative combinations of scoring of CIMP positivity on probe-, gene-, and panel-level were analysed and compared. For 47 samples (71%), the CIMP status was constant and independent of criteria used for scoring; 34 samples were constantly scored as CIMP negative, and 13 (20%) consistently scored as CIMP positive. Only four of 31 probes (13%) investigated showed no difference in the numbers of positive samples using the different cut-offs. Within the panels a trend was observed that increasing the gene-level stringency resulted in a larger difference in CIMP positive samples than increasing the probe-level stringency. A significant difference between positive samples using 'the most stringent' as compared to 'the least stringent' criteria (20% vs 46%, respectively; pCIMP depending on the cut-offs and genes included in a panel was found, with twice as many positives samples by least compared to most stringent definition used.

  7. Pre-return-to-work medical consultation for low back pain workers. Good practice recommendations based on systematic review and expert consensus.

    Science.gov (United States)

    Petit, A; Rozenberg, S; Fassier, J B; Rousseau, S; Mairiaux, P; Roquelaure, Y

    2015-10-01

    The pre-return-to-work medical consultation during sick leave for low back pain (LBP) aims at assessing the worker's ability to resume working without risk for his/her health, and anticipating any difficulties inherent to returning to work and job retention. This article summarizes the good practices guidelines proposed by the French Society of Occupational Medicine (SFMT) and the French National Health Authority (HAS), and published in October 2013. Good practices guidelines developed by a multidisciplinary and independent task force (24 experts) and peer review committee (50 experts) based on a literature review from 1990 to 2012, according to the HAS methodology. According to the labour regulations, workers can request a medical consultation with their occupational physician at any time. The pre-return-to-work consultation precedes the effective return-to-work and can be requested by the employee regardless of their sick leave duration. It must be scheduled early enough to: (i) deliver reassuring information regarding risks to the lower back and managing LBP; (ii) evaluate prognostic factors of chronicity and prolonged disability in relations to LBP and its physical, social and occupational consequences in order to implement the necessary conditions for returning to work; (iii) support and promote staying at work by taking into account all medical, social and occupational aspects of the situation and ensure proper coordination between the different actors. A better understanding of the pre-return-to-work consultation would improve collaboration and coordination of actions to facilitate resuming work and job retention for patients with LBP. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis.

    Science.gov (United States)

    Möller, Ingrid; Loza, Estibaliz; Uson, Jacqueline; Acebes, Carlos; Andreu, Jose Luis; Batlle, Enrique; Bueno, Ángel; Collado, Paz; Fernández-Gallardo, Juan Manuel; González, Carlos; Jiménez Palop, Mercedes; Lisbona, María Pilar; Macarrón, Pilar; Maymó, Joan; Narváez, Jose Antonio; Navarro-Compán, Victoria; Sanz, Jesús; Rosario, M Piedad; Vicente, Esther; Naredo, Esperanza

    To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. These recommendations will help clinicians use US and MRI in RA patients. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  9. Expert recommendation: contributions to clinical practice of the new prodrug lisdexamfetamine dimesylate (LDX) in the treatment of attention deficit hyperactivity disorder (ADHD).

    Science.gov (United States)

    Alda, José A; Soutullo, César; Ramos-Quiroga, Josep A; Quintero, Javier; Hervás, Amaia; Hernández-Otero, Isabel; Sans-Fitó, Anna; Cardo-Jalón, Esther Cardo-Jalón; Fernández-Jaén, Alberto; Fernández-Pérez, Maximino; Hidalgo-Vicario, M Inés; Eddy-Ives, Lefa S; Sánchez, Javier

    2014-12-01

    Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobiological disorders in childhood, and is characterized by inappropriate levels of inattention, hyperactivity and/or impulsiveness, with an estimated prevalence of 5.29%. ADHD can have a negative impact upon all areas of the life of the patient. The main clinical guides accept multimodal treatment, involving both pharmacological and psychological measures, as the best management approach in ADHD (psychoeducational, behavioural and academic). Lisdexamfetamine dimesylate (LDX) is a new drug for the treatment of ADHD. A multidiscipline expert document has been developed, compiling the scientific evidence referred to this new molecule. The study also addresses the existing shortcomings in current drug therapy for ADHD and the contributions of LDX to routine clinical practice, in an attempt to help and guide physicians in the use of this new treatment. This document is endorsed by the ADHD and Psychoeducational Development task Group of the Spanish Society of Primary Care Pediatrics (Grupo de TDAH y Desarrollo Psicoeducativo de la Asociación Española de Pediatría de Atención Primaria, AEPap), the Spanish Society of Pediatric Neurology (Sociedad Española de Neurología Pediátrica, SENEP) and the Spanish Society of Out-hospital Pediatrics and Primary Care (Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria, SEPEAP).

  10. Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

    Science.gov (United States)

    Pereira, José L.; Davis, Daniel H.J.; Currow, David C.; Meagher, David; Rabheru, Kiran; Wright, David; Bruera, Eduardo; Hartwick, Michael; Gagnon, Pierre R.; Gagnon, Bruno; Breitbart, William; Regnier, Laura; Lawlor, Peter G.

    2014-01-01

    Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. PMID:24480529

  11. EXPERT SYSTEMS

    OpenAIRE

    Georgiana Marin; Mihai Catalin Andrei

    2011-01-01

    In recent decades IT and computer systems have evolved rapidly in economic informatics field. The goal is to create user friendly information systems that respond promptly and accurately to requests. Informatics systems evolved into decision assisted systems, and such systems are converted, based on gained experience, in expert systems for creative problem solving that an organization is facing. Expert systems are aimed at rebuilding human reasoning on the expertise obtained from experts, sto...

  12. Expert System

    DEFF Research Database (Denmark)

    Hildebrandt, Thomas Troels; Cattani, Gian Luca

    2016-01-01

    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 b...... for the application of expert systems, but also raises issues regarding privacy and legal liability....

  13. Clinical practice recommendations for depression.

    Science.gov (United States)

    Malhi, G S; Adams, D; Porter, R; Wignall, A; Lampe, L; O'Connor, N; Paton, M; Newton, L A; Walter, G; Taylor, A; Berk, M; Mulder, R T

    2009-01-01

    To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making. A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.

  14. ENSI's view on NTB 08-02 'Report on how to handle the recommendations in expert reports and statements of views on the demonstration of the nuclear waste disposal programme'

    International Nuclear Information System (INIS)

    2012-03-01

    In the framework of a review of the project Opalinus clay for the disposal of spent fuel assemblies, high-level radioactive waste and long living intermediate-level waste, a team of experts worked out numerous recommendations to be considered in the future. In 2006, the Swiss Federal Council stated that the realization of a radioactive waste disposal had been demonstrated to be possible. At the same time, the operators of the Swiss nuclear power plants were instructed to answer the open questions and to decide how they would proceed in the future. Similarly, the National Cooperative for the Disposal of Radioactive Waste (NAGRA) presented a report which ENSI had to review and evaluate. This review is reported in the present document. The NAGRA report, as well as ENSI's comments, is structured in accordance with the 200 recommendations made by the experts' team. ENSI states that the recommendations and all open questions of the experts' team were treated completely and transparently by NAGRA; they were considered in the elaboration of proposals for underground storage sites. ENSI declares that the recommendations for the demonstration of the feasibility of the waste disposal were given the correct priority. An important mile stone for more precise indications about site specific data will be the future request for the granting of the framework license, at the end of the site selection process, according to the Sectoral Plan for Geologic Deep Repositories. The recommendations about Opalinus clay as host rock are of general nature. They concern a repository for high-level (HLW) waste as well as for low- and intermediate-level (ILW) wastes. They also concern techniques independent of the host rock, like how to handle filling and sealing material. In step 1 of the Sectoral Plan, besides the Opalinus clay NAGRA proposed exclusively clay-rich host rocks with similar properties. Opalinus clay was proposed for 5 of the 6 potential disposal sites for a ILW repository. Some

  15. Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative.

    Science.gov (United States)

    Subbe, Christian P; Kellett, John; Barach, Paul; Chaloner, Catriona; Cleaver, Hayley; Cooksley, Tim; Korsten, Erik; Croke, Eilish; Davis, Elinor; De Bie, Ashley Jr; Durham, Lesley; Hancock, Chris; Hartin, Jilian; Savijn, Tracy; Welch, John

    2017-05-08

    'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology. A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use. Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. 'Check In'), a list of prompts regarding common omissions (i.e. 'Stop & Think'), and, a list of items required for the safe "handover" of patients that remain on the general ward (i.e. 'Check Out'). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients. Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are

  16. Expert group study on recommended practices for wind turbine testing and evaluation. 10. Measurement of noise immission from wind turbines at noise receptor locations

    International Nuclear Information System (INIS)

    Ljunggren, S.

    1997-01-01

    The purpose of this guide is to provide a set of techniques and methods for the measurement and description of wind turbine noise immission, that is, wind turbine noise at receptor locations. These techniques and methods have been prepared so that they can be used by: manufacturers; developers; operators; planning authorities; research and development engineers, for the purpose of verification of compliance with noise immission limits and of noise propagation models. The measurement of noise immission from wind turbines is a complex acoustic task. This guideline cannot cover all possible problems that may be encountered on, for instance: determination of wind speed; measurements in cases of low signal-to-noise ratio; allowance for reflections from buildings. Thus, it is strongly recommended that the measurements described in this guide are always carried out by experienced acousticians. (au)

  17. Book Review: Radiological Conditions in the Dnieper River Basin: Assessment by an International Expert Team and Recommendations for an Action Plan

    International Nuclear Information System (INIS)

    Napier, Bruce A.

    2007-01-01

    This article is a book review of a report from the International Atomic Energy Agency that was prepared by a team of scientists from Belarus, the Russian Federation, and Ukraine as an assessment of radiological contamination of the Dnieper River, which flows through these three countries. The topics covered begin with radioactive sources (actual and potential) including areas affected by the Chernobyl nuclear accident, nuclear power plants along the river and its tributaries, uranium mining and ore processing, radioactive waste storage and disposal sites, and non-power sources, such as medicine, industry, and research. The report continues with an assessment of human exposures to radiation from these sources. An additional area of consideration is radiological 'hot spots' in the region. The report finishes with conclusions and recommendations to the regional governments for a strategic action plan and individual government national plans.

  18. Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts.

    Science.gov (United States)

    Poole, Daniele; Chieregato, Arturo; Langer, Martin; Viaggi, Bruno; Cingolani, Emiliano; Malacarne, Paolo; Mengoli, Francesca; Nardi, Giuseppe; Nascimben, Ennio; Riccioni, Luigi; Turriziani, Ilaria; Volpi, Annalisa; Coniglio, Carlo; Gordini, Giovanni

    2014-01-01

    Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field. The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more

  19. Expert ease

    Energy Technology Data Exchange (ETDEWEB)

    1984-04-01

    Expert-ease allows the most inexperienced of computer users to build an expert system in a matter of hours. It is nothing more or less than a computer based problem-solving system. It allows the expert to preserve his or her knowledge in the form of rules, which can be applied to problems put to the system by the non-expert. The crucial piece of software at the heart of Expert-Ease extracts rules from data, and is called the analogue concept learning system. It was developed by Intelligent Terminals Ltd. and supplied to Export Software International to be incorporated into a commercially attractive package for business users. The resulting product runs on the Act Sirius and the IBM PC and compatibles. It is a well conceived and polished product with a popular appeal that should ensure widespread acceptance even at a cost of >1500 plus vat.

  20. Recommendations for reporting economic evaluations of haemophilia prophylaxis: a nominal groups consensus statement on behalf of the Economics Expert Working Group of The International Prophylaxis Study Group.

    Science.gov (United States)

    Nicholson, A; Berger, K; Bohn, R; Carcao, M; Fischer, K; Gringeri, A; Hoots, K; Mantovani, L; Schramm, W; van Hout, B A; Willan, A R; Feldman, B M

    2008-01-01

    The need for clearly reported studies evaluating the cost of prophylaxis and its overall outcomes has been recommended from previous literature. To establish minimal ''core standards'' that can be followed when conducting and reporting economic evaluations of hemophilia prophylaxis. Ten members of the IPSG Economic Analysis Working Group participated in a consensus process using the Nominal Groups Technique (NGT). The following topics relating to the economic analysis of prophylaxis studies were addressed; Whose perspective should be taken? Which is the best methodological approach? Is micro- or macro-costing the best costing strategy? What information must be presented about costs and outcomes in order to facilitate local and international interpretation? The group suggests studies on the economic impact of prophylaxis should be viewed from a societal perspective and be reported using a Cost Utility Analysis (CUA) (with consideration of also reporting Cost Benefit Analysis [CBA]). All costs that exceed $500 should be used to measure the costs of prophylaxis (macro strategy) including items such as clotting factor costs, hospitalizations, surgical procedures, productivity loss and number of days lost from school or work. Generic and disease specific quality of lífe and utility measures should be used to report the outcomes of the study. The IPSG has suggested minimal core standards to be applied to the reporting of economic evaluations of hemophilia prophylaxis. Standardized reporting will facilitate the comparison of studies and will allow for more rational policy decisions and treatment choices.

  1. Strategic transformation of population studies: recommendations of the working group on epidemiology and population sciences from the National Heart, Lung, and Blood Advisory Council and Board of External Experts.

    Science.gov (United States)

    Roger, Véronique L; Boerwinkle, Eric; Crapo, James D; Douglas, Pamela S; Epstein, Jonathan A; Granger, Christopher B; Greenland, Philip; Kohane, Isaac; Psaty, Bruce M

    2015-03-15

    In 2013, the National Heart, Lung, and Blood Institute assembled a working group on epidemiology and population sciences from its Advisory Council and Board of External Experts. The working group was charged with making recommendations to the National Heart, Lung, and Blood Advisory Council about how the National Heart, Lung, and Blood Institute could take advantage of new scientific opportunities and delineate future directions for the epidemiology of heart, lung, blood, and sleep diseases. Seven actionable recommendations were proposed for consideration. The themes included 1) defining the compelling scientific questions and challenges in population sciences and epidemiology of heart, lung, blood, and sleep diseases; 2) developing methods and training mechanisms to integrate "big data" science into the practice of epidemiology; 3) creating a cohort consortium and inventory of major studies to optimize the efficient use of data and specimens; and 4) fostering a more open, competitive approach to evaluating large-scale longitudinal epidemiology and population studies. By building on the track record of success of the heart, lung, blood, and sleep cohorts to leverage new data science opportunities and encourage broad research and training partnerships, these recommendations lay a strong foundation for the transformation of heart, lung, blood, and sleep epidemiology. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Expert Witness

    African Journals Online (AJOL)

    Adele

    formal rules of evidence apply) to help it understand the issues of a case and ... statements on medical expert witness by professional representative bodies in .... determining the size of the financial settlement that may have to be made to the.

  3. Interdisciplinary management of EGFR-inhibitor-induced skin reactions: a German expert opinion.

    Science.gov (United States)

    Potthoff, K; Hofheinz, R; Hassel, J C; Volkenandt, M; Lordick, F; Hartmann, J T; Karthaus, M; Riess, H; Lipp, H P; Hauschild, A; Trarbach, T; Wollenberg, A

    2011-03-01

    Anti-epidermal growth factor receptor treatment strategies, i.e. monoclonal antibodies such as cetuximab and panitumumab, or epidermal growth factor receptor (EGFR) small molecule tyrosine kinase inhibitors, such as erlotinib and gefitinib, have expanded the treatment options for different tumor types. Dermatologic toxic effects are the most common side-effects of EGFR inhibitor therapy. They can profoundly affect the patient's quality of life. The aim of this study was to provide interdisciplinary expert recommendations on how to treat patients with skin reactions undergoing anti-EGFR treatment. An expert panel from Germany with expertise in medical oncology, dermatology or clinical pharmacology was convened to develop expert recommendations based on published peer-reviewed literature. The expert recommendations for the state-of-the-art treatment of skin reactions induced by EGFR inhibitor therapy include recommendations for diagnostics and grading as well as grade-specific and stage-adapted treatment approaches and preventive measures. It was concluded that EGFR-inhibitor-related dermatologic reactions should always be treated combining basic care of the skin and a specific therapy adapted to stage and grade of skin reaction. For grade 2 and above, specific treatment recommendations for early- and later-stage skin reactions induced by EGFR-inhibitor therapy were proposed. This paper presents a German national expert opinion for the treatment of skin reactions in patients receiving EGFR inhibitor therapy.

  4. Using long-acting beta2-agonists safely: What will be the impact of the US Food and Drug Administration's panel recommendations?

    Science.gov (United States)

    Smart, Brian A

    2009-01-01

    The US Food and Drug Administration (FDA) has launched an investigation into the safety of long-acting beta(2)-agonists (LABAs). While the impact of this investigation is yet to be seen, clinicians should be circumspect in the use of these agents and prescribe them according to the recommendations of current asthma guidelines, informing patients and their caretakers about potential risks. As clinical trials attempt to address the question of whether LABAs are safe for use in pediatric and adult populations, current data provide no clear answers. A special hearing of the FDA's Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee, and Pediatric Advisory Committee attempted to seek consensus on the matter as it reviewed the results of controlled clinical trials and conducted a benefit:risk assessment of LABAs to make recommendations on their safety.

  5. A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery.

    Science.gov (United States)

    van Vliet, Daphne C R; van der Meij, Eva; Bouwsma, Esther V A; Vonk Noordegraaf, Antonie; van den Heuvel, Baukje; Meijerink, Wilhelmus J H J; van Baal, W Marchien; Huirne, Judith A F; Anema, Johannes R

    2016-12-01

    Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.

  6. Panel Analysis

    DEFF Research Database (Denmark)

    Brænder, Morten; Andersen, Lotte Bøgh

    2014-01-01

    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...... points in time. In comparison with traditional cross-sectional studies, the advantage of using panel studies is that the time dimension enables us to study effects. Whereas experimental designs may have a clear advantage in regard to causal inference, the strength of panel studies is difficult to match...

  7. Panel 5: Microbiology and Immunology Panel

    Science.gov (United States)

    Murphy, Timothy F.; Chonmaitree, Tasnee; Barenkamp, Stephen; Kyd, Jennelle; Nokso-Koivisto, Johanna; Patel, Janak A.; Heikkinen, Terho; Yamanaka, Noboru; Ogra, Pearay; Swords, W. Edward; Sih, Tania; Pettigrew, Melinda M.

    2014-01-01

    Objective The objective is to perform a comprehensive review of the literature from January 2007 through June 2011 on the virology, bacteriology, and immunology related to otitis media. Data Sources PubMed database of the National Library of Medicine. Review Methods Three subpanels with co-chairs comprising experts in the virology, bacteriology, and immunology of otitis media were formed. 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 second draft was created. The entire panel met at the 10th International Symposium on Recent Advances in Otitis Media in June 2011 and discussed the review and refined the content further. A final draft was created, circulated, and approved by the panel. Conclusion Excellent progress has been made in the past 4 years in advancing an understanding of the microbiology and immunology of otitis media. Advances include laboratory-based basic studies, cell-based assays, work in animal models, and clinical studies. Implications for Practice The advances of the past 4 years formed the basis of a series of short-term and long-term research goals in an effort to guide the field. Accomplishing these goals will provide opportunities for the development of novel interventions, including new ways to better treat and prevent otitis media. PMID:23536533

  8. Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline.

    Science.gov (United States)

    Ramakrishna, Naren; Temin, Sarah; Chandarlapaty, Sarat; Crews, Jennie R; Davidson, Nancy E; Esteva, Francisco J; Giordano, Sharon H; Gonzalez-Angulo, Ana M; Kirshner, Jeffrey J; Krop, Ian; Levinson, Jennifer; Modi, Shanu; Patt, Debra A; Perez, Edith A; Perlmutter, Jane; Winer, Eric P; Lin, Nancy U

    2014-07-01

    To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. The American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging (MRI) to screen for brain metastases, but rather should have a low threshold for MRI of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. © 2014 by American Society of Clinical Oncology.

  9. Expert Systems: What Is an Expert System?

    Science.gov (United States)

    Duval, Beverly K.; Main, Linda

    1994-01-01

    Describes expert systems and discusses their use in libraries. Highlights include parts of an expert system; expert system shells; an example of how to build an expert system; a bibliography of 34 sources of information on expert systems in libraries; and a list of 10 expert system shells used in libraries. (Contains five references.) (LRW)

  10. Assessment of phthalates/phthalate alternatives in children's toys and childcare articles: Review of the report including conclusions and recommendation of the Chronic Hazard Advisory Panel of the Consumer Product Safety Commission.

    Science.gov (United States)

    Lioy, Paul J; Hauser, Russ; Gennings, Chris; Koch, Holger M; Mirkes, Philip E; Schwetz, Bernard A; Kortenkamp, Andreas

    2015-01-01

    The Consumer Product Safety Commission (CPSC) convened a Chronic Hazard Advisory Panel (CHAP) on Phthalates found in children's toys, and childcare products, and in products used by women of childbearing age. The CHAP conducted a risk assessment on phthalates and phthalate substitutes, and made recommendations to either ban, impose an interim ban, or allow the continued use of phthalates and phthalate substitutes in the above products. After a review of the literature, the evaluation included toxic end points of primary concern, biomonitoring results, extant exposure reconstruction, and epidemiological results. The health end points chosen were associated with the rat phthalate syndrome, which is characterized by malformations of the epididymis, vas deferens, seminal vesicles, prostate, external genitalia (hypospadias), and by cryptorchidism (undescended testes), retention of nipples/areolae, and demasculinization (~incomplete masculinization) of the perineum, resulting in reduced anogenital distance. Risk assessment demonstrated that some phthalates should be permanently banned, removed from the banned list, or remain interim banned. Biomonitoring and toxicology data provided the strongest basis for a mixture risk assessment. In contrast, external exposure data were the weakest and need to be upgraded for epidemiological studies and risk assessments. Such studies would focus on routes and sources. The review presents recommendations and uncertainties.

  11. Youth injury prevention in Canada: use of the Delphi method to develop recommendations.

    Science.gov (United States)

    Pike, Ian; Piedt, Shannon; Davison, Colleen M; Russell, Kelly; Macpherson, Alison K; Pickett, William

    2015-12-22

    The Health Behaviour in School-aged Children Survey is one of very few cross-national health surveys that includes information on injury occurrence and prevention within adolescent populations. A collaboration to develop a Canadian youth injury report using these data resulted in, Injury among Young Canadians: A national study of contextual determinants. The objective of this study was to develop specific evidence-based, policy-oriented recommendations arising from the national report, using a modified-Delphi process with a panel of expert stakeholders. Eight injury prevention experts and a 3-person youth advisory team associated with a Canadian injury prevention organization (Parachute Canada) reviewed, edited and commented on report recommendations through a three-stage iterative modified-Delphi process. From an initial list of 27 draft recommendations, the modified-Delphi process resulted in a final list of 19 specific recommendations, worded to resonate with the group(s) responsible to lead or take the recommended action. Two recommendations were rated as "extremely important" or "very important" by 100 % of the expert panel, two were deleted, a further two recommendations were deleted but the content included as text in the report, and four were merged with other existing recommendations. The modified-Delphi process was an appropriate method to achieve agreement on 19 specific evidence-based, policy-oriented recommendations to complement the national youth injury report. In providing their input, it is noted that the injury stakeholders each acted as individual experts, unattached to any organizational position or policy. These recommendations will require multidisciplinary collaborations in order to support the proposed policy development, additional research, programming and clear decision-making for youth injury prevention.

  12. Soft sensors in bioprocessing: A status report and recommendations

    DEFF Research Database (Denmark)

    Luttmann, Reiner; Bracewell, Daniel G.; Cornelissen, Gesine

    2012-01-01

    The following report with recommendations is the result of an expert panel meeting on soft sensor applications in bioprocess engineering that was organized by the Measurement, Monitoring, Modelling and Control (M3C) Working Group of the European Federation of Biotechnology - Section of Biochemical...... Engineering Science (ESBES). The aim of the panel was to provide an update on the present status of the subject and to identify critical needs and issues for the furthering of the successful development of soft sensor methods in bioprocess engineering research and for industrial applications, in particular...... with focus on biopharmaceutical applications. It concludes with a set of recommendations, which highlight current prospects for the extended use of soft sensors and those areas requiring development....

  13. Progress on Oceanographic Tables and Standards 1983-1986: Work and Recommendations of the Unesco/SCOR/ICES/IAPSO Joint Panel. Unesco Technical Papers in Marine Science No. 50.

    Science.gov (United States)

    United Nations Educational, Scientific, and Cultural Organization, Paris (France). Div. of Marine Sciences.

    The present document covers activities carried out by and under the auspices of the Joint Panel on Oceanographic Tables and Standards (JPOTS) over the period of 1983-1986. The first part is the report of the Chairman of JPOTS on the activities of the Panel during the period 1983-1985. Two major topics were considered by the Panel: (1) the…

  14. Evaluation of proposed panel closure modifications at WIPP

    Energy Technology Data Exchange (ETDEWEB)

    Allen, Lawrence E.; Silva, Matthew K.; Channell, James K.; Abel, John F.; Morgan, Dudley R.

    2001-12-31

    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.

  15. The expert meeting dedicated to the discussion of results of a local open-label multicenter observational study of the efficiency and safety of tofacitinib in patients with active rheumatoid arthritis with the inefficiency of disease-modifying antirheumatic drugs and to the elaboration of recommendations for the use for tofacitinib in the therapy of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    2016-01-01

    Full Text Available The expert meeting dedicated to the discussion of results of a local open-label multicenter observational study of the efficiency and safety of tofacitinib in patients with active rheumatoid arthritis with the inefficiency of disease-modifying antirheumatic drugs and to the elaboration of recommendations for the use for tofacitinib in the therapy of rheumatoid arthritis.

  16. Use of expert judgement in NUREG-1150

    International Nuclear Information System (INIS)

    Ortiz, N.R.; Wheeler, T.A.; Breeding, R.J.; Hora, S.; Meyer, M.A.; Kenney, R.L.

    1991-01-01

    The explicit expert judgment process used in NUREG-1150, 'Severe Accident Risks: An Assessment for Five US Nuclear Plants', is discussed in this paper. The main steps of the process are described, including selection of issues and experts, elicitation training, presentation of issues to the experts, preparation of issue analyses by the experts, discussion of issue analyses and elicitation, and recomposition and aggregation of results. To demonstrate the application of the expert judgment process to NUREG-1150, two issues are summarized: one from the accident frequency analysis, and one from the accident progression analysis. Recommendations and insights are provided to improve the use of explicit expert judgment in complex technical issues. (orig.)

  17. Clinical practice recommendations for bipolar disorder.

    Science.gov (United States)

    Malhi, G S; Adams, D; Lampe, L; Paton, M; O'Connor, N; Newton, L A; Walter, G; Taylor, A; Porter, R; Mulder, R T; Berk, M

    2009-01-01

    To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making. A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives. The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative. These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

  18. Panel Session

    DEFF Research Database (Denmark)

    Bertelsen, Olav Wedege

    2004-01-01

    In this panel session, four researchers will discuss the role of a theoretical foundation, in particular AT, in the design of information technology based artefacts. The general discussion will take of from a specific examination of the ActAD approach.......In this panel session, four researchers will discuss the role of a theoretical foundation, in particular AT, in the design of information technology based artefacts. The general discussion will take of from a specific examination of the ActAD approach....

  19. 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).

    Science.gov (United States)

    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

    2008-01-01

    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

  20. Law for nuclear experts only

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, H [Kernforschungszentrum Karlsruhe G.m.b.H. (Germany, F.R.)

    1980-02-01

    The Federal Ministry of the Interior is preparing an ordinance on expert consultants under the Atomic Energy Act which, among other topics, is to include legal norms for the criteria to be met by experts in terms of non-partisanship, training, capabilities, technical equipment and cooperation in expert organizations of members of various scientific and technical disciplines. A summary of general criteria relating to the qualification, selection and status of experts called in by the legislative and executive branches and by courts of law, which could be organized as a series of guidelines without any original qualities of legal norms, could be recommended in view of the increasing quantitative and qualitative importance of experts. However, passing an ordinance merely fixing and putting into concrete terms the image of an 'expert under the Atomic Energy Act' is intolerable, because the status of scientific and technical experts by far extends beyond the field of nuclear law in our industrial society characterized by a far reaching division of labor. Weak points in the organization of expert services are not confined to technology or nuclear power. Separate rules establishing legal norms are not convincing also for reasons of technology policy and legal policy as well as for those of social psychology and practice.

  1. Secondary prophylaxis with rFVIIa in hemophilia and inhibitors: Recommendations from an Experts Committee from Argentina Profilaxis secundaria con rFVIIa en pacientes con hemofilia e inhibidores: Recomendaciones de un comité de expertos de Argentina

    Directory of Open Access Journals (Sweden)

    Raúl Pérez Bianco

    2010-06-01

    Full Text Available Secondary prophylaxis with rFVIIa has been the subject of several publications in the past few years. However, there is no general consensus on how this treatment should be put into practice, as publications have been very heterogeneous in the dosing schedule they report. Furthermore, the mechanism of action of rFVIIa and its short half life have been used as arguments against its role in prophylaxis. There have been a series of recent publications that show that rFVIIa can traffic through the intact endothelium and be stored in the subendothelium of several organs for a prolonged period of time. In order to consensuate the role of rFVIIa in prophylaxis, a group of experts from Argentina, resumed available information regarding pharmacology and clinical experience with this treatment, and developed a series of recommendations to use this drug in the prophylaxis setting.La profilaxis secundaria con factor VII activado recombinante (rFVIIa ha sido objeto de varias publicaciones en los últimos años. Sin embargo, no existe un consenso general sobre cómo este tratamiento debe ser puesto en práctica, dado que las publicaciones han sido muy heterogéneas respecto del régimen de dosificación que publican. Además, el mecanismo de acción del rFVIIa y su vida media corta se han utilizado como argumentos en contra de su papel en la profilaxis. Ha habido una serie de publicaciones recientes que muestran que el rFVIIa puede atravesar el endotelio intacto y almacenarse en el subendotelio de diversos órganos durante un período prolongado de tiempo. Con el fin de consensuar el papel de rFVIIa en la profilaxis, un grupo de expertos de Argentina, ha recopilado la información disponible sobre la farmacología y la experiencia clínica con este tratamiento, y desarrolló una serie de recomendaciones para utilizar este fármaco en el ámbito de profilaxis.

  2. ALICE Expert System

    CERN Document Server

    Ionita, C

    2014-01-01

    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...

  3. ALICE Expert System

    International Nuclear Information System (INIS)

    Ionita, C; Carena, F

    2014-01-01

    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 different 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 regular shifters during the next data taking period

  4. Lipid Panel

    Science.gov (United States)

    ... A routine cardiac risk assessment typically includes a fasting lipid panel. Beyond that, research continues into the usefulness of other non-traditional markers of cardiac risk, such as Lp-PLA 2 . A health practitioner may choose to evaluate one or more ...

  5. Expert opinion vs. empirical evidence

    Science.gov (United States)

    Herman, Rod A; Raybould, Alan

    2014-01-01

    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

  6. Aerospace Safety Advisory Panel

    Science.gov (United States)

    1999-01-01

    little flexibility to begin long lead-time items for upgrades or contingency planning. For example, the section on computer hardware and software contains specific findings related to required longer range safety-related actions. NASA can be proud of its accomplishments this past year, but must remain ever vigilant, particularly as ISS assembly begins to accelerate. The Panel will continue to focus on both the short- and long-term aspects of risk management and safety planning. This task continues to be made manageable and productive by the excellent cooperation the Panel receives from both NASA and its contractors. Particular emphasis will continue to be directed to longer term workforce and program planning issues as well as the immediate risks associated with ISS assembly and the initial flights of the X-33 and X-34. Section 2 of this report presents specific findings and recommendations generated by ASAP activities during 1998. Section 3 contains more detailed information in support of these findings and recommendations. Appendix A is a current roster of Panel members, consultants, and staff. Appendix B contains NASA's response to the findings and recommendations from the 1997 ASAP Annual Report. Appendix C details the fact-finding activities of the Panel in 1998. During the year, Mr. Richard D. Blomberg was elected chair of the Panel and Vice Admiral (VADM) Robert F Dunn was elected deputy chair. VADM Bernard M. Kauderer moved from consultant to member. Mr. Charles J. Donlan retired from the Panel after many years of meritorious service. Ms. Shirley C. McCarty and Mr. Robert L. ('Hoot') Gibson joined the Panel as consultants.

  7. Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.

    Science.gov (United States)

    Marques, Andréa; Rodrigues, Ana M; Romeu, José Carlos; Ruano, Afonso; Barbosa, Ana Paula; Simões, Eugénia; Águas, Fernanda; Canhão, Helena; Alves, José Delgado; Lucas, Raquel; Branco, Jaime Cunha; Laíns, Jorge; Mascarenhas, Mário; Simões, Susete; Tavares, Viviana; Lourenço, Oscar; da Silva, José António Pereira

    2016-01-01

    To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

  8. Law Panel in action.

    Science.gov (United States)

    Odulana, J

    In September 1976 the Africa Regional Council (ARC) of IPPF created a Law Panel to 1) advise the ARC on the emphasis of laws and parenthood programs in the region, 2) investigate legal obstacles to family planning and ways of removing them, 3) institute a monitoring service on laws and court decisions affecting planned parenthood, and 4) prepare a list of lawyers and legal reformers by country. The panel has 1) recommended adoption of an IPPF Central Medical Committee and Central Law Panel statement on sterilization, adolescent fertility control, and the use of medical and auxiliary personnel in family planning services with guidelines for Africa; 2) appointed National Legal Correspondents to carry on the monitoring service mentioned above in 18 countries; and 3) discussed solutions to problems in delivering family planning services with family planning associations in Tanzania, Zambia, Mauritius, Madagascar, and Kenya. Laws governing family planning education and services, marriage, divorce, and maternity benefits in these countries are summarized. In 1978 the panel will hold 2 workshops on law and the status of women.

  9. Integrated Thermal Treatment Systems study: US Department of Energy Internal Review Panel report

    International Nuclear Information System (INIS)

    Cudahy, J.; Escarda, T.; Gimpel, R.

    1995-04-01

    The U.S. Department of Energy's (DOE) Office of Technology Development (OTD) commissioned two studies to uniformly evaluate nineteen thermal treatment technologies. These studies were called the Integrated Thermal Treatment System (ITTS) Phase I and Phase II. With the advice and guidance of the DOE Office of Environmental Management's (EM's) Mixed Waste Focus Group, OTD formed an ITTS Internal Review Panel, composed of scientists and engineers from throughout the DOE complex, the U.S. Environmental Protection Agency (EPA), the California EPA, and private experts. The Panel met from November 15-18, 1994, to review and comment on the ITTS studies, to make recommendations on the most promising thermal treatment systems for DOE mixed low level wastes (MLLW), and to make recommendations on research and development necessary to prove the performance of the technologies on MLLW

  10. Experimental evaluation of an expert system for nuclear reactor operators

    International Nuclear Information System (INIS)

    Nelson, W.R.

    1984-10-01

    The United States Nuclear Regulatory Commission (USNRC) is supporting a program for the experimental evaluation of an expert system for nuclear reactor operators. A prototype expert system, called the Response Tree System, has been developed and implemented at INEL. The Response Tree System is designed to assess the status of a reactor system following an accident and recommend corrective actions to reactor operators. The system is implemented using color graphic displays and is driven by a computer simulation of the reactor system. Control of the system is accomplished using a transparent touch panel. Controlled experiments are being conducted to measure performance differences between operators using the Response Tree System and those not using it to respond to simulated accident situations. This paper summarizes the methodology and results of the evaluation of the Response Tree System, including the quantitative results obtained in the experiments thus far. Design features of the Response Tree System are discussed, and general conclusions regarding the applicability of expert systems in reactor control rooms are presented

  11. Panel discussion

    International Nuclear Information System (INIS)

    Anon.

    1980-01-01

    The panel discussion at the 10th Allianz Forum on 'Technology and Insurance' dealt with the following topics: New technologies: energy conversion (coal, petroleum, natural gas, nuclear energy, solar energy); infrastructure (transport, data processing); basic products (metallic materials, chemical products, pharmaceutical products); integrated products (microprocessors, production line machines) as well as new risks: political; general economic (financing, market structure); insurance-related, dangers to persons and property; reduction of risks. (orig.) [de

  12. Evaluation of a Performance-Based Expert Elicitation: WHO Global Attribution of Foodborne Diseases

    DEFF Research Database (Denmark)

    Aspinall, W. P.; Cooke, R. M.; Havelaar, A. H.

    2016-01-01

    . This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five...... 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...

  13. Differing professional opinions: 1987 Special Review Panel

    International Nuclear Information System (INIS)

    1987-11-01

    In mid-1987, the Executive Director for Operations of the US Nuclear Regulatory Commission appointed a Special Review Panel to review the existing NRC policy for expressing differing professional views and to recommend possible improvements to the policy, if warranted. Through its own efforts and those of three subpanels and three consultants, the Panel developed recommendations for changes and improvements in five major areas. This report presents those recommendations, along with a detailed explanation of the Panel's findings, copies of the reports of the subpanels and consultants, and the results of a survey of NRC non-clerical employees on the issue

  14. Social assessment methods recommendation report: Draft, May 1986

    International Nuclear Information System (INIS)

    1986-11-01

    These recommendations reflect the Peer Review Panel positions on each issue. The recommendations were developed following a day-long discussion held by the Review Panel. These recommendations were reviewed by each Panelist. Significant disagreements within the Panel are noted, and, of course, not all members shared identical perspectives on each issue. The order in which these recommendations are listed and discussed also reflects a general prioritizing by the Panel, although the Panel also agrees that all recommendations included here are of major importance to the project

  15. Use of expert consensus to improve atherogenic dyslipidemia management.

    Science.gov (United States)

    Millán Núñez-Cortés, Jesús; Pedro-Botet, Juan; Brea-Hernando, Ángel; Díaz-Rodríguez, Ángel; González-Santos, Pedro; Hernández-Mijares, Antonio; Mantilla-Morató, Teresa; Pintó-Sala, Xavier; Simó, Rafael

    2014-01-01

    Although atherogenic dyslipidemia is a recognized cardiovascular risk factor, it is often underassessed and thus undertreated and poorly controlled in clinical practice. The objective of this study was to reach a multidisciplinary consensus for the establishment of a set of clinical recommendations on atherogenic dyslipidemia to optimize its prevention, early detection, diagnostic evaluation, therapeutic approach, and follow-up. After a review of the scientific evidence, a scientific committee formulated 87 recommendations related to atherogenic dyslipidemia, which were grouped into 5 subject areas: general concepts (10 items), impact and epidemiology (4 items), cardiovascular risk (32 items), detection and diagnosis (19 items), and treatment (22 items). A 2-round modified Delphi method was conducted to compare the opinions of a panel of 65 specialists in cardiology (23%), endocrinology (24.6%), family medicine (27.7%), and internal medicine (24.6%) on these issues. After the first round, the panel reached consensus on 65 of the 87 items discussed, and agreed on 76 items by the end of the second round. Insufficient consensus was reached on 3 items related to the detection and diagnosis of atherogenic dyslipidemia and 3 items related to the therapeutic goals to be achieved in these patients. The external assessment conducted by experts on atherogenic dyslipidemia showed a high level of professional agreement with the proposed clinical recommendations. These recommendations represent a useful tool for improving the clinical management of patients with atherogenic dyslipidemia. A detailed analysis of the current scientific evidence is required for those statements that eluded consensus. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  16. Human factors inspection of current control room panel in Jose Cabrera NPP

    International Nuclear Information System (INIS)

    Almeida, P.; O'Hara, J.; Higgins, J.

    2002-01-01

    Within the process of renewal of Exploitation Permit of Jose Cabrera Nuclear Power Plant, UNION FENOSA GENERACIO, S. A. (UFG) has carried out an analysis and evaluation project regarding human factors implications of current control room panel arrangement. The project has been developed in two phases. In the first phase, leaded by EPRI and carried out by experts from SAIC, an independent review from a double viewpoint of human reliability and human factors was developed. In the second phase, a multidisciplinary team (composed by human factors, risk analysis, operation, engineering, training and instrumentation and controls experts) has developed a study on human factors implications of current panel arrangement, following the methodology pointed out in NUREG-0711. The project has been developed under the direction of Brookhaven National Laboratory (BNL), organisation that has authored the aforementioned methodology, with the participation of UFG and SOLUZIONA Ingenieria. For the development of the second study the following steps were taken: Firstly, the potential effects of panel arrangement on crew performance were identified its real evidence was analysed and the goals for the improvement of control room operation were established; following NUREG-0711. After this, several design alternatives that addressed these goals were identified and were analysed along three dimensions: human factors, risk analysis and economic costs. Finally the results of these evaluations were combined using a multi-attribute decision method to arrive at a recommended alternative as he best proposal to incorporate human factors criteria and good practices in the design of control room panels. (Author)

  17. Panel surveys

    OpenAIRE

    MADRE, JL; ZUMKELLER, D; CHLOND, B; ARMOOGUM, J

    2004-01-01

    l'analyse du comportement humain constitue un enjeu important dans le domaine des transports, lequel se transforme radicalement sous la pression des évolutions économique, écologique et démographique. les premières grandes études ont commence il y a plus d'une dizaine d'années : parc auto sofres en france, puget sound panel a seattle. cet article fait le bilan de ces expériences et met en évidence les principaux problèmes méthodologiques rencontres tout en proposant de nouvelles directions d'...

  18. Chapter 10: Management recommendations

    Science.gov (United States)

    Deborah M. Finch; Janie Agyagos; Tracy McCarthey; Robert M. Marshall; Scott H. Stoleson; Mary J. Whitfield

    2000-01-01

    This chapter was developed over a series of meetings using a group-consensus process. Our recommendations are based on published results, on information compiled in the previous chapters, on expert opinion, and on unpublished data of conservation team members. This chapter is available as temporary guidance until the Recovery Plan for the southwestern willow flycatcher...

  19. Expert judgment for nuclear energy

    International Nuclear Information System (INIS)

    Choi, Young Sung; Lee, Sun Ho; Lee, Byong Whi

    2000-01-01

    Public perception on nuclear energy is much influenced by subjective impressions mostly formed through sensational and dramatic news of mass media or anti-nuclear groups. However, nuclear experts, those who have more relevant knowledge and information about nuclear energy, may have reasonable opinion based on scientific facts or inferences. Thus their opinion and consensus should be examined and taken into account during the process of nuclear energy policy formulation. For the purpose of eliciting experts' opinion, the web-based on-line survey system (eBOSS) was developed. Using the survey system, experts' views on nuclear energy were tallied, analyzed and compared with the public's. Based on the survey results, the paper suggests some recommendations about the future direction of the public information program in Korea

  20. Expert systems as decision tools

    International Nuclear Information System (INIS)

    Scott, C.K.

    1989-01-01

    The feasibility of using expert systems as an aid in regulatory compliance functions has been investigated. A literature review was carried out to identify applications of expert systems to regulatory affairs. A bibliography of the small literature on such applications was prepared. A prototype system, ARIES, was developed to demonstrate the use of an expert system as an aid to a Project Officer in assuring compliance with licence requirements. The system runs on a personal computer with a graphical interface. Extensive use is made of hypertext to link interrelated rules and requirements as well as to provide an explanation facility. Based on the performance of ARIES the development of a field version is recommended

  1. Curricula for Media Literacy Education According to International Experts

    Science.gov (United States)

    Fedorov, Alexander; Levitskaya, Anastasia; Camarero, Emma

    2016-01-01

    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…

  2. Panel backs next-generation synchrotron

    CERN Multimedia

    Service, R F

    1999-01-01

    A key federal panel recommended continued research into development of a fourth-generation synchrotron. It would be capable of creating x-ray pulses billions of times more intense than current designs (1 page).

  3. Earthquakes and Tectonics Expert Judgment Elicitation Project

    International Nuclear Information System (INIS)

    Coppersmith, K.J.; Perman, R.C.; Youngs, R.R.

    1993-02-01

    This report summarizes the results of the Earthquakes and Tectonics Expert Judgement Excitation Project sponsored by the Electric Power Research Institute (EPRI). The objectives of this study were two-fold: (1) to demonstrate methods for the excitation of expert judgement, and (2) to quantify the uncertainties associated with earthquake and tectonics issues for use in the EPRI-HLW performance assessment. Specifically, the technical issue considered is the probability of differential fault displacement through the proposed repository at Yucca Mountain, Nevada. For this study, a strategy for quantifying uncertainties was developed that relies on the judgements of multiple experts. A panel of seven geologists and seismologists was assembled to quantify the uncertainties associated with earthquake and tectonics issues for the performance assessment model. A series of technical workshops focusing on these issues were conducted. Finally, each expert was individually interviewed in order to elicit his judgement regarding the technical issues and to provide the technical basis for his assessment. This report summarizes the methodologies used to elicit the judgements of the earthquakes and tectonics experts (termed ''specialists''), and summarizes the technical assessments made by the expert panel

  4. Medical Expert Systems Survey

    OpenAIRE

    Abu-Nasser, Bassem S.

    2017-01-01

    International audience; There is an increased interest in the area of Artificial Intelligence in general and expert systems in particular. Expert systems are rapidly growing technology. Expert systems are 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 ...

  5. TU Delft expert judgment data base

    International Nuclear Information System (INIS)

    Cooke, Roger M.; Goossens, Louis L.H.J.

    2008-01-01

    We review the applications of structured expert judgment uncertainty quantification using the 'classical model' developed at the Delft University of Technology over the last 17 years [Cooke RM. Experts in uncertainty. Oxford: Oxford University Press; 1991; Expert judgment study on atmospheric dispersion and deposition. Report Faculty of Technical Mathematics and Informatics No.01-81, Delft University of Technology; 1991]. These involve 45 expert panels, performed under contract with problem owners who reviewed and approved the results. With a few exceptions, all these applications involved the use of seed variables; that is, variables from the experts' area of expertise for which the true values are available post hoc. Seed variables are used to (1) measure expert performance, (2) enable performance-based weighted combination of experts' distributions, and (3) evaluate and hopefully validate the resulting combination or 'decision maker'. This article reviews the classical model for structured expert judgment and the performance measures, reviews applications, comparing performance-based decision makers with 'equal weight' decision makers, and collects some lessons learned

  6. Collective knowledge: Using a Consensus Conference approach to develop recommendations for physical activity and nutrition programs for persons with Type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Tanya eBerry

    2012-12-01

    Full Text Available The purpose of this consensus conference was to have a lay panel of persons with type 2 diabetes (T2D work in collaboration with an expert panel of diabetes professionals to develop strategies designed to improve dietary and physical activity adherence in persons with T2D. Lay panel participants were 15 people living with T2D. The seven experts had expertise in exercise management, cardiovascular risk factors, community-based lifestyle interventions, healthy weight strategies, the glycemic index, exercise motivation, and social, environmental and cultural interactions. All meetings were facilitated by a professional, neutral facilitator. During the conference each expert gave a 15-minute presentation answering questions developed by the lay panel and all panel members worked to generate suggestions for programs and ways in which the needs of persons with T2D may be better met. A subgroup of the lay panel used the suggestions created from the conference to generate a final list of recommendations. Recommendations were categorized into 1 diagnosis/awareness (e.g., increasing awareness about T2D in the general public, need for lifelong self-monitoring post-diagnosis; 2 education for the person with diabetes (e.g., periodic refresher courses, professionals (e.g., regular interactions between researchers and persons with T2D so researchers better understand the needs of the affected population, and the community (e.g., support for families and employers; and 3 ongoing support (e.g., peer support groups. The recommendations from the conference can be used by researchers to design and evaluate physical activity and nutrition programs. The results can also be of use to policy makers and health promoters interested in increasing adherence to physical activity and nutrition guidelines among persons with T2D.

  7. The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis.

    Science.gov (United States)

    Brosseau, Lucie; Thevenot, Odette; MacKiddie, Olivia; Taki, Jade; Wells, George A; Guitard, Paulette; Léonard, Guillaume; Paquet, Nicole; Aydin, Sibel Z; Toupin-April, Karine; Cavallo, Sabrina; Moe, Rikke Helene; Shaikh, Kamran; Gifford, Wendy; Loew, Laurianne; De Angelis, Gino; Shallwani, Shirin Mehdi; Aburub, Ala' S; Mizusaki Imoto, Aline; Rahman, Prinon; Álvarez Gallardo, Inmaculada C; Cosic, Milkana Borges; Østerås, Nina; Lue, Sabrina; Hamasaki, Tokiko; Gaudreault, Nathaly; Towheed, Tanveer E; Koppikar, Sahil; Kjeken, Ingvild; Mahendira, Dharini; Kenny, Glen P; Paterson, Gail; Westby, Marie; Laferrière, Lucie; Longchamp, Guy

    2018-06-01

    To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P 12 weeks) trials for physical function and pinch strength. Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.

  8. Report of the Federal Internetworking Requirements Panel

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-05-31

    The Federal Internetworking Requirements Panel (FIRP) was established by the National Institute of Standards and Technology (NIST) to reassess Federal requirements for open systems networks and to recommend policy on the Government`s use of networking standards. The Panel was chartered to recommend actions which the Federal Government can take to address the short and long-term issues of interworking and convergence of networking protocols--particularly the Internet Protocol Suite (IPS) and Open Systems Interconnection (OSI) protocol suite and, when appropriate, proprietary protocols. The Panel was created at the request of the Office of Management and Budget in collaboration with the Federal Networking Council and the Federal Information Resources Management Policy Council. The Panel`s membership and charter are contained in an appendix to this report.

  9. Data Base Management Systems Panel. Third workshop summary

    Science.gov (United States)

    Urena, J. L. (Editor)

    1981-01-01

    The discussions and results of a review by a panel of data base management system (DRMS) experts of various aspects of the use of DBMSs within NASA/Office of Space and Terrestrial Applications (OSTA) and related organizations are summarized. The topics discussed included the present status of the use of DBMS technology and of the various ongoing DBMS-related efforts within NASA. The report drafts of a study that seeks to determine the functional requirements for a generalized DBMS for the NASA/OSTA and related data bases are examined. Future problems and possibilities with the use of DBMS technology are also considered. A list of recommendations for NASA/OSTA data systems is included.

  10. Panel Discussion

    Science.gov (United States)

    Langer, James

    1997-03-01

    Panelists: Arthur Bienenstock, Stanford University Cherry Ann Murray, Lucent Technologies Venkatesh Narayanamurti, University of California-Santa Barbara Paul Peercy, SEMI-SEMATECH Robert Richardson, Cornell University James Roberto, Oak Ridge National Laboratory The Board on Physics and Astronomy is undertaking a series of reassessments of all branches of physics as the foundation of a new physics survey. As part of this project, a Committee on Condensed Matter and Materials Physics has been established under the leadership of Venkatesh Narayanamurti of the University of California-Santa Barbara. The committee has been working since June on a study that will include an illustrative recounting of major recent achievements; identification of new opportunities and challenges facing the field; and articulation-for leaders in government, industry, universities, and the public at large-of the important roles played by the field in modern society. An especially urgent issue is how to maintain the intellectual vitality of condensed matter and materials physics, and its contributions to the well-being of the United States, in an era of limited resources. The forum will feature a panel of materials researchers who are members of the Committee on Condensed Matter and Materials Physics. They will give a brief report on the status of the study and engage in a dialogue with the audience about issues facing the condensed matter and materials physics community. Broad community input is vital to the success of the study. Please come and make your voice heard!

  11. Information Retrieval Diary of an Expert Technical Translator.

    Science.gov (United States)

    Cremmins, Edward T.

    1984-01-01

    Recommends use of entries from the information retrieval diary of Ted Crump, expert technical translator at the National Institute of Health, in the construction of computer models showing how expert translators solve problems of ambiguity in language. Expert and inexpert translation systems, eponyms, abbreviations, and alphabetic solutions are…

  12. Nuclear containment steel liner corrosion workshop : final summary and recommendation report.

    Energy Technology Data Exchange (ETDEWEB)

    Erler, Bryan A. (Erler Engineering Ltd., Chicago, IL); Weyers, Richard E. (Virginia Tech University, Blacksburg, VA); Sagues, Alberto (University of South Florida, Tampa, FL); Petti, Jason P.; Berke, Neal Steven (Tourney Consulting Group, LLC, Kalamazoo, MI); Naus, Dan J. (Oak Ridge National Laboratory, Oak Ridge, TN)

    2011-07-01

    This report documents the proceedings of an expert panel workshop conducted to evaluate the mechanisms of corrosion for the steel liner in nuclear containment buildings. The U.S. Nuclear Regulatory Commission (NRC) sponsored this work which was conducted by Sandia National Laboratories. A workshop was conducted at the NRC Headquarters in Rockville, Maryland on September 2 and 3, 2010. Due to the safety function performed by the liner, the expert panel was assembled in order to address the full range of issues that may contribute to liner corrosion. This report is focused on corrosion that initiates from the outer surface of the liner, the surface that is in contact with the concrete containment building wall. Liner corrosion initiating on the outer diameter (OD) surface has been identified at several nuclear power plants, always associated with foreign material left embedded in the concrete. The potential contributing factors to liner corrosion were broken into five areas for discussion during the workshop. Those include nuclear power plant design and operation, corrosion of steel in contact with concrete, concrete aging and degradation, concrete/steel non-destructive examination (NDE), and concrete repair and corrosion mitigation. This report also includes the expert panel member's recommendations for future research.

  13. Hepatic (Liver) Function Panel

    Science.gov (United States)

    ... Educators Search English Español Blood Test: Hepatic (Liver) Function Panel KidsHealth / For Parents / Blood Test: Hepatic (Liver) ... kidneys ) is working. What Is a Hepatic (Liver) Function Panel? A liver function panel is a blood ...

  14. Comprehensive metabolic panel

    Science.gov (United States)

    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) - blood. In: ... Tests and Diagnostic Procedures . 6th ed. St Louis, MO: ...

  15. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis.

    Science.gov (United States)

    Brosseau, Lucie; Wells, George A; Pugh, Arlanna G; Smith, Christine Am; Rahman, Prinon; Àlvarez Gallardo, Inmaculada C; Toupin-April, Karine; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Taki, Jade; Marcotte, Rachel; Fransen, Marlene; Hernandez-Molina, Gabriela; Kenny, Glen P; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; Brooks, Sydney; Laferriere, Lucie; McLean, Linda; Longchamp, Guy

    2016-10-01

    The primary objective is to identify effective land-based therapeutic exercise interventions and provide evidence-based recommendations for managing hip osteoarthritis. A secondary objective is to develop an Ottawa Panel evidence-based clinical practice guideline for hip osteoarthritis. The search strategy and modified selection criteria from a Cochrane review were used. Studies included hip osteoarthritis patients in comparative controlled trials with therapeutic exercise interventions. An Expert Panel arrived at a Delphi survey consensus to endorse the recommendations. The Ottawa Panel hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) considered the study design (level I: randomized controlled trial and level II: controlled clinical trial), statistical significance (p osteoarthritis. Strength training exercises displayed the greatest improvements for pain (Grade A), disability (Grades A and C+), physical function (Grade A), stiffness (Grade A), and range of motion (Grade A) within a short time period (8-24 weeks). Stretching also greatly improved physical function (Grade A), and flexibility exercises improved pain (Grade A), range of motion (Grade A), physical function (Grade A), and stiffness (Grade C+). The Ottawa Panel recommends land-based therapeutic exercise, notably strength training, for management of hip osteoarthritis in reducing pain, stiffness and self-reported disability, and improving physical function and range of motion. © The Author(s) 2015.

  16. Expert auditors’ services classification

    OpenAIRE

    Jolanta Wisniewska

    2013-01-01

    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...

  17. A proposed panel of biomarkers of healthy ageing.

    Science.gov (United States)

    Lara, Jose; Cooper, Rachel; Nissan, Jack; Ginty, Annie T; Khaw, Kay-Tee; Deary, Ian J; Lord, Janet M; Kuh, Diana; Mathers, John C

    2015-09-15

    There is no criterion reference for assessing healthy ageing and this creates difficulties when conducting and comparing research on ageing across studies. A cardinal feature of ageing is loss of function which translates into wide-ranging consequences for the individual and for family, carers and society. We undertook comprehensive reviews of the literature searching for biomarkers of ageing on five ageing-related domains including physical capability and cognitive, physiological and musculoskeletal, endocrine and immune functions. Where available, we used existing systematic reviews, meta-analyses and other authoritative reports such as the recently launched NIH Toolbox for assessment of neurological and behavioural function, which includes test batteries for cognitive and motor function (the latter described here as physical capability). We invited international experts to comment on our draft recommendations. In addition, we hosted an experts workshop in Newcastle, UK, on 22-23 October 2012, aiming to help capture the state-of-the-art in this complex area and to provide an opportunity for the wider ageing research community to critique the proposed panel of biomarkers. Here we have identified important biomarkers of healthy ageing classified as subdomains of the main areas proposed. Cardiovascular and lung function, glucose metabolism and musculoskeletal function are key subdomains of physiological function. Strength, locomotion, balance and dexterity are key physical capability subdomains. Memory, processing speed and executive function emerged as key subdomains of cognitive function. Markers of the HPA-axis, sex hormones and growth hormones were important biomarkers of endocrine function. Finally, inflammatory factors were identified as important biomarkers of immune function. We present recommendations for a panel of biomarkers that address these major areas of function which decline during ageing. This biomarker panel may have utility in epidemiological

  18. WHO Expert Committee on Biological Standardization. Sixty-fifth report.

    Science.gov (United States)

    2015-01-01

    This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activities leading to the adoption of international recommendations for the production and control of vaccines and other biological substances, and the establishment of international biological reference materials. Following a brief introduction, the report summarizes a number of general issues brought to the attention of the Committee. The next part of the report, of particular relevance to manufacturers and national regulatory authorities, outlines the discussions held on the development and adoption of new and revised WHO Recommendations, Guidelines and guidance documents. Following these discussions, a WHO guidance document on the Scientific principles for regulatory risk evaluation on finding an adventitious agent in a marketed vaccine was adopted along with WHO Guidelines on procedures and data requirements for changes to approved vaccines and revised WHO Recommendations to assure the quality, safety and efficacy of poliomyelitis vaccines (inactivated). Subsequent sections of the report provide information on the current status and proposed development of international reference materials in the areas of antibiotics; biotherapeutics other than blood products; blood products and related substances; in vitro diagnostic device reagents; and vaccines and related substances. A series of annexes are then presented which include an updated list of all WHO Recommendations, Guidelines and other documents on biological substances used in medicine (Annex 1) followed by the above three WHO documents adopted on the advice of the Committee (Annexes 2-4). All additions and discontinuations made during the 2014 meeting to the list of International Standards, Reference Reagents and Reference Panels for biological substances maintained by WHO are summarized in Annex 5. The updated full catalogue of WHO International Reference Preparations is available at: http://www.who.int/bloodproducts/catalogue/en/.

  19. Delegating Decisions to Experts

    Science.gov (United States)

    Li, Hao; Suen, Wing

    2004-01-01

    We present a model of delegation with self-interested and privately informed experts. A team of experts with extreme but opposite biases is acceptable to a wide range of decision makers with diverse preferences, but the value of expertise from such a team is low. A decision maker wants to appoint experts who are less partisan than he is in order…

  20. Validation of consensus panel diagnosis in dementia.

    Science.gov (United States)

    Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

    2010-12-01

    The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

  1. Expert status and performance.

    Directory of Open Access Journals (Sweden)

    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.

  2. Strategic Choice Analysis by Expert Panels for Migration Impact Assessment

    NARCIS (Netherlands)

    Kourtit, K.; Nijkamp, P.

    2011-01-01

    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

  3. Expert paper for the Future Panel on Public Health Genomics

    NARCIS (Netherlands)

    Stemerding, D.; Krom, A.

    2013-01-01

    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

  4. Expert panel on weight loss surgery: executive report update.

    Science.gov (United States)

    Blackburn, George L; Hutter, Matthew M; Harvey, Alan M; Apovian, Caroline M; Boulton, Hannah R W; Cummings, Susan; Fallon, John A; Greenberg, Isaac; Jiser, Michael E; Jones, Daniel B; Jones, Stephanie B; Kaplan, Lee M; Kelly, John J; Kruger, Rayford S; Lautz, David B; Lenders, Carine M; Lonigro, Robert; Luce, Helen; McNamara, Anne; Mulligan, Ann T; Paasche-Orlow, Michael K; Perna, Frank M; Pratt, Janey S A; Riley, Stancel M; Robinson, Malcolm K; Romanelli, John R; Saltzman, Edward; Schumann, Roman; Shikora, Scott A; Snow, Roger L; Sogg, Stephanie; Sullivan, Mary A; Tarnoff, Michael; Thompson, Christopher C; Wee, Christina C; Ridley, Nancy; Auerbach, John; Hu, Frank B; Kirle, Leslie; Buckley, Rita B; Annas, Catherine L

    2009-05-01

    Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.

  5. The Conservation of Panel paintings

    DEFF Research Database (Denmark)

    Until the early 17th century almost all portable paintings were created on wood supports, including masterpieces by famous painters, ranging from Giotto to Dürer to Rembrandt. The structural conservation of these paintings requires specific knowledge and skills as the supports are susceptible...... and conservation of these artworks. The Netherlands Organisation for Scientific Research (NWO) and the Rijksmuseum Amsterdam brought together a group of experts from different disciplines to recommend specific areas in the field that would benefit from systematic research. The experts concluded that targeted...

  6. A practical guideline for examining a uterine niche using ultrasonography in non-pregnant women: a modified Delphi method amongst European experts.

    Science.gov (United States)

    Jordans, I P M; de Leeuw, R; Stegwee, S I; Amso, N N; Barri-Soldevila, P N; van den Bosch, T; Bourne, T; Brolmann, H A M; Donnez, O; Dueholm, M; Hehenkamp, W J K; Jastrow, N; Jurkovic, D; Mashiach, R; Naji, O; Streuli, I; Timmerman, D; Vd Voet, L F; Huirne, J A F

    2018-03-14

    To generate a uniform, internationally recognized guideline for detailed uterine niche evaluation by ultrasonography in non-pregnant women using a modified Delphi method amongst international experts. Fifteen international gynecological experts were recruited by their membership of the European niche taskforce group. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche studies. Relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group. Two online questionnaires were sent to the expert panel and one group meeting was organized. Consensus was predefined as a consensus rate of at least 70%. In total 15 experts participated in this study. Consensus was reached for a total of 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. All experts agreed on the proposed guideline for niche evaluation in non-pregnant women as presented in this paper. Consensus between niche experts was achieved on all items regarding ultrasonographic niche measurement. This article is protected by copyright. All rights reserved.

  7. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

    Science.gov (United States)

    Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

    2017-12-01

    Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

  8. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009.

    Science.gov (United States)

    Kreyenbuhl, Julie; Buchanan, Robert W; Dickerson, Faith B; Dixon, Lisa B

    2010-01-01

    The Schizophrenia Patient Outcomes Research Team (PORT) project has played a significant role in the development and dissemination of evidence-based practices for schizophrenia. In contrast to other clinical guidelines, the Schizophrenia PORT Treatment Recommendations, initially published in 1998 and first revised in 2003, are based primarily on empirical data. Over the last 5 years, research on psychopharmacologic and psychosocial treatments for schizophrenia has continued to evolve, warranting an update of the PORT recommendations. In consultation with expert advisors, 2 Evidence Review Groups (ERGs) identified 41 treatment areas for review and conducted electronic literature searches to identify all clinical studies published since the last PORT literature review. The ERGs also reviewed studies preceding 2002 in areas not covered by previous PORT reviews, including smoking cessation, substance abuse, and weight loss. The ERGs reviewed over 600 studies and synthesized the research evidence, producing recommendations for those treatments for which the evidence was sufficiently strong to merit recommendation status. For those treatments lacking empirical support, the ERGs produced parallel summary statements. An Expert Panel consisting of 39 schizophrenia researchers, clinicians, and consumers attended a conference in November 2008 in which consensus was reached on the state of the evidence for each of the treatment areas reviewed. The methods and outcomes of the update process are presented here and resulted in recommendations for 16 psychopharmacologic and 8 psychosocial treatments for schizophrenia. Another 13 psychopharmacologic and 4 psychosocial treatments had insufficient evidence to support a recommendation, representing significant unmet needs in important treatment domains.

  9. Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

    Science.gov (United States)

    Haas, Ann P.; Eliason, Mickey; Mays, Vickie M.; Mathy, Robin M.; Cochran, Susan D.; D'Augelli, Anthony R.; Silverman, Morton M.; Fisher, Prudence W.; Hughes, Tonda; Rosario, Margaret; Russell, Stephen T.; Malley, Effie; Reed, Jerry; Litts, David A.; Haller, Ellen; Sell, Randall L.; Remafedi, Gary; Bradford, Judith; Beautrais, Annette L.; Brown, Gregory K.; Diamond, Gary M.; Friedman, Mark S.; Garofalo, Robert; Turner, Mason S.; Hollibaugh, Amber; Clayton, Paula J.

    2011-01-01

    Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice. PMID:21213174

  10. Expert judgement in performance assessment

    International Nuclear Information System (INIS)

    Wilmot, R.D.; Galson, D.A.

    2000-01-01

    This report is a pilot study that systematically describes the various types of expert judgement that are made throughout the development of a PA, and summarizes existing tools and practices for dealing with expert judgements. The report also includes recommendations for further work in the area of expert judgement. Expert judgements can be classified in a number of ways, including classification according to why the judgements are made and according to how the judgements are made. In terms of why judgements are made, there is a broad distinction between: Judgements concerning data that are made because alternatives are not feasible; and Judgements about the conduct of a PA that are made because there are no alternative approaches for making the decision. In the case of how judgements are made, the report distinguishes between non-elicited judgements made by individuals, non-elicited judgements made by groups, and elicited judgements made by individuals or groups. These types of judgement can generally be distinguished by the extent of the associated documentation, and hence their traceability. Tools for assessing judgements vary depending on the type of judgements being examined. Key tools are peer review, an appropriate QA regime, documentation, and elicitation. Dialogue with stake holders is also identified as important in establishing whether judgements are justified in the context in which they are used. The PA process comprises a number of stages, from establishing the assessment context, through site selection and repository design, to scenario and model development and parametrisation. The report discusses how judgements are used in each of these stages, and identifies which of the tools and procedures for assessing judgements are most appropriate at each stage. Recommendations for further work include the conduct of a trial expert elicitation to gain experience in the advantages and disadvantages of this technique, the development of guidance for peer

  11. Expert judgement in performance assessment

    Energy Technology Data Exchange (ETDEWEB)

    Wilmot, R.D.; Galson, D.A. [Galson Sciences Ltd, Oakham (United Kingdom)

    2000-01-01

    This report is a pilot study that systematically describes the various types of expert judgement that are made throughout the development of a PA, and summarizes existing tools and practices for dealing with expert judgements. The report also includes recommendations for further work in the area of expert judgement. Expert judgements can be classified in a number of ways, including classification according to why the judgements are made and according to how the judgements are made. In terms of why judgements are made, there is a broad distinction between: Judgements concerning data that are made because alternatives are not feasible; and Judgements about the conduct of a PA that are made because there are no alternative approaches for making the decision. In the case of how judgements are made, the report distinguishes between non-elicited judgements made by individuals, non-elicited judgements made by groups, and elicited judgements made by individuals or groups. These types of judgement can generally be distinguished by the extent of the associated documentation, and hence their traceability. Tools for assessing judgements vary depending on the type of judgements being examined. Key tools are peer review, an appropriate QA regime, documentation, and elicitation. Dialogue with stake holders is also identified as important in establishing whether judgements are justified in the context in which they are used. The PA process comprises a number of stages, from establishing the assessment context, through site selection and repository design, to scenario and model development and parametrisation. The report discusses how judgements are used in each of these stages, and identifies which of the tools and procedures for assessing judgements are most appropriate at each stage. Recommendations for further work include the conduct of a trial expert elicitation to gain experience in the advantages and disadvantages of this technique, the development of guidance for peer

  12. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East.

    Science.gov (United States)

    Al Sayed, Nasreen; Al Waili, Khalid; Alawadi, Fatheya; Al-Ghamdi, Saeed; Al Mahmeed, Wael; Al-Nouri, Fahad; Al Rukhaimi, Mona; Al-Rasadi, Khalid; Awan, Zuhier; Farghaly, Mohamed; Hassanein, Mohamed; Sabbour, Hani; Zubaid, Mohammad; Barter, Philip

    2016-12-15

    Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  13. Application of expert systems

    Energy Technology Data Exchange (ETDEWEB)

    Basden, A

    1983-11-01

    This article seeks to bring together a number of issues relevant to the application of expert systems by discussing their advantages and limitations, their roles and benefits, and the influence that real-life applications might have on the design of expert systems software. Part of the expert systems strategy of one major chemical company is outlined. Because it was in constructing one particular expert system that many of these issues became important this system is described briefly at the start of the paper and used to illustrate much of the later discussion. It is of the plausible-inference type and has application in the field of materials engineering. 22 references.

  14. Being an expert

    International Nuclear Information System (INIS)

    Brechet, Y.; Musseau, O.; Bruna, G.; Sperandio, M.; Roulleaux-Dugage, M.; Andrieux, S.; Metteau, L.

    2014-01-01

    This series of short articles are dedicated to the role of the expert in the enterprise. There is an important difference between a scientific counsellor and an expert, the expert, recognized by his peers, can speak publicly in his field of expertise but has a duty of transparency while the job of a scientific counsellor requires confidentiality. The making and the use of an expert in an enterprise requires a dedicated organization. The organization of the expertise in 5 enterprises in nuclear industry are considered: CEA (French Alternative Energies and Atomic Energy Commission), IRSN (Institute of Radioprotection and Nuclear Safety), AREVA, ANDRA (National Radioactive Waste Management Agency) and EDF (Electricity of France)

  15. A law for nuclear experts only

    International Nuclear Information System (INIS)

    Wagner, H.

    1980-01-01

    The Federal Ministry of the Interior is preparing an ordinance on expert consultants under the Atomic Energy Act which, among other topics, is to include legal norms for the criteria to be met by experts in terms of non-partisanship, training, capabilities, technical equipment and cooperation in expert organizations of members of various scientific and technical disciplines. A summary of general criteria relating to the qualification, selection and status of experts called in by the legislative and executive branches and by courts of law, which could be organized as a series of guidelines without any original qualities of legal norms, could be recommended in view of the increasing quantitative and qualitative importance of experts. However, passing an ordinance merely fixing and putting into concrete terms the image of an 'expert under the Atomic Energy Act' is intolerable, because the status of scientific and technical experts by far extends beyond the field of nuclear law in our industrial society characterized by a far reaching division of labor. Weak points in the organization of expert services are not confined to technology or nuclear power. Separate rules establishing legal norms are not convincing also for reasons of technology policy and legal policy as well as for those of social psychology and practice. (orig.) 891 HP/orig. 892 MKO [de

  16. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.

    Science.gov (United States)

    Kane, John M; Leucht, Stefan; Carpenter, Daniel; Docherty, John P

    2003-01-01

    A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders. However, a number of important questions concerning medication selection, dosing and dose equivalence, and the management of inadequate response, compliance problems, and relapse have not been adequately addressed by clinical trials. To aid clinical decision-making, a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature. Based on a literature review, a written survey was developed with 60 questions and 994 options. Approximately half of the options were scored using a modified version of the RAND 9-point scale for rating the appropriateness of medical decisions. For the other options, the experts were asked to write in answers (e.g., average doses) or check a box to indicate their preferred answer. The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders, 47 (94%) of whom completed it. In analyzing the responses to items rated on the 9-point scale, consensus on each option was defined as a non random distribution of scores by chi-square "goodness-of-fit"test. We assigned a categorical rank (first line/preferred choice,second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. The expert panel reached consensus on 88% of the options rated on the 9-point scale. The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders. Risperidone was the top choice for first-episode and multi-episode patients, with the other newer atypicals rated first line or high second line depending on the clinical situation. Clozapine and a long-acting injectable atypical

  17. Differing professional opinions: 1987 special review panel

    International Nuclear Information System (INIS)

    1988-01-01

    In November 1987, the five-member Differing Professional Opinions Special Review Panel established by the Executive Director for Operations of the US Nuclear Regulatory Commission to review agency policies and procedures for handling differing professional opinions (DPOs) presented its findings and recommendations in NUREG-1290. The issuance of that report completed the first task of the panel's charter. In accordance with Manual chapter 4125, Section L, and the charter of the Special Review Panel, the panel's second task was to ''...review...the DPOs submitted subsequent to the previous Panel's review, in order to identify any employee whose DPO made a significant contribution to the Agency or to the public safety but who has not yet been recognized for such contribution.'' This Addendum provides the findings of that review

  18. Gene panel testing for inherited cancer risk.

    Science.gov (United States)

    Hall, Michael J; Forman, Andrea D; Pilarski, Robert; Wiesner, Georgia; Giri, Veda N

    2014-09-01

    Next-generation sequencing technologies have ushered in the capability to assess multiple genes in parallel for genetic alterations that may contribute to inherited risk for cancers in families. Thus, gene panel testing is now an option in the setting of genetic counseling and testing for cancer risk. This article describes the many gene panel testing options clinically available to assess inherited cancer susceptibility, the potential advantages and challenges associated with various types of panels, clinical scenarios in which gene panels may be particularly useful in cancer risk assessment, and testing and counseling considerations. Given the potential issues for patients and their families, gene panel testing for inherited cancer risk is recommended to be offered in conjunction or consultation with an experienced cancer genetic specialist, such as a certified genetic counselor or geneticist, as an integral part of the testing process. Copyright © 2014 by the National Comprehensive Cancer Network.

  19. ENETS Consensus Recommendations for the Standards of Care in Neuroendocrine Neoplasms

    DEFF Research Database (Denmark)

    Knigge, U.; Capdevila, J.; Bartsch, D. K.

    2017-01-01

    and coming WHO classification and ENETS/UICC recommendations for TNM staging. The recommendations for follow-up in patients with thymic, bronchopulmonary and gastroenteropancreatic NEN are given in Table 1. However, it should be stressed that evidence-based studies for follow-up are largely missing.......ENETS consensus recommendations for the standards of care in neuroendocrine neoplasms (NEN) concerning follow-up and documentation are considered in this review. The documentation of patients with NEN should include the most relevant data characterizing an individual patient from the first contact...... with his/her physician/hospital until his/her last presentation during follow-up. It is advocated that follow-up occurs in specialized NEN centers with regular NEN tumor boards with expert panels. The follow-up should be in accordance with the ENETS consensus guidelines from 2011 and 2016, the present...

  20. Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.

    Science.gov (United States)

    Lima, Valter C; Mattos, Luiz Alberto P; Caramori, Paulo R A; Perin, Marco A; Mangione, José A; Machado, Bruno M; Coelho, Wilson M C; Bueno, Ronaldo R L

    2006-10-01

    The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents2, which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System's participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the

  1. Computer Based Expert Systems.

    Science.gov (United States)

    Parry, James D.; Ferrara, Joseph M.

    1985-01-01

    Claims knowledge-based expert computer systems can meet needs of rural schools for affordable expert advice and support and will play an important role in the future of rural education. Describes potential applications in prediction, interpretation, diagnosis, remediation, planning, monitoring, and instruction. (NEC)

  2. Real time expert systems

    International Nuclear Information System (INIS)

    Asami, Tohru; Hashimoto, Kazuo; Yamamoto, Seiichi

    1992-01-01

    Recently, aiming at the application to the plant control for nuclear reactors and traffic and communication control, the research and the practical use of the expert system suitable to real time processing have become conspicuous. In this report, the condition for the required function to control the object that dynamically changes within a limited time is presented, and the technical difference between the real time expert system developed so as to satisfy it and the expert system of conventional type is explained with the actual examples and from theoretical aspect. The expert system of conventional type has the technical base in the problem-solving equipment originating in STRIPS. The real time expert system is applied to the fields accompanied by surveillance and control, to which conventional expert system is hard to be applied. The requirement for the real time expert system, the example of the real time expert system, and as the techniques of realizing real time processing, the realization of interruption processing, dispersion processing, and the mechanism of maintaining the consistency of knowledge are explained. (K.I.)

  3. Expert systems: An overview

    International Nuclear Information System (INIS)

    Verdejo, F.

    1985-01-01

    The purpose of this article is to introduce readers to the basic principles of rule-based expert systems. Four topics are discussed in subsequent sections: (1) Definition; (2) Structure of an expert system; (3) State of the art and (4) Impact and future research. (orig.)

  4. Trendwatch combining expert opinion

    NARCIS (Netherlands)

    Hendrix, E.M.T.; Kornelis, M.; Pegge, S.M.; Galen, van M.A.

    2006-01-01

    In this study, focus is on a systematic way to detect future changes in trends that may effect the dynamics in the agro-food sector, and on the combination of opinions of experts. For the combination of expert opinions, the usefulness of multilevel models is investigated. Bayesian data analysis is

  5. Relevance of the international spinal cord injury basic data sets to youth: an Inter-Professional review with recommendations.

    Science.gov (United States)

    Carroll, A; Vogel, L C; Zebracki, K; Noonan, V K; Biering-Sørensen, F; Mulcahey, M J

    2017-09-01

    Mixed methods, using the Modified Delphi Technique and Expert Panel Review. To evaluate the utility and relevance of the International Spinal Cord Injury (SCI) Core and Basic Data Sets for children and youth with SCI. International. Via 20 electronic surveys, an interprofessional sample of healthcare professionals with pediatric SCI experience participated in an iterative critical review of the International SCI Data Sets, and submitted suggestions for modifications for use with four pediatric age groups. A panel of 5 experts scrutinized the utility of all data sets, correlated any modifications with the developing National Institute of Neurological Disorders and Stroke (NINDS) pediatric SCI Common Data Elements (CDE) and distributed final recommendations for modifications required to the adult data sets to the International SCI Data Set Committee and the associated Working Groups. Two International SCI Data Sets were considered relevant and appropriate for use with children without any changes. Three were considered not appropriate or applicable for use with children, regardless of age. Recommendations were made for five data sets to enhance their relevance and applicability to children across the age groups, and recommendations for seven data sets were specific to infants and younger children. The results of this critical review are significant in that substantive recommendations to align the International SCI Core and Basic Data Sets to pediatric practice were made. This project was funded by the Rick Hansen Institute Grant# 2015-27.

  6. New Insulin Delivery Recommendations.

    Science.gov (United States)

    Frid, Anders H; Kreugel, Gillian; Grassi, Giorgio; Halimi, Serge; Hicks, Debbie; Hirsch, Laurence J; Smith, Mike J; Wellhoener, Regine; Bode, Bruce W; Hirsch, Irl B; Kalra, Sanjay; Ji, Linong; Strauss, Kenneth W

    2016-09-01

    Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  7. Pantex Falling Man - Independent Review Panel Report.

    Energy Technology Data Exchange (ETDEWEB)

    Brannon, Nathan Gregory; L. Bertolini, N. Brannon, J. Olsen, B. Price, M. Steinzig, R. Wardle, & M. Winfield

    2014-11-01

    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.

  8. Hepatitis virus panel

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003558.htm Hepatitis virus panel To use the sharing features on this page, please enable JavaScript. The hepatitis virus panel is a series of blood tests used ...

  9. Antinuclear antibody panel

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003535.htm Antinuclear antibody panel To use the sharing features on this page, please enable JavaScript. The antinuclear antibody panel is a blood test that looks at ...

  10. Paneling architectural freeform surfaces

    KAUST Repository

    Eigensatz, Michael; Kilian, Martin; Schiftner, Alexander; Mitra, Niloy J.; Pottmann, Helmut; Pauly, Mark

    2010-01-01

    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

  11. Recommender systems

    OpenAIRE

    Lu L.; Medo M.; Yeung C.H.; Zhang Y.-C.; Zhang Z.-K.; Zhou T.

    2012-01-01

    The ongoing rapid expansion of the Internet greatly increases the necessity of effective recommender systems for filtering the abundant information. Extensive research for recommender systems is conducted by a broad range of communities including social and computer scientists, physicists, and interdisciplinary researchers. Despite substantial theoretical and practical achievements, unification and comparison of different approaches are lacking, which impedes further advances. In this article...

  12. USING EXPERT OPINION IN HEALTH TECHNOLOGY ASSESSMENT: A GUIDELINE REVIEW.

    Science.gov (United States)

    Hunger, Theresa; Schnell-Inderst, Petra; Sahakyan, Narine; Siebert, Uwe

    2016-01-01

    External experts can be consulted at different stages of an HTA. When using vague information sources, it is particularly important to plan, analyze, and report the information processing in a standardized and transparent way. Our objective was to search and analyze recommendations regarding where and how to include expert data in HTA. We performed a systematic database search and screened the Internet pages of seventy-seven HTA organizations for guidelines, recommendations, and methods papers that address the inclusion of experts in HTA. Relevant documents were downloaded, and information was extracted in a standard form. Results were merged in tables and narrative evidence synthesis. From twenty-two HTA organizations, we included forty-two documents that consider the use of expert opinion in HTA. Nearly all documents mention experts in the step of preparation of the evidence report. Six documents address their role for priority setting of topics, fifteen for scoping, twelve for the appraisal of evidence and results, another twelve documents mention experts when considering the dissemination of HTA results. During the assessment step, experts are most often asked to amend the literature search or to provide expertise for special data analyses. Another issue for external experts is to appraise the HTA results and refer them back to a clinical and social context. Little is reported on methods of expert elicitation when their input substitutes study data. Despite existing recommendations on the use of expert opinion in HTA, common standards for elicitation are scarce in HTA guidelines.

  13. Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Riesco Miranda, Juan Antonio; Alcázar, Bernardino; Alfageme, Inmaculada; Casanova, Ciro; Celli, Bartolomé; de-Torres, Juan P; Jiménez Ruiz, Carlos A

    2017-10-01

    To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. European canine lymphoma network consensus recommendations for reporting flow cytometry in canine hematopoietic neoplasms.

    Science.gov (United States)

    Comazzi, S; Avery, P R; Garden, O A; Riondato, F; Rütgen, B; Vernau, W

    2017-09-01

    Flow cytometry (FC) is assuming increasing importance in diagnosis in veterinary oncology. The European Canine Lymphoma Network (ECLN) is an international cooperation of different institutions working on canine lymphoma diagnosis and therapy. The ECLN panel of experts on FC has defined the issue of reporting FC on canine lymphoma and leukemia as their first hot topic, since a standardized report that includes all the important information is still lacking in veterinary medicine. The flow cytometry panel of the ECLN started a consensus initiative using the Delphi approach. Clinicians were considered the main target of FC reports. A panel of experts in FC was interrogated about the important information needed from a report. Using the feedback from clinicians and subsequent discussion, a list of information to be included in the report was made, with four different levels of recommendation. The final report should include both a quantitative part and a qualitative or descriptive part with interpretation of the salient results. Other items discussed included the necessity of reporting data regarding the quality of samples, use of absolute numbers of positive cells, cutoff values, the intensity of fluorescence, and possible aberrant patterns of antigen expression useful from a clinical point of view. The consensus initiative is a first step toward standardization of diagnostic approach to canine hematopoietic neoplasms among different institutions and countries. This harmonization will improve communication and patient care and also facilitate the multicenter studies necessary to further our knowledge of canine hematopoietic neoplasms. © 2016 International Clinical Cytometry Society. © 2016 International Clinical Cytometry Society.

  15. Experts on public trial

    DEFF Research Database (Denmark)

    Blok, Anders

    2007-01-01

    a case study of the May 2003 Danish consensus conference on environmental economics as a policy tool, the article reflects on the politics of expert authority permeating practices of public participation. Adopting concepts from the sociology of scientific knowledge (SSK), the conference is seen......-than-successful defense in the citizen perspective. Further, consensus conferences are viewed alternatively as "expert dissent conferences," serving to disclose a multiplicity of expert commitments. From this perspective, some challenges for democratizing expertise through future exercises in public participation...

  16. Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

    Directory of Open Access Journals (Sweden)

    Linei Augusta Brolini Dellê Urban

    Full Text Available Abstract Objective: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. Materials and methods: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. Recommendations: Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

  17. Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations.

    Science.gov (United States)

    Knowles, C H; Grossi, U; Horrocks, E J; Pares, D; Vollebregt, P F; Chapman, M; Brown, S; Mercer-Jones, M; Williams, A B; Yiannakou, Y; Hooper, R J; Stevens, N; Mason, J

    2017-09-01

    This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR). Summary of review data, development of GPR and future research recommendations as outlined in detail in the 'introduction and methods' paper. The overall quality of data in the five reviews was poor with 113/156(72.4%) of included studies providing only level IV evidence and only four included level I RCTs. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred 'prototype' GPRs developed by the clinical guideline group, 85/100 were deemed 'appropriate' based on the independent scoring of a panel of 18 European experts and use of RAND-UCLA consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential RCTs but also a strong emphasis on delivery of large multinational high-quality prospective cohort studies. While the evidence base for surgery in CC is poor, the widespread European consensus for GPRs is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines. © 2017 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

  18. Experts' meeting: Maintenance '83

    International Nuclear Information System (INIS)

    1983-01-01

    The brochure presents, in full wording, 20 papers read at the experts' meeting ''Maintenance '83'' in Wiesbaden. Most of the papers discuss reliability data (acquisition, evaluation, processing) of nearly all fields of industry. (RW) [de

  19. [Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report].

    Science.gov (United States)

    Camblor-Álvarez, Miguel; Ocón-Bretón, María Julia; Luengo-Pérez, Luis Miguel; Viruzuela, Juan Antonio; Sendrós-Maroño, María José; Cervera-Peris, Mercedes; Grande, Enrique; Álvarez-Hernández, Julia; Jiménez-Fonseca, Paula

    2018-01-10

    Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel's criteria, could generate greater controversy or doubt. Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer Patients.

  20. Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis.

    Science.gov (United States)

    Long, Sandra; Monsen, Karen A; Pieczkiewicz, David; Wolfson, Julian; Khairat, Saif

    2017-10-12

    For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer's household, number of visits to providers outside the consumer's insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care. ©Sandra Long, Karen A. Monsen, David Pieczkiewicz, Julian Wolfson, Saif Khairat. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 12.10.2017.

  1. Recommender systems

    CERN Document Server

    Kembellec, Gérald; Saleh, Imad

    2014-01-01

    Acclaimed by various content platforms (books, music, movies) and auction sites online, recommendation systems are key elements of digital strategies. If development was originally intended for the performance of information systems, the issues are now massively moved on logical optimization of the customer relationship, with the main objective to maximize potential sales. On the transdisciplinary approach, engines and recommender systems brings together contributions linking information science and communications, marketing, sociology, mathematics and computing. It deals with the understan

  2. 76 FR 33765 - CHIPRA Pediatric Quality Measures Program: Request for Nominations for Expert Panelists

    Science.gov (United States)

    2011-06-09

    ... discrimination on the basis of age, race, ethnicity, gender, sexual orientation, disability, and cultural... women, all ethnic and racial groups, and people with disabilities are represented on expert panels and...

  3. Seismic hazard analysis. Review panel, ground motion panel, and feedback results

    International Nuclear Information System (INIS)

    Bernreuter, D.L.

    1981-10-01

    The Site Specific Spectra Project (SSSP) was a multi-year study funded by the U.S. Nuclear Regulatory Commission to provide estimates of the seismic hazards at a number of nuclear power plant sites in the Eastern U.S. 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 U.S. 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. (author)

  4. Recommendations for the Use of ICT in Elderly Populations with Affective Disorders.

    Science.gov (United States)

    Gros, Auriane; Bensamoun, David; Manera, Valeria; Fabre, Roxane; Zacconi-Cauvin, Anne-Marie; Thummler, Susanne; Benoit, Michel; Robert, Philippe; David, Renaud

    2016-01-01

    Objective : Affective disorders are frequently encountered among elderly populations, and the use of information and communication technologies (ICT) could provide an added value for their recognition and assessment in addition to current clinical methods. The diversity and lack of consensus in the emerging field of ICTs is however a strong limitation for their global use in daily practice. The aim of the present article is to provide recommendations for the use of ICTs for the assessment and management of affective disorders among elderly populations with or without dementia. Methods : A Delphi panel was organized to gather recommendations from experts in the domain. A set of initial general questions for the use of ICT in affective disorders was used to guide the discussion of the expert panel and to analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing ICT in elderly populations with affective disorders. Based on the results collected from this first round, a web survey was sent to local general practitioners (GPs) and to all interns in psychiatry in France. Results : The results of the first round revealed that ICT may offer very useful tools for practitioners involved in the diagnosis and management of affective disorders. However, the results of the web survey showed the interest to explain better to current and upcoming practitioners the utility of ICT especially for people living with dementia.

  5. Recommendations for the Use of ICT in Elderly Populations with Affective Disorders

    Science.gov (United States)

    Gros, Auriane; Bensamoun, David; Manera, Valeria; Fabre, Roxane; Zacconi-Cauvin, Anne-Marie; Thummler, Susanne; Benoit, Michel; Robert, Philippe; David, Renaud

    2016-01-01

    Objective: Affective disorders are frequently encountered among elderly populations, and the use of information and communication technologies (ICT) could provide an added value for their recognition and assessment in addition to current clinical methods. The diversity and lack of consensus in the emerging field of ICTs is however a strong limitation for their global use in daily practice. The aim of the present article is to provide recommendations for the use of ICTs for the assessment and management of affective disorders among elderly populations with or without dementia. Methods: A Delphi panel was organized to gather recommendations from experts in the domain. A set of initial general questions for the use of ICT in affective disorders was used to guide the discussion of the expert panel and to analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing ICT in elderly populations with affective disorders. Based on the results collected from this first round, a web survey was sent to local general practitioners (GPs) and to all interns in psychiatry in France. Results: The results of the first round revealed that ICT may offer very useful tools for practitioners involved in the diagnosis and management of affective disorders. However, the results of the web survey showed the interest to explain better to current and upcoming practitioners the utility of ICT especially for people living with dementia. PMID:27877126

  6. Consumers and Experts : An Econometric Analysis of the Demand for Water Heaters

    NARCIS (Netherlands)

    Bartels, R.; Fiebig, D.G.; van Soest, A.H.O.

    2003-01-01

    Consumers can accumulate product information on the basis of a combination of searching, product advertising and expert advice.Examples of experts who provide product information include doctors advising patients on treatments, motor mechanics diagnosing car problems and recommending repairs,

  7. All-star sports medicine film panel

    International Nuclear Information System (INIS)

    Rogers, L.F.; Braunstein, E.M.; DeSmet, A.A.; Helms, C.A.; Pavlov, H.; Sukaer, J.R.; Torg, J.S.

    1987-01-01

    All Star Sports Panel cases are selected to test the mettle of the panelists and familiarize the audience with injuries peculiar to participation in a variety of sports. Match wits with the experts on the field. Gear up for the big game by previewing the clinical histories and initial radiographic examinations. Diagnosis requires familiarity with stresses incurred in the performance of various athletic pursuits, knowledge of specific radiographic findings, and awareness of imaging techniques that best demonstrate underlying injury

  8. Speaking to the experts and patients: Recommendations for ...

    African Journals Online (AJOL)

    Opsomming: Gesprekke met kundiges en pasiënte: Aanbevelings ter verbetering van ART-nakoming. Hierdie artikel doen verslag oor die bevindinge van 'n studie wat kundiges en pasiënte se menings en aanbevelings ten opsigte van die nakoming van antiretrovirale medikasievoorskrifte ondersoek het. Die studie is in die ...

  9. How clear is transparent? Reporting expert reasoning in legal cases

    NARCIS (Netherlands)

    Sjerps, M.J.; Berger, C.E.H.

    2012-01-01

    Experts providing evidence in legal cases are universally recommended to be transparent, particularly in their reasoning, so that legal practitioners can critically check whether the conclusions are adequately supported by the results. However, when exploring the practical meaning of this

  10. Prediabetes in Colombia: Expert Consensus

    Science.gov (United States)

    Calderón, Carlos; Castillo, Jorge; Escobar, Iván Darío; Melgarejo, Enrique; Parra, Gustavo Adolfo

    2017-01-01

    Abstract The prevalence of Prediabetes in Colombia is high, and despite being recognized and categorized in the main Medical Guidelines and included in the International Classification of Diseases in Colombia, knowledge and awareness of it is limited amongst healthcare professionals and in the community. Our expert group recommends that educational programs emphasize a global approach to risk which includes a recognition of the importance of prediabetes and its evaluation along with and other risk factors such as a family history of DM2, overweight and obesity, dislipidemia and hypertension. Studies conducted in Colombia demonstrate the value of the FINDRIS questionnaire as a tool to identify subjects at risk of prediabetes and DM2, and we recommend that it should be systematic applied throughout the country as part of government policy. Prediabetes progresses to DM2 at an annual rate of 10%, but it has also been shown that prediabetes is an independent risk factor for cardiovascular outcomes. On this basis, the Committee recommends that once prediabetes is detected and diagnosed, immediate management of the disease begins through lifestyle changes, with follow up assessments performed at 3 and 6 months. If the patient does not respond with a weight loss of at least 5% and if the HbA1C values ​​are not normalized, pharmacological management should be initiated with a metformin dose of 500 mg / day, increasing up to 1,500 - 1,700 mg / day, according to tolerance. PMID:29662261

  11. Prediabetes in Colombia: Expert Consensus.

    Science.gov (United States)

    López-Jaramillo, Patricio; Calderón, Carlos; Castillo, Jorge; Escobar, Iván Darío; Melgarejo, Enrique; Parra, Gustavo Adolfo

    2017-12-30

    The prevalence of Prediabetes in Colombia is high, and despite being recognized and categorized in the main Medical Guidelines and included in the International Classification of Diseases in Colombia, knowledge and awareness of it is limited amongst healthcare professionals and in the community. Our expert group recommends that educational programs emphasize a global approach to risk which includes a recognition of the importance of prediabetes and its evaluation along with and other risk factors such as a family history of DM2, overweight and obesity, dislipidemia and hypertension. Studies conducted in Colombia demonstrate the value of the FINDRIS questionnaire as a tool to identify subjects at risk of prediabetes and DM2, and we recommend that it should be systematic applied throughout the country as part of government policy. Prediabetes progresses to DM2 at an annual rate of 10%, but it has also been shown that prediabetes is an independent risk factor for cardiovascular outcomes. On this basis, the Committee recommends that once prediabetes is detected and diagnosed, immediate management of the disease begins through lifestyle changes, with follow up assessments performed at 3 and 6 months. If the patient does not respond with a weight loss of at least 5% and if the HbA1C values ​​are not normalized, pharmacological management should be initiated with a metformin dose of 500 mg / day, increasing up to 1,500 - 1,700 mg / day, according to tolerance.

  12. Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

    Science.gov (United States)

    Jeste, Dilip V.; Ardelt, Monika; Blazer, Dan; Kraemer, Helena C.; Vaillant, George; Meeks, Thomas W.

    2010-01-01

    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…

  13. A new Expert Finding model based on Term Correlation Matrix

    Directory of Open Access Journals (Sweden)

    Ehsan Pornour

    2015-09-01

    Full Text Available Due to the enormous volume of unstructured information available on the Web and inside organization, finding an answer to the knowledge need in a short time is difficult. For this reason, beside Search Engines which don’t consider users individual characteristics, Recommender systems were created which use user’s previous activities and other individual characteristics to help users find needed knowledge. Recommender systems usage is increasing every day. Expert finder systems also by introducing expert people instead of recommending information to users have provided this facility for users to ask their questions form experts. Having relation with experts not only causes information transition, but also with transferring experiences and inception causes knowledge transition. In this paper we used university professors academic resume as expert people profile and then proposed a new expert finding model that recommends experts to users query. We used Term Correlation Matrix, Vector Space Model and PageRank algorithm and proposed a new hybrid model which outperforms conventional methods. This model can be used in internet environment, organizations and universities that experts have resume dataset.

  14. Paneling architectural freeform surfaces

    KAUST Repository

    Eigensatz, Michael

    2010-07-26

    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.

  15. Paneling architectural freeform surfaces

    KAUST Repository

    Eigensatz, Michael

    2010-07-25

    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.

  16. Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

    Science.gov (United States)

    Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

    2018-04-01

    To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

  17. Heavy water lattices: Second panel report

    Energy Technology Data Exchange (ETDEWEB)

    1963-09-15

    The panel was attended by prominent physicists from most of the laboratories engaged in the field of heavy water lattices throughout the world. The participants presented written contributions and status reports describing the past history and plans for further development of heavy-water reactors. Valuable discussions took place, during which recommendations for future work were formulated. Refs, figs, tabs.

  18. Heavy water lattices: Second panel report

    International Nuclear Information System (INIS)

    1963-01-01

    The panel was attended by prominent physicists from most of the laboratories engaged in the field of heavy water lattices throughout the world. The participants presented written contributions and status reports describing the past history and plans for further development of heavy-water reactors. Valuable discussions took place, during which recommendations for future work were formulated. Refs, figs, tabs

  19. Database and Expert Systems Applications

    DEFF Research Database (Denmark)

    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...

  20. REINFORCED COMPOSITE PANEL

    DEFF Research Database (Denmark)

    2003-01-01

    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 rein...... 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....

  1. Shift scheduling limits for the nuclear industry NRC policy and recommendations

    International Nuclear Information System (INIS)

    Koontz, J.; Morisseau, D.; Lewis, P.

    1985-01-01

    A study on shift scheduling and use of overtime and their effects on human performance in nuclear and non-nuclear industries was conducted. An analysis of the literature, current practices, and federal policy on shift scheduling resulted in human factors recommendations for limiting hours of work in the nuclear industry for nuclear power plant personnel conducting safety related functions. Recommended limits on total hours of work were developed by a panel of experts for both 8-hour and 12-hour daily shift schedules for weekly, biweekly, monthly, and annual work periods. The study results are particularly applicable to control room operators but should also be considered for other personnel where performance degradation due to fatigue could directly affect safe plant operations

  2. Price competition between an expert and a non-expert

    OpenAIRE

    Bouckaert, J.M.C.; Degryse, H.A.

    1998-01-01

    This paper characterizes price competition between an expert and a non-expert. In contrast with the expert, the non-expert’s repair technology is not always successful. Consumers visit the expert after experiencing an unsuccessful match at the non-expert. This re-entry affects the behaviour of both sellers. For low enough probability of successful repair at the non-expert, all consumers first visit the non-expert, and a ‘timid-pricing’ equilibrium results. If the non-expert’s repair technolog...

  3. Solar reflection panels

    Science.gov (United States)

    Diver, Jr., Richard B.; Grossman, James W [Albuquerque, NM; Reshetnik, Michael [Boulder, CO

    2006-07-18

    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.

  4. An evidence-based recommendation on bed head elevation for mechanically ventilated patients.

    Science.gov (United States)

    Niël-Weise, Barbara S; Gastmeier, Petra; Kola, Axel; Vonberg, Ralf P; Wille, Jan C; van den Broek, Peterhans J

    2011-01-01

    A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45° bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45° elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45° position and preferably to a ≥ 30° position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes. Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions.

  5. Expert Systems Research.

    Science.gov (United States)

    Duda, Richard O.; Shortliffe, Edward H.

    1983-01-01

    Discusses a class of artificial intelligence computer programs (often called "expert systems" because they address problems normally thought to require human specialists for their solution) intended to serve as consultants for decision making. Also discusses accomplishments (including information systematization in medical diagnosis and…

  6. Computers Simulate Human Experts.

    Science.gov (United States)

    Roberts, Steven K.

    1983-01-01

    Discusses recent progress in artificial intelligence in such narrowly defined areas as medical and electronic diagnosis. Also discusses use of expert systems, man-machine communication problems, novel programing environments (including comments on LISP and LISP machines), and types of knowledge used (factual, heuristic, and meta-knowledge). (JN)

  7. Stressed skin panels

    Energy Technology Data Exchange (ETDEWEB)

    Anon

    2001-07-01

    Advantages and disadvantages of stressed skin panels, also known as structural insulated panels (SIPs), are discussed as material and labour-saving alternatives to traditional stick framing. Stressed skin panels are manufactured 'sandwich' assemblies with a rigid insulating polystyrene foam core, whose interior and exterior surfaces are bonded into panels. The skins distribute and carry the structural loading while the bonded foam core provides insulation and keeps the two skins aligned. Since there are fewer framing members, there is little thermal bridging and the R-value remains high. SIPs are usually manufactured in four feet by eight feet panels, although some manufacturers can produce panels up to eight feet by forty feet. SIPs are resource efficient as they use less wood than conventional framing (about 25 per cent less); can structurally cover large spans, requiring less supplementary framing. Use of SIPs eliminate the need for headers over small openings; provide the ability to nail anywhere; create less scrap and waste; lessen vulnerability to unfavourable weather and other job-site hazards, can reduce delays, and often can produce significant savings in material and labour costs. Limitations include the more complex approaches to plumbing and electrical systems, although this can be minimized by designers by incorporating much of the plumbing and electrical work on interior (non-panel) walls. Most stressed skin panels require one-half inch interior gypsum drywall. If become wet, stressed skin panels take a long time to dry out and may harbour mold growth. Larger stressed-skin panels used in floors and roofs, may require cranes or other machinery for handling because of their weight. Although not without some environmental impact, overall, stressed skin panels are judged to be a resource-efficient building technology with significant energy-efficiency benefits and distinct advantages over stick framing. 3 photos.

  8. Expert Study to Select Indicators of the Occurence of Emerging Mycotoxin Hazards

    NARCIS (Netherlands)

    Kandhai, M.C.; Booij, C.J.H.; Fels-Klerx, van der H.J.

    2011-01-01

    This article describes a Delphi-based expert judgment study aimed at the selection of indicators to identify the occurrence of emerging mycotoxin hazards related to Fusarium spp. in wheat supply chains. A panel of 29 experts from 12 European countries followed a holistic approach to evaluate the

  9. Current and Emerging Ethical Issues in Counseling: A Delphi Study of Expert Opinions

    Science.gov (United States)

    Herlihy, Barbara; Dufrene, Roxane L.

    2011-01-01

    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…

  10. Solar panel foundation device

    Energy Technology Data Exchange (ETDEWEB)

    Hawley, W.W.

    1983-03-29

    A transportable solar panel foundation device which has a bottom member, at least one upstanding side member, and an essentially open top. The side members are angled to permit nesting of a plurality of the foundation devices, and reinforcement pads are carried by the foundation device to support legs for one or more solar panels.

  11. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs.

    Science.gov (United States)

    Brosseau, Lucie; Taki, Jade; Desjardins, Brigit; Thevenot, Odette; Fransen, Marlene; Wells, George A; Mizusaki Imoto, Aline; Toupin-April, Karine; Westby, Marie; Álvarez Gallardo, Inmaculada C; Gifford, Wendy; Laferrière, Lucie; Rahman, Prinon; Loew, Laurianne; De Angelis, Gino; Cavallo, Sabrina; Shallwani, Shirin Mehdi; Aburub, Ala'; Bennell, Kim L; Van der Esch, Martin; Simic, Milena; McConnell, Sara; Harmer, Alison; Kenny, Glen P; Paterson, Gail; Regnaux, Jean-Philippe; Lefevre-Colau, Marie-Martine; McLean, Linda

    2017-05-01

    To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

  12. RECIPANEL: RECYCLED PAPER PANELS

    Directory of Open Access Journals (Sweden)

    HERNÁN CAÑOLA

    2012-01-01

    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.

  13. Puncture panel optimization

    International Nuclear Information System (INIS)

    Glass, R.E.; Longenbaugh, R.S.

    1986-01-01

    Sandia National Laboratories developed the TRansUranic PACkage Transporter (TRUPACT) to transport defense contact-handled transuranic wastes. The package has been designed to meet the normal and hypothetical accident conditions in 10CFR71 which includes the demonstrated ability to survive a 1-meter drop onto a mild steel pin. The puncture protection is provided by puncture resistant panels. In conjunction with the development of TRUPACT, a series of experiments has been conducted to reduce the weight of the puncture resistant panels. The initial scoping tests resulted in a preliminary design incorporating 30 layers of Kevlar. This design has been shown to meet the regulatory puncture test. To reduce the weight of this panel, subscale tests were conducted on panels utilizing Kevlar yarns with varying mass per unit length (denier) as well as different resins. This paper reviews the testing undertaken in the original panel development and discusses the results obtained from the recent subscale and full-scale optimization tests

  14. Solar panel cleaning robot

    Science.gov (United States)

    Nalladhimmu, Pavan Kumar Reddy; Priyadarshini, S.

    2018-04-01

    As the demand of electricity is increasing, there is need to using the renewable sources to produce the energy at present of power shortage, the use of solar energy could be beneficial to great extent and easy to get the maximum efficiency. There is an urgent in improving the efficiency of solar power generation. Current solar panels setups take a major power loss when unwanted obstructions cover the surface of the panels. To make solar energy more efficiency of solar array systems must be maximized efficiency evaluation of PV panels, that has been discussed with particular attention to the presence of dust on the efficiency of the PV panels have been highlighted. This paper gives the how the solar panel cleaning system works and designing of the cleaning system.

  15. Building America Expert Meeting. Combustion Safety

    Energy Technology Data Exchange (ETDEWEB)

    Brand, Larry [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States)

    2013-03-01

    This is an overview of "The Best Approach to Combustion Safety in a Direct Vent World," held June 28, 2012, in San Antonio, TX. The objective of this Expert Meeting was to identify gaps and barriers that need to be addressed by future research, and to develop data-driven technical recommendations for code updates so that a common approach for combustion safety can be adopted by all members of the building energy efficiency and code communities.

  16. Building America Expert Meeting: Combustion Safety

    Energy Technology Data Exchange (ETDEWEB)

    Brand, L.

    2013-03-01

    This is a meeting overview of 'The Best Approach to Combustion Safety in a Direct Vent World', held June 28, 2012, in San Antonio, Texas. The objective of this Expert Meeting was to identify gaps and barriers that need to be addressed by future research, and to develop data-driven technical recommendations for code updates so that a common approach for combustion safety can be adopted by all members of the building energy efficiency and code communities.

  17. A new way to ask the experts: Rating radioactive waste risks

    International Nuclear Information System (INIS)

    Kerr, R.A.

    1996-01-01

    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

  18. Combining NDE and fracture mechanics by artifical intelligence expert systems techniques

    International Nuclear Information System (INIS)

    Mucciardi, A.N.; Riccardella, P.C.

    1986-01-01

    This paper reports on the development of a PC-based expert system for non-destructive evaluation. Software tools from the expert systems subfield of artificial intelligence are being used to combine both NDE and fracture mechanics algorithms into one, unified package. The system incorporates elements of computer-enhanced ultrasonic signal processing, featuring artificial intelligence learning capability, state-of-the-art fracture mechanics analytical tools, and all relevant metallurgical and design data necessary to emulate the decisions of the panel(s) of experts typically involved in generating and dispositioning NDE data

  19. Use of expert systems in nuclear safety

    International Nuclear Information System (INIS)

    1990-02-01

    One dominant aspect of improvement in safe nuclear power plant operation is the very high speed in the development and introduction of computer technologies. This development commenced recently when advanced control technology was incorporated into the nuclear industry. This led to an increasing implementation of information displays, annunciator windows and other devices inside the control room, eventually overburdening the control room operator with detailed information. Expert systems are a further step in this direction being designed to apply large knowledge bases to solve practical problems. These ''intelligent'' systems have to incorporate enough knowledge to reach expert levels of importance and represent a very advanced man-machine interface. The aims of the Technical Committee were addressed by the three Working Groups and summarized in Sections 2, 3 and 4 of this report. Section 2 summarizes the results and discussions on the current capabilities of expert systems and identifies features for the future development and use of Expert Systems in Nuclear Power Plants. Section 3 provides an overview of the discussions and investigations into the current status of Expert Systems in NPPs. This section develops a method for assessing the overall benefit of different applications and recommends a broad strategy for priority developments of Expert Systems in NPPs. Section 4 assesses the overall use of PSA type studies in Expert Systems in NPPs and identifies specific features to be adopted in the design of these systems in future applications. The conclusions of the three Working Groups are presented in Section 5. The 15 papers presented at the meeting formed the Annex of this document. A separate abstract was prepared for each of these papers. Refs, figs, tabs and pictures

  20. Expert PLSQL Practices

    CERN Document Server

    Beresniewicz, John

    2011-01-01

    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

  1. Bioethics for Technical Experts

    Science.gov (United States)

    Asano, Shigetaka

    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.

  2. Expert tool use

    DEFF Research Database (Denmark)

    Thorndahl, Kathrine Liedtke; Ravn, Susanne

    2017-01-01

    on a case study of elite rope skipping, we argue that the phenomenological concept of incorporation does not suffice to adequately describe how expert tool users feel when interacting with their tools. By analyzing a combination of insights gained from participant observation of 11 elite rope skippers......According to some phenomenologists, a tool can be experienced as incorporated when, as a result of habitual use or deliberate practice, someone is able to manipulate it without conscious effort. In this article, we specifically focus on the experience of expertise tool use in elite sport. Based...... and autoethnographic material from one former elite skipper, we take some initial steps toward the development of a more nuanced understanding of the concept of incorporation; one that is able to accommodate the experiences of expert tool users. In sum, our analyses indicate that the possibility for experiencing...

  3. International recommendations

    International Nuclear Information System (INIS)

    Lindell, Bo

    1986-01-01

    Full text: This short presentation will indicate the general radiation protection background to protective measures against foodstuffs contaminated with radioactive substances. A number of international organizations are involved in various aspects of radiation protection, for example, the International Atomic Energy Agency (IAEA), the United Nations Food and Agriculture Organization (FAO), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO). Two international organizations, however, provide the basic background. These are the International Commission on Radiological Protection (ICRP) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). UNSCEAR provides the scientific information on radiation levels and effects. It consists of 21 member countries, with truly international coverage. It issues reports to the UN General Assembly, including comprehensive scientific annexes. Its latest comprehensive report was issued in 1982, the next is expected to be published in 1988. That report will include an assessment of the radiological consequences of the Chernobyl accident. The ICRP is a non-governmental organization. It has issued recommendations on radiation protection since 1928. The postulated biological basis for radiation protection recommendations involves two types of biological effects. The so-called non-stochastic effects, mainly due to cell death, appear only when the radiation doses exceed a certain threshold value. These effects, therefore, can only appear after high accidental exposures. After the Chernobyl accident, they only affected about 200 individuals involved in fire extinction and rescue work at the damaged nuclear power plant. Stochastic effects, with some simplification, may be seen as the result of initial changes in the genetic code of some surviving cells. If these cells are germ cells, this may lead to hereditary harm. If they are somatic cells, the result could be cancer

  4. Nonmedical interventions for children with ASD: recommended guidelines and further research needs.

    Science.gov (United States)

    Maglione, Margaret A; Gans, Daphna; Das, Lopamudra; Timbie, Justin; Kasari, Connie

    2012-11-01

    To use the findings of a systematic review of scientific evidence to develop consensus guidelines on nonmedical interventions that address cognitive function and core deficits in children with autism spectrum disorders (ASDs) and to recommend priorities for future research. The guidelines were developed by a Technical Expert Panel (TEP) consisting of practitioners, researchers, and parents. A systematic overview of research findings was presented to the TEP; guideline statements were drafted, discussed, debated, edited, reassessed, and presented for formal voting. The strength of evidence of efficacy varied by intervention type from insufficient to moderate. There was some evidence that greater intensity of treatment (hours per week) and greater duration (in months) led to better outcomes. The TEP agreed that children with ASD should have access to at least 25 hours per week of comprehensive intervention to address social communication, language, play skills, and maladaptive behavior. They agreed that applied behavioral analysis, integrated behavioral/developmental programs, the Picture Exchange Communication System, and various social skills interventions have shown efficacy. Based on identified gaps, they recommend that future research focus on assessment and monitoring of outcomes, addressing the needs of pre/nonverbal children and adolescents, and identifying the most effective strategies, dose, and duration to improve specific core deficits. The creation of treatment guidelines and recommendations for future research represents an effort by leading experts to improve access to services for children with ASDs while acknowledging that the research evidence has many gaps.

  5. Make Your Own Solar Panel.

    Science.gov (United States)

    Suzuki, David

    1992-01-01

    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)

  6. Effective medical treatment of opiate addiction. National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction.

    Science.gov (United States)

    1998-12-09

    To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence. A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health. The literature was searched through MEDLINE and other National Library of Medicine and online databases from January 1994 through September 1997 and an extensive bibliography of 941 references was provided to the panel and the conference audience. Experts prepared abstracts for their presentations as speakers at the conference with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its

  7. Behavioral intervention technologies: evidence review and recommendations for future research in mental health.

    Science.gov (United States)

    Mohr, David C; Burns, Michelle Nicole; Schueller, Stephen M; Clarke, Gregory; Klinkman, Michael

    2013-01-01

    A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes. This study on the findings of the technical expert panel. Videoconferencing and standard telephone technologies to deliver psychotherapy have been well validated. Web-based interventions have shown efficacy across a broad range of mental health outcomes. Social media such as online support groups have produced disappointing outcomes when used alone. Mobile technologies have received limited attention for mental health outcomes. Virtual reality has shown good efficacy for anxiety and pediatric disorders. Serious gaming has received little work in mental health. Research focused on understanding reach, adherence, barriers and cost is recommended. Improvements in the collection, storage, analysis and visualization of big data will be required. New theoretical models and evaluation strategies will be required. Finally, for BITs to have a public health impact, research on implementation and application to prevention is required. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. 75 FR 7469 - Panel Member List for Hydropower Licensing Study Dispute Resolution; Notice Extending Filing Date...

    Science.gov (United States)

    2010-02-19

    ... List for Hydropower Licensing Study Dispute Resolution; Notice Extending Filing Date for Applications for Panel Member List for Hydropower Licensing Study Dispute Resolution February 4, 2010. On October... on a list of resource experts willing to serve as a third panel member in the Commission's hydropower...

  9. Blue Ribbon Panel Report

    Science.gov (United States)

    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.

  10. Panel acoustic contribution analysis.

    Science.gov (United States)

    Wu, Sean F; Natarajan, Logesh Kumar

    2013-02-01

    Formulations are derived to analyze the relative panel acoustic contributions of a vibrating structure. The essence of this analysis is to correlate the acoustic power flow from each panel to the radiated acoustic pressure at any field point. The acoustic power is obtained by integrating the normal component of the surface acoustic intensity, which is the product of the surface acoustic pressure and normal surface velocity reconstructed by using the Helmholtz equation least squares based nearfield acoustical holography, over each panel. The significance of this methodology is that it enables one to analyze and rank relative acoustic contributions of individual panels of a complex vibrating structure to acoustic radiation anywhere in the field based on a single set of the acoustic pressures measured in the near field. Moreover, this approach is valid for both interior and exterior regions. Examples of using this method to analyze and rank the relative acoustic contributions of a scaled vehicle cabin are demonstrated.

  11. Autoimmune liver disease panel

    Science.gov (United States)

    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 ...

  12. Hexagon solar power panel

    Science.gov (United States)

    Rubin, I. (Inventor)

    1978-01-01

    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.

  13. Propulsion Systems Panel deliberations

    Science.gov (United States)

    Bianca, Carmelo J.; Miner, Robert; Johnston, Lawrence M.; Bruce, R.; Dennies, Daniel P.; Dickenson, W.; Dreshfield, Robert; Karakulko, Walt; Mcgaw, Mike; Munafo, Paul M.

    1993-01-01

    The Propulsion Systems Panel was established because of the specialized nature of many of the materials and structures technology issues related to propulsion systems. This panel was co-chaired by Carmelo Bianca, MSFC, and Bob Miner, LeRC. Because of the diverse range of missions anticipated for the Space Transportation program, three distinct propulsion system types were identified in the workshop planning process: liquid propulsion systems, solid propulsion systems and nuclear electric/nuclear thermal propulsion systems.

  14. Honeycomb metal panel

    International Nuclear Information System (INIS)

    1979-01-01

    Product constituted by a honeycomb metal panel that can be employed to advantage for manufacturing lagging by sandwiching it between two plane sheets, utilized in particular in the nuclear industry where lagging has to have a very long life strength. The honeycomb metal panel is made of an expanded metal extrusion previously cut so as to form, after additional drawing, a honeycomb structure with square or rectangular cells with a plane surface [fr

  15. Expert Oracle Exadata

    CERN Document Server

    Johnson, Randy

    2011-01-01

    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

  16. The naked experts

    International Nuclear Information System (INIS)

    Martin, B.

    1982-01-01

    In an article critical of experts, the cases argued for and against nuclear power are discussed under the headings: environmental hazards arising from the nuclear fuel cycle; proliferation of nuclear weapons capabilities via expansion of the nuclear power industry; political and social threats and restraints of a nuclear society (terrorism, reduction in civil liberties, centralised political and economic power); economic and employment disadvantages of nuclear power; impact of uranium mining on (Australian) aboriginal culture; inadequacy of nuclear power as a solution to energy problems; advantages of a 'soft energy path' based around conservation and renewable energy technologies. (U.K.)

  17. [Deontology of the medical expert].

    Science.gov (United States)

    Raszeja, S

    1995-09-01

    The authority of prosecuting organ to choose the expert, set his task and verify the following opinion is defined. The qualities of the medical expert and his duties are described, referring to: -his expertise; -his morality; -his ability to issue an independent (objective) opinion. Detailed rules, which can be ascribed to a specific medical expert's deontological code, are listed and explained.

  18. Hilar cholangiocarcinoma: expert consensus statement.

    Science.gov (United States)

    Mansour, John C; Aloia, Thomas A; Crane, Christopher H; Heimbach, Julie K; Nagino, Masato; Vauthey, Jean-Nicolas

    2015-08-01

    An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of hilar cholangiocarcinoma in order to establish practice guidelines and to agree consensus statements. It was established that the treatment of patients with hilar cholangiocarcinoma requires a coordinated, multidisciplinary approach to optimize the chances for both durable survival and effective palliation. An adequate diagnostic and staging work-up includes high-quality cross-sectional imaging; however, pathologic confirmation is not required prior to resection or initiation of a liver transplant trimodal treatment protocol. The ideal treatment for suitable patients with resectable hilar malignancy is resection of the intra- and extrahepatic bile ducts, as well as resection of the involved ipsilateral liver. Preoperative biliary drainage is best achieved with percutaneous transhepatic approaches and may be indicated for patients with cholangitis, malnutrition or hepatic insufficiency. Portal vein embolization is a safe and effective strategy for increasing the future liver remnant (FLR) and is particularly useful for patients with an FLR of hilar cholangiocarcinoma should be evaluated for a standard trimodal protocol incorporating external beam and endoluminal radiation therapy, systemic chemotherapy and liver transplantation. Post-resection chemoradiation should be offered to patients who show high-risk features on surgical pathology. Chemoradiation is also recommended for patients with locally advanced, unresectable hilar cancers. For patients with locally recurrent or metastatic hilar cholangiocarcinoma, first-line chemotherapy with gemcitabine and cisplatin is recommended based on multiple Phase II trials and a large randomized controlled trial including a heterogeneous population of patients with biliary cancers. © 2015 International Hepato-Pancreato-Biliary Association.

  19. Hybrid expert system

    International Nuclear Information System (INIS)

    Tsoukalas, L.; Ikonomopoulos, A.; Uhrig, R.E.

    1991-01-01

    This paper presents a methodology that couples rule-based expert systems using fuzzy logic, to pre-trained artificial neutral networks (ANN) for the purpose of transient identification in Nuclear Power Plants (NPP). In order to provide timely concise, and task-specific information about the may aspects of the transient and to determine the state of the system based on the interpretation of potentially noisy data a model-referenced approach is utilized. In it, the expert system performs the basic interpretation and processing of the model data, and pre-trained ANNs provide the model. having access to a set of neural networks that typify general categories of transients, the rule based system is able to perform identification functions. Membership functions - condensing information about a transient in a form convenient for a rule-based identification system characterizing a transient - are the output of neural computations. This allows the identification function to be performed with a speed comparable to or faster than that of the temporal evolution of the system. Simulator data form major secondary system pipe rupture is used to demonstrate the methodology. The results indicate excellent noise-tolerance for ANN's and suggest a new method for transient identification within the framework of Fuzzy Logic

  20. Safe handling of plutonium: a panel report

    Energy Technology Data Exchange (ETDEWEB)

    1974-01-01

    This guide results from a meeting of a Panel of Experts held by the International Atomic Energy Agency on 8 to 12 November 1971. It is directed to workers in research laboratories handling plutonium in gram amounts. Contents: aspects of the physical and chemical properties of plutonium; metabolic features of plutonium; facility design features for safe handling of plutonium (layout of facility, working zones, decontamination room, etc.); glove boxes; health surveillance (surveillance of environment and supervision of workers); emergencies; organization. Annexes: types of glove boxes; tables; mobile ..cap alpha.. air sampler; aerosol monitor; bio-assay limits of detection; examples of contamination control monitors.

  1. JERAMI SEBAGAI BAHAN BAKU PANEL AKUSTIK PELAPIS DINDING

    Directory of Open Access Journals (Sweden)

    Christina E. Mediastika

    2008-01-01

    Full Text Available The demand of walling panels with acoustic qualification has surprisingly increased, due to the needs for home theaters and mini recording studios in the increase of environmental noise. Therefore, good supply of acoustic panels, especially those with lower price are necessary. A series of study to explore possibility in using paddy-straw as main material to construct cheap and high quality panels has been developed. Prior to this study, an earlier small research showed there was a great potency in using paddy-straw as panels, especially ones drawn from paddy in type IR. The earlier study recommends further research to examine strength of compression and tensile of the constructed panels to go for building materials, which is presented in this paper. Acoustic qualification of the panels is subject for further reserach. Abstract in Bahasa Indonesia: Kebutuhan akan panel pelapis dinding yang bersifat akustik terus meningkat seiring meningkatnya kebisingan dan kebutuhan terhadap ruang studio pribadi. Ketersediaan panel pelapis dinding dengan harga yang lebih terjangkau seperti yang terbuat dari bahan limbah sangatlah dibutuhkan. Pada penelitian awal telah diselidiki kemungkinan penggunaan jerami yang merupakan limbah sebagai bahan baku pembuatan panel akustik. Penelitian tersebut menunjukkan bahwa jerami sangat potensial digunakan sebagai bahan aku panel, terutama jerami padi berjenis IR. Selanjutnya panel jerami ini perlu mendapatkan perlakukan uji desak dan lentur untuk memastikan kemampuannya menahan berat sendiri dan kekuatannya saat proses penggunaan, sebelum akhirnya mengalami pengujian berkaitan dengan kualitas akustik. Kekuatan desak dan lentur panel dimaksud, tersaji dalam tulisan ini. Kata kunci: panel jerami, uji desak, uji lentur.

  2. Processes in construction of failure management expert systems from device design information

    Science.gov (United States)

    Malin, Jane T.; Lance, Nick

    1987-01-01

    This paper analyzes the tasks and problem solving methods used by an engineer in constructing a failure management expert system from design information about the device to te diagnosed. An expert test engineer developed a trouble-shooting expert system based on device design information and experience with similar devices, rather than on specific expert knowledge gained from operating the device or troubleshooting its failures. The construction of the expert system was intensively observed and analyzed. This paper characterizes the knowledge, tasks, methods, and design decisions involved in constructing this type of expert system, and makes recommendations concerning tools for aiding and automating construction of such systems.

  3. Reflecting variable opening insulating panel

    International Nuclear Information System (INIS)

    Nungesser, W.T.

    1976-01-01

    A description is given of a reflecting variable opening insulating panel assembly, comprising a static panel assembly of reflecting insulation sheets forming a cavity along one side of the panel and a movable panel opening out by sliding from the cavity of the static panel, and a locking device for holding the movable panel in a position extending from the cavity of the static panel. This can apply to a nuclear reactor of which the base might require maintenance and periodical checking and for which it is desirable to have available certain processes for the partial dismantling of the insulation [fr

  4. A hybrid fuzzy-ontology based intelligent system to determine level of severity and treatment recommendation for Benign Prostatic Hyperplasia.

    Science.gov (United States)

    Torshizi, Abolfazl Doostparast; Zarandi, Mohammad Hossein Fazel; Torshizi, Ghazaleh Doostparast; Eghbali, Kamyar

    2014-01-01

    This paper deals with application of fuzzy intelligent systems in diagnosing severity level and recommending appropriate therapies for patients having Benign Prostatic Hyperplasia. Such an intelligent system can have remarkable impacts on correct diagnosis of the disease and reducing risk of mortality. This system captures various factors from the patients using two modules. The first module determines severity level of the Benign Prostatic Hyperplasia and the second module, which is a decision making unit, obtains output of the first module accompanied by some external knowledge and makes an appropriate treatment decision based on its ontology model and a fuzzy type-1 system. In order to validate efficiency and accuracy of the developed system, a case study is conducted by 44 participants. Then the results are compared with the recommendations of a panel of experts on the experimental data. Then precision and accuracy of the results were investigated based on a statistical analysis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. Der Patient als Experte.

    Science.gov (United States)

    Dubs

    1998-01-01

    Patients as Experts: Determining Benefit by Using Assessments of Ability (ICIDH)When health economy and quality mangement are dealing with the cost-benefit relationship, to this day description, calculation, and assessment of the benefit are missing to a great extent. Deliberations in terms of cause and effect do not go beyond the model of pathogenesis (etiology - pathology - manifestation) and descriptions on the organ level (ICD). Only the international classification of impairments, disabilities, and handicaps (ICIDH) as a separate estimation of the resulting manifestations of illness on the levels of organ, individual, and society is capable to elucidate this benefit. It is the patient who is the expert to decide what he needs, what he wants, and what he can do, thus, evaluating on an individual level his loss of capability. The ICIDH is regarded as the key for the management of chronic diseases. The characteristics of being chronically ill require the integration of salutogenesis and the consideration of the hierarchy of needs. The specially developed MARA model serves as pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve (mean age-related ability) as ethical guideline. In quality circles the MARA model, which is based on ICIDH, hierarchy of needs and salutogenesis, can offer apatient-oriented basis of discussion for benefit assessments, and, in a pragmatical way, it can facilitate the introduction of evidence-based medicine. By the change of view from the organ level with multifactorial aspects to the individual level, in which the abilities can be understood as a monofactor, a high consensus potential between several participants of discussion in health service is possible.

  6. Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs.

    Science.gov (United States)

    Edwards, Beatrice J; Hellstein, John W; Jacobsen, Peter L; Kaltman, Steven; Mariotti, Angelo; Migliorati, Cesar A

    2008-12-01

    and Overview. In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

  7. Rational Design of Composite Panels

    DEFF Research Database (Denmark)

    Riber, Hans Jørgen

    1996-01-01

    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...... Norske Veritas', DNV, building rules concerning high-speed light craft, in which the panel scantlings are often restricted by a maximum lateral deflection connected with the panel span....

  8. Panels of microporous insulation

    Energy Technology Data Exchange (ETDEWEB)

    McWilliams, J.A.; Morgan, D.E.; Jackson, J.D.J.

    1990-08-07

    Microporous thermal insulation materials have a lattice structure in which the average interstitial dimension is less than the mean free path of the molecules of air or other gas in which the material is arranged. This results in a heat flow which is less than that attributable to the molecular heat diffusion of the gas. According to this invention, a method is provided for manufacturing panels of microporous thermal insulation, in particular such panels in which the insulation material is bonded to a substrate. The method comprises the steps of applying a film of polyvinyl acetate emulsion to a non-porous substrate, and compacting powdery microporous thermal insulation material against the film so as to cause the consolidated insulation material to bond to the substrate and form a panel. The polyvinyl acetate may be applied by brushing or spraying, and is preferably allowed to dry prior to compacting the insulation material. 1 fig.

  9. Strategic environmental assessment quality assurance: evaluating and improving the consistency of judgments in assessment panels

    International Nuclear Information System (INIS)

    Noble, Bram F.

    2004-01-01

    Assessment panels and expert judgment are playing increasing roles in the practice of strategic environmental assessment (SEA). Thus, the quality of an SEA decision rests considerably on the quality of the judgments of the assessment panel. However, there exists very little guidance in the SEA literature for practitioners concerning the treatment and integration of expert judgment into SEA decision-making processes. Subsequently, the performance of SEAs based on expert judgment is often less than satisfactory, and quality improvements are required in the SEA process. Based on the lessons learned from strategic- and project-level impact assessment practices, this paper outlines a number of principles concerning the use of assessment panels in SEA decision-making, and attempts to provide some guidance for SEA practitioners in this regard. Particular attention is given to the notion and value of consistency in assessment panel judgments

  10. Advanced solar panel designs

    Science.gov (United States)

    Ralph, E. L.; Linder, E.

    1995-01-01

    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.

  11. Panel 3 - characterization

    Energy Technology Data Exchange (ETDEWEB)

    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)

    1993-01-01

    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.

  12. Analysis of Panel Data

    Science.gov (United States)

    Hsiao, Cheng

    2003-02-01

    Panel data models have become increasingly popular among applied researchers due to their heightened capacity for capturing the complexity of human behavior, as compared to cross-sectional or time series data models. This second edition represents a substantial revision of the highly successful first edition (1986). Recent advances in panel data research are presented in an accessible manner and are carefully integrated with the older material. The thorough discussion of theory and the judicious use of empirical examples make this book useful to graduate students and advanced researchers in economics, business, sociology and political science.

  13. Expert system application for prioritizing preventive actions for shift work: shift expert.

    Science.gov (United States)

    Esen, Hatice; Hatipoğlu, Tuğçen; Cihan, Ahmet; Fiğlali, Nilgün

    2017-09-19

    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.

  14. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus : recommendations and future directions

    NARCIS (Netherlands)

    Sharif, A.; Hecking, M.; de Vries, A. P. J.; Porrini, E.; Hornum, M.; Rasoul-Rockenschaub, S.; Berlakovich, G.; Krebs, M.; Kautzky-Willer, A.; Schernthaner, G.; Marchetti, P.; Pacini, G.; Ojo, A.; Takahara, S.; Larsen, J. L.; Budde, K.; Eller, K.; Pascual, J.; Jardine, A.; Bakker, S. J. L.; Valderhaug, T. G.; Jenssen, T. G.; Cohney, S.; Saeemann, M. D.

    A consensus meeting was held in Vienna on September 8-9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists,

  15. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions

    DEFF Research Database (Denmark)

    Sharif, A.; Hecking, M.; de Vries, A.P.

    2014-01-01

    A consensus meeting was held in Vienna on September 8-9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientist...

  16. ICRP-26, the recommendations on radiological protection

    International Nuclear Information System (INIS)

    Jun, J.S.

    1983-01-01

    Since the last ICRP recommendations on radiological protection was pubished in 1966 as it's publication 9, the revised edition of the recommendations had first been published in 1977, accommodating up-to-date knowledge of radiobiology and operational experiences of radiation protection built up for over a decade. In this article, the new version of the recommendations is reviewed in comparison with those of the publication 9, while the corrections and modifications made afterward are introduced together with the recent trends and responses of the experts in various countries for the pracical adoption or legislation of the recommendations. (Author)

  17. Expert system in PNC, 5

    International Nuclear Information System (INIS)

    Tobita, Yoshimasa; Yamaguchi, Takashi; Matsumoto, Mitsuo; Ono, Kiyoshi.

    1990-01-01

    The computer code system which can evaluate the mass balance and cycle cost in nuclear fuel cycle has been developing a PNC using an artificial intelligence technique. This system is composed of the expert system, data base and analysis codes. The expert system is the most important one in the system and the content of the expert system is explained in this paper. The expert system has the three functions. The first is the function of understanding the meaning of user's questions by natural language, the second is the function of selecting the best way to solve the problem given by the user using the knowledge which is already installed in the system, and the last is the function of answering the questions. The knowledge of the experts installed in the expert system is represented by the frame-type rules. Therefore, the knowledge will be simply added to the system, and consequently the system will be easily extended. (author)

  18. Efficiency of solar radiation conversion in photovoltaic panels

    OpenAIRE

    Kurpaska Sławomir; Knaga Jarosław; Latała Hubert; Sikora Jakub; Tomczyk Wiesław

    2018-01-01

    This paper included analysis the conversion efficiency in photovoltaic panels. The tests were done between February and June at a test stand equipped with three commonly used types of photovoltaic panels: poly- and monocrystalline silicon and with semi-conductive layer made of copper (Cu), indium (In), gallium (Ga) and selenium (Se) (CIGS). Five days of each month were selected for a detailed analysis. They were close to the so-called recommended day for calculations in solar power engineerin...

  19. Context-aware recommender system based on ontology for recommending tourist destinations at Bandung

    Science.gov (United States)

    Rizaldy Hafid Arigi, L.; Abdurahman Baizal, Z. K.; Herdiani, Anisa

    2018-03-01

    Recommender System is software that is able to provide personalized recommendation suits users’ needs. Recommender System has been widely implemented in various domains, including tourism. One approach that can be done for more personalized recommendations is the use of contextual information. This paper proposes a context aware recommender based ontology system in the tourism domain. The system is capable of recommending tourist destinations by using user preferences of the categories of tourism and contextual information such as user locations, weather around tourist destinations and close time of destination. Based on the evaluation, the system has accuracy of of 0.94 (item recommendation precision evaluated by expert) and 0.58 (implicitly from system-end user interaction). Based on the evaluation of user satisfaction, the system provides a satisfaction level of more than 0.7 (scale 0 to 1) for speed factors for providing liked recommendations (PE), informative description of recommendations (INF) and user trust (TR).

  20. The First Expert CAI System

    Science.gov (United States)

    Feurzeig, Wallace

    1984-01-01

    The first expert instructional system, the Socratic System, was developed in 1964. One of the earliest applications of this system was in the area of differential diagnosis in clinical medicine. The power of the underlying instructional paradigm was demonstrated and the potential of the approach for valuably supplementing medical instruction was recognized. Twenty years later, despite further educationally significant advances in expert systems technology and enormous reductions in the cost of computers, expert instructional methods have found very little application in medical schools.

  1. Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding.

    Science.gov (United States)

    Martínez López, Juan Antonio; García Vivar, M Luz; Cáliz, Rafael; Freire, Mercedes; Galindo, María; Hernández, Maria Victoria; López Longo, Francisco Javier; Martínez Taboada, Víctor; Pego Reigosa, Jose María; Rubio, Esteban; Trujillo, Elisa; Vela-Casasempere, Paloma

    To develop recommendations on the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, post-partum and breastfeeding based on the best evidence and experience. Recommendations were generated using nominal group and Delphi techniques. An expert panel of 12 rheumatologists was established. A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in its 1 st meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinement. A national survey analyzing different aspects of this topic was undertaken separately, followed by a Delphi process (2 rounds). Agreement with each recommendation was ranked on a scale of 1 (total disagreement) to 10 (total agreement), and was considered to be achieved if at least 70% voted≥7. The level of evidence and grade of recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. A total of 14 recommendations were generated for the preconception period (oral and hormonal contraception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High-risk situations such as lupus or antiphospholipid syndrome were included. A consensus>90% was reached for all but one recommendation. These recommendations are intended to provide rheumatologists, patients, families and other stakeholders with a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  2. MRI of the scrotum. Recommendations of the ESUR Scrotal and Penile Imaging Working Group

    Energy Technology Data Exchange (ETDEWEB)

    Tsili, Athina C.; Ntorkou, Alexandra [University of Ioannina, Department of Clinical Radiology, Medical School, Ioannina (Greece); Bertolotto, Michele [Uco di Radiologia, Trieste Univ. (Italy); Turgut, Ahmet Tuncay [Ankara Training and Research Hospital, Department of Radiology, Ankara (Turkey); Dogra, Vikram [University of Rochester School of Medicine and Dentistry, Department of Imaging Sciences, Rochester, NY (United States); Freeman, Simon [Plymouth Hospitals NHS Trust, Plymouth (United Kingdom); Rocher, Laurence [Hopitaux Universitaires Paris Sud, APHP, Ecole Doctorale Biosigne, Le Kremlin Bicetre (France); Belfield, Jane [Royal Liverpool University Hospital, Liverpool (United Kingdom); Studniarek, Michal [Medical University of Gdansk, Gdansk (Poland); Derchi, Lorenzo E. [Universita di Genova, Genova (Italy); Oyen, Raymond [KU Leuven, Radiology, Leuven (Belgium); Ramchandani, Parvati [Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA (United States); Secil, Mustafa [Dokuz Eylul University Faculty of Medicine, Department of Radiology, Izmir (Turkey); Richenberg, Jonathan [Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex (United Kingdom)

    2018-01-15

    The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were 'magnetic resonance imaging', 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. (orig.)

  3. MRI of the scrotum. Recommendations of the ESUR Scrotal and Penile Imaging Working Group

    International Nuclear Information System (INIS)

    Tsili, Athina C.; Ntorkou, Alexandra; Bertolotto, Michele; Turgut, Ahmet Tuncay; Dogra, Vikram; Freeman, Simon; Rocher, Laurence; Belfield, Jane; Studniarek, Michal; Derchi, Lorenzo E.; Oyen, Raymond; Ramchandani, Parvati; Secil, Mustafa; Richenberg, Jonathan

    2018-01-01

    The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were 'magnetic resonance imaging', 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. (orig.)

  4. Advanced Solar Panel Designs

    Science.gov (United States)

    Ralph, E. L.; Linder, E. B.

    1995-01-01

    Solar panel designs that utilize new high-efficiency solar cells and lightweight rigid panel technologies are described. The resulting designs increase the specific power (W/kg) achievable in the near-term and are well suited to meet the demands of higher performance small satellites (smallsats). Advanced solar panel designs have been developed and demonstrated on two NASA SBIR contracts at Applied Solar. The first used 19% efficient, large area (5.5 cm x 6.5 cm) GaAs/Ge solar cells with a lightweight rigid graphite epoxy isogrid substrate configuration. A 1,445 sq cm coupon was fabricated and tested to demonstrate 60 W/kg with a high potential of achieving 80 W/kg. The second panel design used new 22% efficiency, dual-junction GaInP2/GaAs/Ge solar cells combined with a lightweight aluminum core/graphite fiber mesh facesheet substrate. A 1,445 sq cm coupon was fabricated and tested to demonstrate 105 W/kg with the potential of achieving 115 W/kg.

  5. INTERNATIONAL COLLABORATION: Panelling

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    At the meeting of the International Committee for Future Accelerators (ICFA), in Geneva in July, Chairman A.N. Skrinsky of Novosibirsk reviewed ICFA progress, particularly the activities of the specialist Panels which pursue specific Committee objectives in guiding worldwide collaboration in high energy physics

  6. INTERNATIONAL COLLABORATION: Panelling

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1991-10-15

    At the meeting of the International Committee for Future Accelerators (ICFA), in Geneva in July, Chairman A.N. Skrinsky of Novosibirsk reviewed ICFA progress, particularly the activities of the specialist Panels which pursue specific Committee objectives in guiding worldwide collaboration in high energy physics.

  7. Paneling architectural freeform surfaces

    KAUST Repository

    Eigensatz, Michael; Kilian, Martin; Schiftner, Alexander; Mitra, Niloy J.; Pottmann, Helmut; Pauly, Mark

    2010-01-01

    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

  8. Photovoltaic-Panel Laminator

    Science.gov (United States)

    Keenan, R.

    1985-01-01

    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.

  9. Dynamic panel data models

    NARCIS (Netherlands)

    Bun, M.J.G.; Sarafidis, V.

    2013-01-01

    This Chapter reviews the recent literature on dynamic panel data models with a short time span and a large cross-section. Throughout the discussion we considerlinear models with additional endogenous covariates. First we give a broad overview of available inference methods placing emphasis on GMM.

  10. Surgical experts: born or made?

    Science.gov (United States)

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

    2013-01-01

    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Composite panel development at JPL

    Science.gov (United States)

    Mcelroy, Paul; Helms, Rich

    1988-01-01

    Parametric computer studies can be use in a cost effective manner to determine optimized composite mirror panel designs. An InterDisciplinary computer Model (IDM) was created to aid in the development of high precision reflector panels for LDR. The materials properties, thermal responses, structural geometries, and radio/optical precision are synergistically analyzed for specific panel designs. Promising panels designs are fabricated and tested so that comparison with panel test results can be used to verify performance prediction models and accommodate design refinement. The iterative approach of computer design and model refinement with performance testing and materials optimization has shown good results for LDR panels.

  12. Sources of correlation between experts: Empirical results from two extremes

    International Nuclear Information System (INIS)

    Meyer, M.A.; Booker, J.M.

    1987-04-01

    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

  13. Expert Systems for the Analytical Laboratory.

    Science.gov (United States)

    de Monchy, Allan R.; And Others

    1988-01-01

    Discusses two computer problem solving programs: rule-based expert systems and decision analysis expert systems. Explores the application of expert systems to automated chemical analyses. Presents six factors to consider before using expert systems. (MVL)

  14. Expert Systems as Tools for Technical Communicators.

    Science.gov (United States)

    Grider, Daryl A.

    1994-01-01

    Discusses expertise, what an expert system is, what an expert system shell is, what expert systems can and cannot do, knowledge engineering and technical communicators, and planning and managing expert system projects. (SR)

  15. Mapping on complex neutrosophic soft expert sets

    Science.gov (United States)

    Al-Quran, Ashraf; Hassan, Nasruddin

    2018-04-01

    We introduce the mapping on complex neutrosophic soft expert sets. Further, we investigated the basic operations and other related properties of complex neutrosophic soft expert image and complex neutrosophic soft expert inverse image of complex neutrosophic soft expert sets.

  16. System Experts and Decision Making Experts in Transdisciplinary Projects

    Science.gov (United States)

    Mieg, Harald A.

    2006-01-01

    Purpose: This paper aims at a better understanding of expert roles in transdisciplinary projects. Thus, the main purpose is the analysis of the roles of experts in transdisciplinary projects. Design/methodology/approach: The analysis of the ETH-UNS case studies from the point of view of the psychology of expertise and the sociology of professions…

  17. Online-Expert: An Expert System for Online Database Selection.

    Science.gov (United States)

    Zahir, Sajjad; Chang, Chew Lik

    1992-01-01

    Describes the design and development of a prototype expert system called ONLINE-EXPERT that helps users select online databases and vendors that meet users' needs. Search strategies are discussed; knowledge acquisition and knowledge bases are described; and the Analytic Hierarchy Process (AHP), a decision analysis technique that ranks databases,…

  18. Ingredientes Farmacéuticos Activos Potencialmente Inapropiados en Adultos Mayores: Lista IFAsPIAM: Panel de Consenso Argentino.

    Science.gov (United States)

    Marzi, Marta M; Pires, Miryam S; Quaglia, Nora B

    2018-04-18

    To perform a list agreed by Argentinean experts and adapted to the local context containing potentially inappropriate (PI) medications in old people (OP) usingthe Delphi consensus technique optimized for this subject. A preliminary list of potentially inappropriate medications (PIM) was drawn up based on foreign PIM lists and a selective search in the scientific literature. The iterative Delphi process was used to submit the active pharmaceutical ingredients (APIs) of the preliminary PIM list to the panel of Argentinean experts. The analysis of theanswers to determine the arrival to the consensus was carried out applying three criteria specially defined for this purpose. After two Delphi rounds, it was not reached agreement about 12 APIs. The List of explicit criteria for PIAPIs for use in OP (IFAsPIAM List) was finally constituted by 128 APIs corresponding to 9 groups of the ATC classification system to which they were organized. In addition to each API, information justifying the unfavorable benefit/risk profile and therapeutic alternatives or recommendations/precautions was recorded. The group with the most PI APIs was N (NervousSystem) (60; 47%) followed by groups C (Cardiovascular) and M (Musculoskeletal). This study presents the first Latin American list of PIM in OP developed using an expert consensus technique. The IFAs PIAM List would contribute to the rational use of drugs in elderly population, constituting a valuable tool in Argentinean public health. Copyright © 2018. Published by Elsevier Inc.

  19. Plutonium - the ultrapoison? An expert's opinion about an expert opinion

    International Nuclear Information System (INIS)

    Stoll, W.; Becker, K.

    1989-01-01

    In an expert opinion written by Professor H. Kuni, Marburg, for the North Rhine-Westphalian state government, plutonium is called by far the most dangerous element in the Periodic Table. The Marburg medical expert holds that even improved legal instruments are unable to warrant effective protection of the workers handling this material, in the light of the present standards of industrial safety, because of radiological conditions and measuring problems with plutonium isotopes. In this article by an internationally renowned expert in the field, the ideas expressed in the expert opinion about the toxicity of plutonium, the cause-and-effect relationship in radiation damage by plutonium, and recent findings about the toxicity are subjected to a critical review. On the basis of results of radiation protection and of case studies, the statements in the expert opinion are contrasted with facts which make them appear in a very different light. (orig./RB) [de

  20. Recommended methods for range-wide monitoring of prairie dogs in the United States

    Science.gov (United States)

    McDonald, Lyman L.; Stanley, Thomas R.; Otis, David L.; Biggins, Dean E.; Stevens, Patricia D.; Koprowski, John L.; Ballard, Warren

    2011-01-01

    Association of Fish and Wildlife Agencies (WAFWA), in coordination with USFWS and U.S. Geological Survey (USGS), hosted a prairie dog species survey methodology workshop January 25-28, 2010 in Fort Collins, Colorado. The workshop provided all WAFWA partners and interested parties the opportunity to present their survey methodology to a review panel made up of experts in the fields of quantitative biology, population biology, species biology, and biostatistics. This report presents the panel's survey methodology recommendations for each of the four species of prairie dogs found in the United States and, for the black-tailed prairie dog, a list of action items to facilitate implementation of the recommended methodology.

  1. Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

    Science.gov (United States)

    Navas, Carlos; Torres-Duque, Carlos A; Munoz-Ceron, Joe; Álvarez, Carlos; García, Juan R; Zarco, Luis; Vélez, Lázaro A; Awad, Carlos; Castro, Carlos Alberto

    2018-01-01

    Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.

  2. Panel and planar experimental shear behavior of wood panels ...

    African Journals Online (AJOL)

    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 ...

  3. FEMA DFIRM Panel Scheme Polygons

    Data.gov (United States)

    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...

  4. Report of Industry Panel Group

    Science.gov (United States)

    Gallimore, Simon; Gier, Jochen; Heitland, Greg; Povinelli, Louis; Sharma, Om; VandeWall, Allen

    2006-01-01

    A final report is presented from the industry panel group. The contents include: 1) General comments; 2) Positive progress since Minnowbrook IV; 3) Industry panel outcome; 4) Prioritized turbine projects; 5) Prioritized compressor projects; and 6) Miscellaneous.

  5. Expert Systems in Reference Services.

    Science.gov (United States)

    Roysdon, Christine, Ed.; White, Howard D., Ed.

    1989-01-01

    Eleven articles introduce expert systems applications in library and information science, and present design and implementation issues of system development for reference services. Topics covered include knowledge based systems, prototype development, the use of artificial intelligence to remedy current system inadequacies, and an expert system to…

  6. Artificial Intelligence: The Expert Way.

    Science.gov (United States)

    Bitter, Gary G.

    1989-01-01

    Discussion of artificial intelligence (AI) and expert systems focuses on their use in education. Characteristics of good expert systems are explained; computer software programs that contain applications of AI are described, highlighting one used to help educators identify learning-disabled students; and the future of AI is discussed. (LRW)

  7. Component aging evaluation with expert systems

    International Nuclear Information System (INIS)

    Wiesemann, J.S.; Maguire, H.T. Jr.

    1988-01-01

    The age degradation of components involves a complex relationship between a variety of variables. These relationships are typically modeled using probabilistic and deterministic analyses. These methods depend upon a formal understanding of the underlying degradation mechanisms and a database of experience which allows statistical analyses to extract numerical trends. At present, not all age degradation mechanisms are adequately modeled and available data for age degradation is in most cases insufficient. In addition, these methods tend to focus upon answers to isolated questions (e.g., What is the component failure rate?) rather than the more pertinent questions concerning operations and maintenance (e.g., should the component be replaced at the next outage). Fortunately, knowledge in the form of personal experience does exist which allows plant personnel to make decisions concerning operations and maintenance. This knowledge can be modeled using expert systems. This paper discusses CAGES (Component Aging Expert System). It combines expert rules (heuristics), probabilistic models, and deterministic models to make evaluations of component aging; predict the implications for component life extension, operational readiness, maintenance effectiveness, and safety, and make recommendations for maintenance and operation

  8. Evidence and consensus recommendations for the pharmacological management of pain in India

    Directory of Open Access Journals (Sweden)

    Dureja GP

    2017-03-01

    Full Text Available Gur Prasad Dureja,1 Rajagopalan N Iyer,2 Gautam Das,3 Jaishid Ahdal,4 Prashant Narang4 On behalf of the Pain Working Group 1Delhi Pain Management Centre, New Delhi, Delhi, 2Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka, 3Daradia Pain Clinic, Kolkata, West Bengal, 4Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India Abstract: Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease

  9. IRCAD recommendation on safe laparoscopic cholecystectomy.

    Science.gov (United States)

    Conrad, Claudius; Wakabayashi, Go; Asbun, Horacio J; Dallemagne, Bernard; Demartines, Nicolas; Diana, Michele; Fuks, David; Giménez, Mariano Eduardo; Goumard, Claire; Kaneko, Hironori; Memeo, Riccardo; Resende, Alexandre; Scatton, Olivier; Schneck, Anne-Sophie; Soubrane, Olivier; Tanabe, Minoru; van den Bos, Jacqueline; Weiss, Helmut; Yamamoto, Masakazu; Marescaux, Jacques; Pessaux, Patrick

    2017-11-01

    An expert recommendation conference was conducted to identify factors associated with adverse events during laparoscopic cholecystectomy (LC) with the goal of deriving expert recommendations for the reduction of biliary and vascular injury. Nineteen hepato-pancreato-biliary (HPB) surgeons from high-volume surgery centers in six countries comprised the Research Institute Against Cancer of the Digestive System (IRCAD) Recommendations Group. Systematic search of PubMed, Cochrane, and Embase was conducted. Using nominal group technique, structured group meetings were held to identify key items for safer LC. Consensus was achieved when 80% of respondents ranked an item as 1 or 2 (Likert scale 1-4). Seventy-one IRCAD HPB course participants assessed the expert recommendations which were compared to responses of 37 general surgery course participants. The IRCAD recommendations were structured in seven statements. The key topics included exposure of the operative field, appropriate use of energy device and establishment of the critical view of safety (CVS), systematic preoperative imaging, cholangiogram and alternative techniques, role of partial and dome-down (fundus-first) cholecystectomy. Highest consensus was achieved on the importance of the CVS as well as dome-down technique and partial cholecystectomy as alternative techniques. The put forward IRCAD recommendations may help to promote safe surgical practice of LC and initiate specific training to avoid adverse events. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  10. Expert judgment and uncertainty regarding the protection of imperiled species.

    Science.gov (United States)

    Heeren, Alexander; Karns, Gabriel; Bruskotter, Jeremy; Toman, Eric; Wilson, Robyn; Szarek, Harmony

    2017-06-01

    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 arct