76 FR 44592 - Cooperative Agreement With the World Health Organization Department of Food Safety and Zoonoses...

Science.gov (United States)

2011-07-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0010] Cooperative Agreement With the World Health Organization Department of Food Safety and Zoonoses in Support of... agreement with the World Health Organization. The document published stating that the total funding...

Level of agreement between physician and patient assessment of non-medical health factors.

Science.gov (United States)

Ludovic, Casanova; Virginie, Ringa; Sophia, Chatelard; Sylvain, Paquet; Isabelle, Pendola-Luchel; Henri, Panjo; Camille, Bideau; Eric, Deflesselle; Raphaëlle, Delpech; Géraldine, Bloy; Laurent, Rigal

2018-01-29

GPs need to consider assorted relevant non-medical factors, such as family or work situations or health insurance coverage, to determine appropriate patient care. If GPs' knowledge of these factors varies according to patients' social position, less advantaged patients might receive poorer care, resulting in the perpetuation of social inequalities in health. To assess social disparities in GPs' knowledge of non-medical factors relevant to patient care. Observational survey of GPs who supervise internships in the Paris metropolitan area. Each of the 52 enrolled GPs randomly selected 70 patients from their patient list. Their knowledge of five relevant factors (coverage by publicly funded free health insurance, or by supplementary health insurance, living with a partner, social support and employment status) was analysed as the agreement between the patients' and GPs' answers to matching questions. Occupational, educational and financial disparities were estimated with multilevel models adjusted for age, sex, chronic disease and GP-patient relationship. Agreement varied according to the factor considered from 66% to 91%. The global agreement score (percentage of agreement for all five factors) was 72%. Social disparities and often gradients, disfavouring the less well-off patients, were observed for each factor considered. Social gradients were most marked according to perceived financial situation and for health insurance coverage. GPs must be particularly attentive toward their least advantaged patients, to be aware of the relevant non-medical factors that affect these patients' health and care, and thus provide management adapted to each individual's personal situation. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement

Science.gov (United States)

2013-01-01

Trade poses risks and opportunities to public health nutrition. This paper discusses the potential food-related public health risks of a radical new kind of trade agreement: the Trans Pacific Partnership agreement (TPP). Under negotiation since 2010, the TPP involves Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA, and Vietnam. Here, we review the international evidence on the relationships between trade agreements and diet-related health and, where available, documents and leaked text from the TPP negotiations. Similar to other recent bilateral or regional trade agreements, we find that the TPP would propose tariffs reductions, foreign investment liberalisation and intellectual property protection that extend beyond provisions in the multilateral World Trade Organization agreements. The TPP is also likely to include strong investor protections, introducing major changes to domestic regulatory regimes to enable greater industry involvement in policy making and new avenues for appeal. Transnational food corporations would be able to sue governments if they try to introduce health policies that food companies claim violate their privileges in the TPP; even the potential threat of litigation could greatly curb governments’ ability to protect public health. Hence, we find that the TPP, emblematic of a new generation of 21st century trade policy, could potentially yield greater risks to health than prior trade agreements. Because the text of the TPP is secret until the countries involved commit to the agreement, it is essential for public health concerns to be articulated during the negotiation process. Unless the potential health consequences of each part of the text are fully examined and taken into account, and binding language is incorporated in the TPP to safeguard regulatory policy space for health, the TPP could be detrimental to public health nutrition. Health advocates and health-related policymakers must be

A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement.

Science.gov (United States)

Friel, Sharon; Gleeson, Deborah; Thow, Anne-Marie; Labonte, Ronald; Stuckler, David; Kay, Adrian; Snowdon, Wendy

2013-10-16

Trade poses risks and opportunities to public health nutrition. This paper discusses the potential food-related public health risks of a radical new kind of trade agreement: the Trans Pacific Partnership agreement (TPP). Under negotiation since 2010, the TPP involves Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA, and Vietnam. Here, we review the international evidence on the relationships between trade agreements and diet-related health and, where available, documents and leaked text from the TPP negotiations. Similar to other recent bilateral or regional trade agreements, we find that the TPP would propose tariffs reductions, foreign investment liberalisation and intellectual property protection that extend beyond provisions in the multilateral World Trade Organization agreements. The TPP is also likely to include strong investor protections, introducing major changes to domestic regulatory regimes to enable greater industry involvement in policy making and new avenues for appeal. Transnational food corporations would be able to sue governments if they try to introduce health policies that food companies claim violate their privileges in the TPP; even the potential threat of litigation could greatly curb governments' ability to protect public health. Hence, we find that the TPP, emblematic of a new generation of 21st century trade policy, could potentially yield greater risks to health than prior trade agreements. Because the text of the TPP is secret until the countries involved commit to the agreement, it is essential for public health concerns to be articulated during the negotiation process. Unless the potential health consequences of each part of the text are fully examined and taken into account, and binding language is incorporated in the TPP to safeguard regulatory policy space for health, the TPP could be detrimental to public health nutrition. Health advocates and health-related policymakers must be

Assessing implementation mechanisms for an international agreement on research and development for health products.

Science.gov (United States)

Hoffman, Steven J; Røttingen, John-Arne

2012-11-01

The Member States of the World Health Organization (WHO) are currently debating the substance and form of an international agreement to improve the financing and coordination of research and development (R&D) for health products that meet the needs of developing countries. In addition to considering the content of any possible legal or political agreement, Member States may find it helpful to reflect on the full range of implementation mechanisms available to bring any agreement into effect. These include mechanisms for states to make commitments, administer activities, manage financial contributions, make subsequent decisions, monitor each other's performance and promote compliance. States can make binding or non-binding commitments through conventions, contracts, declarations or institutional reforms. States can administer activities to implement their agreements through international organizations, sub-agencies, joint ventures or self-organizing processes. Finances can be managed through specialized multilateral funds, financial institutions, membership organizations or coordinated self-management. Decisions can be made through unanimity, consensus, equal voting, modified voting or delegation. Oversight can be provided by peer review, expert review, self-reports or civil society. Together, states should select their preferred options across categories of implementation mechanisms, each of which has advantages and disadvantages. The challenge lies in choosing the most effective combinations of mechanisms for supporting an international agreement (or set of agreements) that achieves collective aspirations in a way and at a cost that are both sustainable and acceptable to those involved. In making these decisions, WHO's Member States can benefit from years of experience with these different mechanisms in health and its related sectors.

Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study

OpenAIRE

Prof Anil Markandya, PhD; Jon Sampedro, MSc; Steven J Smith, PhD; Rita Van Dingenen, PhD; Cristina Pizarro-Irizar, PhD; Prof Iñaki Arto, PhD; Prof Mikel González-Eguino, PhD

2018-01-01

Background: Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which ...

Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement.

Science.gov (United States)

Hirono, Katherine; Haigh, Fiona; Gleeson, Deborah; Harris, Patrick; Thow, Anne Marie; Friel, Sharon

2016-04-04

The Trans Pacific Partnership Agreement (TPP) is a recently concluded free trade agreement involving Australia and 11 other Pacific-rim nations, which has the potential for far-reaching impacts on public health. A health impact assessment (HIA) was carried out during the negotiations to determine the potential future public health impact in Australia and to provide recommendations to mitigate potential harms. This paper explores the findings and outcomes of the HIA, and how this approach can be used to provide evidence for public health advocacy. A modified version of the standard HIA process was followed. The HIA was led by technical experts in HIA, trade policy, and health policy, in collaboration with advocacy organisations concerned with the TPP and health. The HIA reviewed the provisions in leaked TPP text in order to determine their potential impact on future health policy. As part of this process, researchers developed policy scenarios in order to examine how TPP provisions may affect health policies and their subsequent impact to health for both the general and vulnerable populations. The four policy areas assessed were the cost of medicines, tobacco control, alcohol control and food labelling. In all areas assessed, the HIA found that proposed TPP provisions were likely to adversely affect health. These provisions are also likely to more adversely affect the health of vulnerable populations. The HIA produced relevant evidence that was useful in advocacy efforts by stakeholders, and engaging the public through various media platforms. 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/

Agreement Execution Process Study: CRADAs and NF-WFO Agreements and the Speed of Business

Energy Technology Data Exchange (ETDEWEB)

Harrer, Bruce J.; Cejka, Cheryl L.; Macklin, Richard; Miksovic, Ann

2011-02-01

This report summarizes the findings of a study on the execution of Cooperative Research and Development Agreements (CRADAs) and Non-Federal Work for Others (NF-WFO) agreements across the U.S. Department of Energy (DOE) laboratory complex. The study provides quantitiative estimates of times required to negotiate and execute these agreements across the DOE complex. It identifies factors impacting on cycle times and describes best practicies used at various laboratories and site offices that reduce cycle times.

Use of Nondisclosure Agreements in Medical Malpractice Settlements by a Large Academic Health Care System.

Science.gov (United States)

Sage, William M; Jablonski, Joseph S; Thomas, Eric J

2015-07-01

Honesty and transparency are essential aspects of health care, including in physicians' and hospitals' responses to medical error. Biases and habits associated with medical malpractice litigation, however, may work at cross-purposes with compassion in clinical care and with efforts to improve patient safety. To determine the frequency of nondisclosure agreements in medical malpractice settlements and the extent to which the restrictions in these agreements seem incompatible with good patient care. We performed a retrospective review of medical malpractice claim files, including settlement agreements, for claims closed before (fiscal year 2001-2002), during (fiscal year 2006-2007), and after (fiscal years 2009-2012) the implementation of tort reform in Texas. We studied The University of Texas System, which self-insures malpractice claims that involve 6000 physicians at 6 medical campuses in 5 cities. Nondisclosure provisions in medical malpractice settlements. During the 5 study years, The University of Texas System closed 715 malpractice claims and made 150 settlement payments. For the 124 cases that met our selection criteria, the median compensation paid by the university was $100,000 (range, $500-$1.25 million), and the mean compensation was $185,372. A total of 110 settlement agreements (88.7%) included nondisclosure provisions. All the nondisclosure clauses prohibited disclosure of the settlement terms and amount, 61 (55.5%) prohibited disclosure that the settlement had been reached, 51 (46.4%) prohibited disclosure of the facts of the claim, 29 (26.4%) prohibited reporting to regulatory agencies, and 10 (9.1%) prohibited disclosure by the settling physicians and hospitals, not only by the claimant. Three agreements (2.7%) included specific language that prohibited the claimant from disparaging the physicians or hospitals. The 50 settlement agreements signed after tort reform took full effect in Texas (2009-2012) had stricter nondisclosure provisions than the

Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study.

Science.gov (United States)

Markandya, Anil; Sampedro, Jon; Smith, Steven J; Van Dingenen, Rita; Pizarro-Irizar, Cristina; Arto, Iñaki; González-Eguino, Mikel

2018-03-01

Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which the emissions abatement effort is shared between countries in accordance with three established equity criteria. Our study had three stages. First, we used an integrated assessment model, the Global Change Assessment Model (GCAM), to investigate the emission (greenhouse gases and air pollutants) pathways and abatement costs of a set of scenarios with varying temperature objectives (nationally determined contributions, 2°C, or 1·5°C) and approaches to the distribution of climate change methods (capability, constant emission ratios, and equal per capita). The resulting emissions pathways were transferred to an air quality model (TM5-FASST) to estimate the concentrations of particulate matter and ozone in the atmosphere and the resulting associated premature deaths and morbidity. We then applied a monetary value to these health impacts by use of a term called the value of statistical life and compared these values with those of the mitigation costs calculated from GCAM, both globally and regionally. Our analysis looked forward to 2050 in accordance with the socioeconomic narrative Shared Socioeconomic Pathways 2. The health co-benefits substantially outweighed the policy cost of achieving the target for all of the scenarios that we analysed. In some of the mitigation strategies, the median co-benefits were double the median costs at a global level. The ratio of health co-benefit to mitigation cost ranged from 1·4 to 2·45, depending on the scenario. At the regional level, the costs of

Name agreement in picture naming : An ERP study

NARCIS (Netherlands)

Cheng, Xiaorong; Schafer, Graham; Akyürek, Elkan G.

Name agreement is the extent to which different people agree on a name for a particular picture. Previous studies have found that it takes longer to name low name agreement pictures than high name agreement pictures. To examine the effect of name agreement in the online process of picture naming, we

The Free Trade Agreement and the Mexican health sector.

Science.gov (United States)

Laurell, A C; Ortega, M E

1992-01-01

This article presents a discussion of the probable implications for the Mexican health sector of the Free Trade Agreement (FTA) between the United States, Canada, and Mexico. The authors argue that the FTA should be seen as part of neoliberal policies adopted by the Mexican government in 1983 that are based on large-scale privatization and deregulation of labor relations. In this general context the health sector, which traditionally has been dominated by public institutions, is undergoing a deep restructuring. The main trends are the decapitalization of the public sector and a selective process of privatization that tends to constitute the private health sector in a field of capital accumulation. The FTA is likely to force a change in Mexican health legislation, which includes health services in the public social security system and recognizes the right to health, and to accelerate selective privatization. The U.S. insurance industry and hospital corporations are interested in promoting these changes in order to gain access to the Mexican market, estimated at 20 to 25 million persons. This would lead to further deterioration of the public institutions, increasing inequalities in health and strengthening the private sector. The historical trend toward the integration of a National Health Service in Mexico would be interrupted in favor of formation of a dual private-public system.

"Trade creep" and implications of the Transatlantic Trade and Investment Partnership Agreement for the United Kingdom National Health Service.

Science.gov (United States)

Koivusalo, Meri; Tritter, Jonathan

2014-01-01

The ambitious and comprehensive Transatlantic Trade and Investment Partnership Agreement (TTIP/TAFTA) agreement between the European Union and United States is now being negotiated and may have far-reaching consequences for health services. The agreement extends to government procurement, investment, and further regulatory cooperation. In this article, we focus on the United Kingdom National Health Service and how these negotiations can limit policy space to change policies and to regulate in relation to health services, pharmaceuticals, medical devices, and health industries. The negotiation of TTIP/TAFTA has the potential to "harmonize" more corporate-friendly regulation, resulting in higher costs and loss of policy space, an example of "trade creep" that potentially compromises health equity, public health, and safety concerns across the Atlantic.

The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the electric power generation sector under the Paris Agreement: a modelling study

OpenAIRE

Wenjia Cai, PhD; Jingxuan Hui, PhD; Can Wang, ProfPhD; Yixuan Zheng, PhD; Xin Zhang, PhD; Qiang Zhang, ProfPhD; Peng Gong, ProfPhD

2018-01-01

Summary: Background: Except for comparing the implementation costs of the Paris Agreement with potential health benefits at the national levels, previous studies have not explored the health impacts of the nationally determined contributions (NDCs) by countries and in regional details. In this Lancet Countdown study, we aimed to estimate and monetise the health benefits of China's NDCs in the electric power generation sector, and then compare them with the implementation costs, both at the n...

MRMC analysis of agreement studies

Science.gov (United States)

Gallas, Brandon D.; Anam, Amrita; Chen, Weijie; Wunderlich, Adam; Zhang, Zhiwei

2016-03-01

The purpose of this work is to present and evaluate methods based on U-statistics to compare intra- or inter-reader agreement across different imaging modalities. We apply these methods to multi-reader multi-case (MRMC) studies. We measure reader-averaged agreement and estimate its variance accounting for the variability from readers and cases (an MRMC analysis). In our application, pathologists (readers) evaluate patient tissue mounted on glass slides (cases) in two ways. They evaluate the slides on a microscope (reference modality) and they evaluate digital scans of the slides on a computer display (new modality). In the current work, we consider concordance as the agreement measure, but many of the concepts outlined here apply to other agreement measures. Concordance is the probability that two readers rank two cases in the same order. Concordance can be estimated with a U-statistic and thus it has some nice properties: it is unbiased, asymptotically normal, and its variance is given by an explicit formula. Another property of a U-statistic is that it is symmetric in its inputs; it doesn't matter which reader is listed first or which case is listed first, the result is the same. Using this property and a few tricks while building the U-statistic kernel for concordance, we get a mathematically tractable problem and efficient software. Simulations show that our variance and covariance estimates are unbiased.

Agreement between clients with schizophrenia and mental health workers on clients' social quality of life: The role of social cognition and symptoms.

Science.gov (United States)

Ofir-Eyal, Shani; Hasson-Ohayon, Ilanit; Bar-Kalifa, Eran; Kravetz, Shlomo; Lysaker, Paul H

2017-06-01

Studies have showed that therapists and mental health workers of persons with schizophrenia tend to estimate their patients' social quality of life (SQoL) as poorer than the clients' own estimation. This study explores the hypothesis that this discrepancy is related to clients' social cognition and symptomatology. Cross-sectional assessment of both clients and their mental health workers. Ninety persons with schizophrenia and 12 persons who were formal care providers participated in the study. All responded to a parallel version (client and clinician) of social quality-of-life scales. Clients' emotion identification, theory of mind and symptoms were also assessed. Low social cognitive abilities of persons with schizophrenia, as well as negative symptomatology and having children, may be related to the negative bias of mental health workers, with regard to their client's SQoL. While more severe levels of negative symptoms and more deficits of social cognition were related to reduced levels of agreement, paradoxically, a relatively normative family life that includes parenting was also related to lower levels of agreement. Attention should be given to low agreement between clients with schizophrenia and clinicians with regard to the client's quality of life, as it is central to alliance and outcome. Clinicians tend to estimate clients' social quality of life as poorer than the clients' own estimation when those clients have low social cognition, high negative symptomatology and children. There is a need to identify additional factors that contribute to agreement and alliance in therapy. Longitudinal assessment during therapy can trace the process of construction of agreement. © 2016 The British Psychological Society.

78 FR 49757 - Notification of an Expansion to the Cooperative Agreement Award to the World Health Organization

Science.gov (United States)

2013-08-15

... Award to the World Health Organization AGENCY: Biomedical Advanced Research and Development Authority... requires notification to World Health Organization (WHO) as soon as possible, and any confirmed smallpox... Services (HHS). ACTION: Notification of an expansion to the Cooperative Agreement Award to the World Health...

From conceptual pluralism to practical agreement on policy: global responsibility for global health.

Science.gov (United States)

Ruger, Jennifer Prah; Hammonds, Rachel; Ooms, Gorik; Barry, Donna; Chapman, Audrey; Van Damme, Wim

2015-10-28

As the human cost of the global economic crisis becomes apparent the ongoing discussions surrounding the post-2015 global development framework continue at a frenzied pace. Given the scale and scope of increased globalization moving forward in a post-Millennium Development Goals era, to protect and realize health equity for all people, has never been more challenging or more important. The unprecedented nature of global interdependence underscores the importance of proposing policy solutions that advance realizing global responsibility for global health. This article argues for advancing global responsibility for global health through the creation of a Global Fund for Health. It suggests harnessing the power of the exceptional response to the combined epidemics of AIDS, TB and Malaria, embodied in the Global Fund to Fight AIDS, Tuberculosis and Malaria, to realize an expanded, reconceptualized Global Fund for Health. However this proposal creates both an analytical quandary embedded in conceptual pluralism and a practical dilemma for the scope and raison d'etre of a new Global Fund for Health. To address these issues we offer a logical framework for moving from conceptual pluralism in the theories supporting global responsibility for health to practical agreement on policy to realize this end. We examine how the innovations flowing from this exceptional response can be coupled with recent ideas and concepts, for example a global social protection floor, a Global Health Constitution or a Framework Convention for Global Health, that share the global responsibility logic that underpins a Global Fund for Health. The 2014 Lancet Commission on Global Governance for Health Report asks whether a single global health protection fund would be better for global health than the current patchwork of global and national social transfers. We concur with this suggestion and argue that there is much room for practical agreement on a Global Fund for Health that moves from the

Health-Related Quality of Life in adolescent survivors of burns : Agreement on self-reported and mothers' and fathers' perspectives

NARCIS (Netherlands)

Pan, R.; Egberts, M.; Nascimento, L.C.; Rossi, L.A.; Vandermeulen, E.; Geenen, R.; Van Loey, N.E.E.

AIM: This study examined the agreement on self-reported Health-Related Quality of Life (HRQOL) between adolescents with burns and their mother's and father's observation at 6 and 18 months after the burn. Moreover, factors potentially influencing discrepancies between the adolescent and proxy

The vulnerability of being ill informed: the Trans-Pacific Partnership Agreement and Global Public Health.

Science.gov (United States)

Greenberg, Henry; Shiau, Stephanie

2014-09-01

The Trans Pacific Partnership Agreement (TPPA) is a regional trade agreement currently being negotiated by 11 Pacific Rim countries, excluding China. While the negotiations are being conducted under a veil of secrecy, substantive leaks over the past 4 years have revealed a broad view of the proposed contents. As it stands the TPPA poses serious risks to global public health, particularly chronic, non-communicable diseases. At greatest risk are national tobacco regulations, regulations governing the emergence of generic drugs and controls over food imports by transnational corporations. Aside from a small group of public health professionals from Australia, the academic public health community has missed these threats to the global community, although many other health-related entities, international lawyers and health-conscious politicians have voiced serious concerns. As of mid-2014 there has been no comment in the leading public health journals. This large lacuna in interest or recognition reflects the larger problem that the public health education community has all but ignored global non-communicable diseases. Without such a focus, the risks are unseen and the threats not perceived. This cautionary tale of the TPPA reflects the vulnerability of being ill informed of contemporary realities. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Review of occupational safety and health activities in Southern Africa funded under the DANIDA/ILO framework agreement on technical cooperation

DEFF Research Database (Denmark)

Hasle, Peter; Jørgensen, Claus

2003-01-01

A review of occupational safety and health activities in Southern Africa (SADC region) which have been funded under the DANIDA/ILO framework agreement on technical cooperation.......A review of occupational safety and health activities in Southern Africa (SADC region) which have been funded under the DANIDA/ILO framework agreement on technical cooperation....

48 CFR 1642.7001 - Management agreement.

Science.gov (United States)

2010-10-01

... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Management Agreement (in Lieu of Novation Agreement) 1642.7001 Management agreement. When it is in the best interest of... day-to-day performance of the contract. Examples of situations in which a Management Agreement may be...

Negative ethical behaviors in Saudi hospitals: How prevalent are they perceived to be? - Statement agreement study.

Science.gov (United States)

Fayez, R; Nawwab, A; Al-Jahdali, H; Baharoon, S; Binsalih, S; Al Sayyari, A

2013-07-01

There is limited information about the prevalence of unethical behavior and how is perceived among health care providers. The aim of this study is to assess such behavior and how is perceived. This is a cross-sectional study among three groups of professionals. Total participants were 370 and included medical staff, medical residents, and nurses in five medical specialties in four tertiary hospitals in Saudi Arabia (two Ministry of Health Hospitals and two military Hospitals). Participants were asked to rate their agreement with occurrence of 15 "negative" unethical behavior scenarios in their workplace. The scenarios covered areas of "respect for persons", "interprofessional relationships", and "empathy with patients". Majority of respondents agreed that "unethical" behavior occurred in their workplace, including confidentiality being compromised (36.3%), informed consent not taken properly (60.2%), and bad news not well-delivered (62.2%). Other significant area agreement included doctors lacking empathy (47.8%), patient autonomy not fully respected (42.5%), discrimination (41.2%), and being pressurized to write inaccurate reports (31.2%). Respondents in medicine had the lowest rate of agreement and those in psychiatry had the highest (mean of 49.8% and 82.3%, respectively). Respondents with length of employment of less than 6 years had significantly higher agreement that unethical behavior occurs compared to those with length of employment of more than 6 years. Males were more likely than females to agree that unethical behavior occurs. The biggest difference was seen in the behavior of "informed consent not properly taken" with a gender margin of 18.7% (P = 0.001). There is high prevalence of behavior that is considered unethical as perceived by various health care workers at Saudi hospitals.

The Trans-Pacific Partnership Agreement: challenges for Australian health and medicine policies.

Science.gov (United States)

Faunce, Thomas A; Townsend, Ruth

2011-01-17

Four formal rounds of Trans-Pacific Partnership Agreement (TPPA) negotiations took place in 2010. They involved over 200 officials from Australia, the United States, New Zealand, Chile, Singapore, Brunei, Peru, Vietnam and Malaysia. Future negotiations officially are set to include three issues with public health and medicines policy implications for Australia and our region: ways to approach regulatory coherence and transparency; how to benefit multinational and small-medium enterprises; and multilateral investor-state dispute settlement. US-based multinational pharmaceutical companies are lobbying for TPPA provisions like those in the Australia-US Free Trade Agreement, which reduce government cost-effectiveness regulatory control of pharmaceuticals, threatening equitable access to medicines. They also advocate increased TPPA intellectual monopoly privilege protection, which will further limit the development of Australian generic medicine enterprises and restrict patient access to cheap, bioequivalent prescription drugs. Of particular concern is that proposed TPPA multilateral investor-state dispute settlement procedures would allow US corporations (as well as those of other TPPA nations) to obtain damages against Australian governments through international arbitral proceedings if their investments are impeded by Australian public health and environment protection legislation.

Corporate Integrity Agreement (CIA) documents

Data.gov (United States)

U.S. Department of Health & Human Services — OIG negotiates corporate integrity agreements (CIA) with health care providers and other entities as part of the settlement of Federal health care program...

A longitudinal study of childhood social behaviour : Inter-informant agreement, inter-context agreement, and social preference linkages

NARCIS (Netherlands)

Kuppens, Sofie; Grietens, Hans; Onghena, Patrick; Michiels, Daisy

2009-01-01

This study examined inter-informant agreement, inter-context agreement, and social preference linkages for social behaviour subtypes. On two occasions, data was collected on 600 children (8-10 years old) via mother, father, teacher, and peer reports. Informant reports converged within each context

Health Impacts from Corn Production Pre-and Post-NAFTA Trade Agreement (1986-2013).

Science.gov (United States)

Mendoza-Cano, Oliver; Sánchez-Piña, Ramón Alberto; González-Ibarra, Álvaro Jesús; Murillo-Zamora, Efrén; Nava-Garibaldi, Cynthia Monique

2016-07-13

Life cycle assessment (LCA) is a powerful methodology for the study of health impacts and public policies. We performed this study to quantitatively explain the potential health impacts on disability-adjusted life years (DALYs) of corn produced in Mexico and imported from the United States of America (U.S.) from 1984 until 2014. The processes are hybrid and organic corn production. The functional unit was defined as 1 ton of corn production. Results indicate a total value of 178,431, 244,175, and 283,426 DALYs of three decades: 1984-1993, 1994-2003, and 2004-2013, of Mexican production; the U.S. production and transport were also calculated, showing values of 29,815, 65,837, and 107,729 for the same three decades. Additionally, DALYs were obtained for the category of human health and climate change by functional unit: 802.31 (1984-1993), 802.67 (1994-2003), and 803.92 (2004-2013), and for imported corn transported to Mexico from the U.S., 859.12 (1984-2013). DALYs on human toxicity were obtained: 99.05 (1984-1993), 99.05 (1994-2003), and 99.04 (2004-2013), and for the corn imported and transported to Mexico from the U.S., 116.25 (1984-2013). Environmental and health impacts in terms of DALYs are higher when corn is imported versus the corn produced in Mexico. Environmental health and nominal corn cultivation and transport impacts have increased as a result of the North American Free Trade Agreement (NAFTA). Mexico needs to redefine its public policies to suffer less of an environmental burden from corn to ensure global environmental health and food security.

International investment agreements and public health: neutralizing a threat through treaty drafting.

Science.gov (United States)

Mercurio, Bryan

2014-07-01

The high profile investment claims filed by Philip Morris challenging Uruguayan and Australian measures that restrict advertising and logos on tobacco packaging awakened the public health community to the existence and potential detrimental impact of international investment agreements (IIAs). More recently, Eli Lilly challenged Canada's invalidation of a pharmaceutical patent under an IIA. All of the cases claim that the intellectual property rights of the investor were infringed. As a result of these cases, many commentators and activists view IIAs as a threat to public health and have lobbied against their inclusion in ongoing trade negotiations. This article does not argue against IIAs. Instead, it seeks to demonstrate how more sophisticated treaty drafting can neutralize the threat to public health. In this regard, the article seeks to engage members of the public health community as campaigners not against IIAs but as advocates of better treaty drafting to ensure that IIAs do not infringe upon the right of a nation to take non-discriminatory measures for the promotion and protection of the health of their populations.

Protecting policy space for public health nutrition in an era of international investment agreements.

Science.gov (United States)

Thow, Anne Marie; McGrady, Benn

2014-02-01

Philip Morris has recently brought claims against Australia (2011) and Uruguay (2010) under international investment agreements (IIAs). The claims allege that Philip Morris is entitled to compensation following the introduction of innovative tobacco packaging regulations to reduce smoking and prevent noncommunicable diseases (NCDs). Since tobacco control measures are often viewed as a model for public health nutrition measures, the claims raise the question of how investment law governs the latter. This paper begins to answer this question and to explain how governments can proactively protect policy space for public health nutrition in an era of expanding IIAs. The authors first consider the main interventions proposed to reduce diet-related NCDs and their intersection with investment in the food supply chain. They then review the nature of investment regimes and relevant case law and examine ways to maximize policy space for public health nutrition intervention within this legal context. As foreign investment increases across the food-chain and more global recommendations discouraging the consumption of unhealthful products are issued, investment law will increase in importance as part of the legal architecture governing the food supply. The implications of investment law for public health nutrition measures depend on various factors: the measures themselves, the terms of the applicable agreements, the conditions surrounding the foreign investment and the policies governing agricultural support. This analysis suggests that governments should adopt proactive measures--e.g. the clarification of terms and reliance on exceptions--to manage investment and protect their regulatory autonomy with respect to public health nutrition.

Has the implementation of the TRIPS Agreement in Latin America and the Caribbean produced intellectual property legislation that favours public health?

Science.gov (United States)

Oliveira, Maria Auxiliadora; Bermudez, Jorge Antonio Zepeda; Chaves, Gabriela Costa; Velásquez, Germán

2004-11-01

The World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement establishes minimum standards for intellectual property rights, including patent protection for pharmaceuticals; therefore, it may make it difficult for developing countries to gain access to medicines, especially those countries that are the least developed. This study aims to determine whether implementation of the TRIPS Agreement in Latin American and Caribbean countries has generated patent legislation that is sensitive to public health needs. Legislation in 11 Latin American and Caribbean countries was analysed. The variables considered in the analysis were: the term of patents issued, patentable subject matter, transition periods (that is, time until legislation was enacted), reversal of the burden of proof of patent infringement, exhaustion of rights, compulsory licensing and the early working exception (which allows a country to complete all procedures necessary to register a generic product before the original patent expires). By 2000, all of the countries studied had reformed their legislation to conform to the agreement. Brazil and Argentina used the transition period until 2005 to grant patents in the pharmaceutical industry. All countries, except Panama, made use of the safeguards and flexibilities available through the agreement by including mechanisms for compulsory licensing in their legislation. Argentina; Bolivia, Colombia, Ecuador, Peru and Venezuela (countries that represented the Andean community); the Dominican Republic; and Panama included mechanisms to allow parallel importation. Mexico did not. Brazil only permits parallel importation after a compulsory licence has been issued. The early working exception is included in legislation in Brazil and the Dominican Republic. The countries in this study did not incorporate all of the mechanisms allowed for by the Agreement and are not adequately using the provisions that enable World Trade

Has the implementation of the TRIPS Agreement in Latin America and the Caribbean produced intellectual property legislation that favours public health?

Science.gov (United States)

Oliveira, Maria Auxiliadora; Bermudez, Jorge Antonio Zepeda; Chaves, Gabriela Costa; Velásquez, Germán

2004-01-01

OBJECTIVE: The World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement establishes minimum standards for intellectual property rights, including patent protection for pharmaceuticals; therefore, it may make it difficult for developing countries to gain access to medicines, especially those countries that are the least developed. This study aims to determine whether implementation of the TRIPS Agreement in Latin American and Caribbean countries has generated patent legislation that is sensitive to public health needs. METHODS: Legislation in 11 Latin American and Caribbean countries was analysed. The variables considered in the analysis were: the term of patents issued, patentable subject matter, transition periods (that is, time until legislation was enacted), reversal of the burden of proof of patent infringement, exhaustion of rights, compulsory licensing and the early working exception (which allows a country to complete all procedures necessary to register a generic product before the original patent expires). FINDINGS: By 2000, all of the countries studied had reformed their legislation to conform to the agreement. Brazil and Argentina used the transition period until 2005 to grant patents in the pharmaceutical industry. All countries, except Panama, made use of the safeguards and flexibilities available through the agreement by including mechanisms for compulsory licensing in their legislation. Argentina; Bolivia, Colombia, Ecuador, Peru and Venezuela (countries that represented the Andean community); the Dominican Republic; and Panama included mechanisms to allow parallel importation. Mexico did not. Brazil only permits parallel importation after a compulsory licence has been issued. The early working exception is included in legislation in Brazil and the Dominican Republic. CONCLUSION: The countries in this study did not incorporate all of the mechanisms allowed for by the Agreement and are not adequately using the

A proposal for measuring the degree of public health-sensitivity of patent legislation in the context of the WTO TRIPS Agreement.

Science.gov (United States)

Chaves, Gabriela Costa; Oliveira, Maria Auxiliadora

2007-01-01

This study aims to propose a framework for measuring the degree of public health-sensitivity of patent legislation reformed after the World Trade Organization's TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement entered into force. The methodology for establishing and testing the proposed framework involved three main steps:(1) a literature review on TRIPS flexibilities related to the protection of public health and provisions considered "TRIPS-plus"; (2) content validation through consensus techniques (an adaptation of Delphi method); and (3) an analysis of patent legislation from nineteen Latin American and Caribbean countries. The results show that the framework detected relevant differences in countries' patent legislation, allowing for country comparisons. The framework's potential usefulness in monitoring patent legislation changes arises from its clear parameters for measuring patent legislation's degree of health sensitivity. Nevertheless, it can be improved by including indicators related to government and organized society initiatives that minimize free-trade agreements' negative effects on access to medicines.

Agreement between children aged 5-6 years and their mothers in rating child oral health-related quality of life.

Science.gov (United States)

Abanto, Jenny; Tsakos, Georgios; Paiva, Saul Martins; Raggio, Daniela Prócida; Celiberti, Paula; Bönecker, Marcelo

2014-09-01

Studies have assessed parent-child agreement on ratings of school-aged children's OHRQoL. There are, however, no studies on children younger than 7 years of age. The aim was to assess the agreement between children aged 5-6 years and their mothers regarding child's oral health-related quality of life (OHRQoL). In this cross-sectional study, a total of 298 mother-child pairs (MCP), seeking the pediatric dental screening at the Dental School, University of São Paulo, completed the Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), validated for children aged 5-6 years in Brazil. Agreement between total and items' scores was assessed using comparison and correlation analyses, by comparing the mean directional differences and by computing the intraclass correlation coefficient (ICC) values, respectively. The mean directional difference in the total scores was 0.13 (CI 95% -0.076; 0.338) and therefore not significant for MCP. The mean absolute difference for MCP was 1.26, representing 11% of the maximum possible score. The ICC for total score was 0.84 (CI 95% 0.798; 0.867) for MCP. Mothers do rate their young children's OHRQoL similarly to children's self-reports. When assessing OHRQoL of children aged 5-6 years, mothers may be reliable proxies for their young children. © 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Monitoring the impacts of trade agreements on food environments.

Science.gov (United States)

Friel, S; Hattersley, L; Snowdon, W; Thow, A-M; Lobstein, T; Sanders, D; Barquera, S; Mohan, S; Hawkes, C; Kelly, B; Kumanyika, S; L'Abbe, M; Lee, A; Ma, J; Macmullan, J; Monteiro, C; Neal, B; Rayner, M; Sacks, G; Swinburn, B; Vandevijvere, S; Walker, C

2013-10-01

The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Analysis of agreement among definitions of metabolic syndrome in nondiabetic Turkish adults: a methodological study

Directory of Open Access Journals (Sweden)

Bersot Thomas P

2007-12-01

Full Text Available Abstract Background We aimed to explore the agreement among World Health Organization (WHO, European Group for the Study of Insulin Resistance (EGIR, National Cholesterol Education Program (NCEP, American College of Endocrinology (ACE, and International Diabetes Federation (IDF definitions of the metabolic syndrome. Methods 1568 subjects (532 men, 1036 women, mean age 45 and standard deviation (SD 13 years were evaluated in this cross-sectional, methodological study. Cardiometabolic risk factors were determined. Insulin sensitivity was calculated by HOMA-IR. Agreement among definitions was determined by the kappa statistic. ANOVA and post hoc Tukey's test were used to compare multiple groups. Results The agreement between WHO and EGIR definitions was very good (kappa: 0.83. The agreement between NCEP, ACE, and IDF definitions was substantial to very good (kappa: 0.77–0.84. The agreement between NCEP or ACE or IDF and WHO or EGIR definitions was fair (kappa: 0.32–0.37. The age and sex adjusted prevalence of metabolic syndrome was 38% by NCEP, 42% by ACE and IDF, 20% by EGIR and 19% by WHO definition. The evaluated definitions were dichotomized after analysis of design, agreement and prevalence: insulin measurement requiring definitions (WHO and EGIR and definitions not requiring insulin measurement (NCEP, ACE, IDF. One definition was selected from each set for comparison. WHO-defined subjects were more insulin resistant than subjects without the metabolic syndrome (mean and SD for log HOMA-IR, 0.53 ± 0.14 vs. 0.07 ± 0.23, respectively, p 0.05, but lower log HOMA-IR values (p Conclusion The metabolic syndrome definitions that do not require measurement of insulin levels (NCEP, ACE and IDF identify twice more patients with insulin resistance and increased Framingham risk scores and are more useful than the definitions that require measurement of insulin levels (WHO and EGIR.

FFTF Authorization Agreement

International Nuclear Information System (INIS)

DAUTEL, W.A.

2000-01-01

The purpose of the Authorization Agreement is to serve as a mechanism whereby the U.S. Department of Energy, Richland Operations Office (RL) and Fluor Hanford (FH) jointly clarify and agree to key conditions for conducting work safely and efficiently in the Fast Flux Test Facility (FFTF). Work must be accomplished in a manner that achieves high levels of quality while protecting the environment and the safety and health of workers and the public, and complying with applicable contractual and regulatory requirements. It is the intent of this Agreement to address those items of significant importance in establishing and supporting the FFTF Authorization Envelope, but this Agreement in no way alters the terms and conditions of the Project Hanford Management Contract (PHMC), Contract Number DE-AC06-96RL13200

76 FR 44958 - Solicitation for a Cooperative Agreement-Quarterly Publication of a “Corrections Mental Health...

Science.gov (United States)

2011-07-27

... Agreements,'' which will be included in the award package); (2) Adhere to best practices in technical writing... there evidence of experience in corrections, mental health, or technical writing that would demonstrate... at http://www.nicic.gov . All technical or programmatic questions concerning this announcement should...

Health Impacts from Corn Production Pre-and Post-NAFTA Trade Agreement (1986–2013)

Science.gov (United States)

Mendoza-Cano, Oliver; Sánchez-Piña, Ramón Alberto; González-Ibarra, Álvaro Jesús; Murillo-Zamora, Efrén; Nava-Garibaldi, Cynthia Monique

2016-01-01

Life cycle assessment (LCA) is a powerful methodology for the study of health impacts and public policies. We performed this study to quantitatively explain the potential health impacts on disability-adjusted life years (DALYs) of corn produced in Mexico and imported from the United States of America (U.S.) from 1984 until 2014. The processes are hybrid and organic corn production. The functional unit was defined as 1 ton of corn production. Results indicate a total value of 178,431, 244,175, and 283,426 DALYs of three decades: 1984–1993, 1994–2003, and 2004–2013, of Mexican production; the U.S. production and transport were also calculated, showing values of 29,815, 65,837, and 107,729 for the same three decades. Additionally, DALYs were obtained for the category of human health and climate change by functional unit: 802.31 (1984–1993), 802.67 (1994–2003), and 803.92 (2004–2013), and for imported corn transported to Mexico from the U.S., 859.12 (1984–2013). DALYs on human toxicity were obtained: 99.05 (1984–1993), 99.05 (1994–2003), and 99.04 (2004–2013), and for the corn imported and transported to Mexico from the U.S., 116.25 (1984–2013). Conclusions: Environmental and health impacts in terms of DALYs are higher when corn is imported versus the corn produced in Mexico. Environmental health and nominal corn cultivation and transport impacts have increased as a result of the North American Free Trade Agreement (NAFTA). Mexico needs to redefine its public policies to suffer less of an environmental burden from corn to ensure global environmental health and food security. PMID:27420088

Joint operating agreements - health and safety and employment issues

International Nuclear Information System (INIS)

Molnar, L.F.

1999-01-01

The extent of non-operator exposure to health and safety and other employment liability is considered. Under the terms of the Canadian Association of Petroleum Landman agreements, the designated operator is the sole employer for joint operations. By these terms, the placement of responsibility for employees involved in a joint operation appears clear. It is to rest with the operator alone. As such, one would expect that the non-operator would be free from liabilities arising out of the employment relations of a project. It has been held, in cases of interrelated companies, that an individual can be an employee of more than one company at the same time. Alberta's Occupational Health and Safety Act, as well as the similar Acts in other provinces, impose a hierarchy of duties and obligations not only on employers but also upon contractors, suppliers and workers to ensure that safety is secured. Relevant definitions in the Act state this. An employer of an employee is vicariously liable for torts committed by the employee in the course of his employment. The questions are asked of what happens if a non-operator lends an employee to the operator and the employee tortiously injures a third party, and if the temporary employer, the operator, becomes the employer in the event of vicarious liability. 20 refs

Data governance and data sharing agreements for community-wide health information exchange: lessons from the beacon communities.

Science.gov (United States)

Allen, Claudia; Des Jardins, Terrisca R; Heider, Arvela; Lyman, Kristin A; McWilliams, Lee; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Topper, Joan; Turske, Scott A

2014-01-01

Unprecedented efforts are underway across the United States to electronically capture and exchange health information to improve health care and population health, and reduce costs. This increased collection and sharing of electronic patient data raises several governance issues, including privacy, security, liability, and market competition. Those engaged in such efforts have had to develop data sharing agreements (DSAs) among entities involved in information exchange, many of whom are "nontraditional" health care entities and/or new partners. This paper shares lessons learned based on the experiences of six federally funded communities participating in the Beacon Community Cooperative Agreement Program, and offers guidance for navigating data governance issues and developing DSAs to facilitate community-wide health information exchange. While all entities involved in electronic data sharing must address governance issues and create DSAs accordingly, until recently little formal guidance existed for doing so - particularly for community-based initiatives. Despite this lack of guidance, together the Beacon Communities' experiences highlight promising strategies for navigating complex governance issues, which may be useful to other entities or communities initiating information exchange efforts to support delivery system transformation. For the past three years, AcademyHealth has provided technical assistance to most of the 17 Beacon Communities, 6 of whom contributed to this collaborative writing effort. Though these communities varied widely in terms of their demographics, resources, and Beacon-driven priorities, common themes emerged as they described their approaches to data governance and DSA development. The 6 Beacon Communities confirmed that DSAs are necessary to satisfy legal and market-based concerns, and they identified several specific issues, many of which have been noted by others involved in network data sharing initiatives. More importantly, these

Cross-national agreement on disability weights: the European Disability Weights Project

Directory of Open Access Journals (Sweden)

Burström Kristina

2003-11-01

Full Text Available Abstract Background Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods. Methods Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS; the time trade-off technique (TTO; and the person trade-off technique (PTO. Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed. Results A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52–0.62] with PTO to 0.72 [0.70–0.74] with VAS and 0.72 [0.69–0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58–0.68] with PTO to 0.73 [0.71–0.75] with VAS and 0.74 [0.72–0.77] with TTO. Conclusions Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation.

Agreement and Anti-Agreement in Berber: A Multiple-Feature Inheritance Account

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Saleem Abdelhady

2017-10-01

Full Text Available This study proposes understanding Agreement and Anti-Agreement in Berber from Multi-Feature Inheritance (MFI account following Branigan’s (2016 recent approach. The study aims to bridge a misunderstanding in the literature where it has been assumed that Feature Inheritance (FI can only account for Agreement relations while Anti-agreement relations can only be established by a direct Agree between C as a probe and its goal. Under MFI, it can be argued that FI can account for all aspects of Agreement/Anti-agreement. The study, therefore, presents a unification of the three mechanisms proposed by Ouali (2008. The new approach is tested on data from Berber.

REGIONAL TRADE AGREEMENTS AND COMPETITION POLICY. CASE STUDY: EU, ASEAN AND NAFTA

Directory of Open Access Journals (Sweden)

Fora Andreea-Florina

2014-07-01

Full Text Available The large number of regional trade agreements notified to the World Trade Organization (WTO significantly influenced the flow of world trade. By April 2014 there had been notified 583 regional trade agreements to the WTO, of which only 379 are in force. The objective of this paper is to highlight the importance of regional trade agreements in world trade, especially the importance of establishing a regional competition policy in these agreements. The research methodology used is the analysis of legislation governing preferential trade agreements at the level of WTO, the collection and interpretation of statistical data provided by the WTO Secretariat, the case study, namely the study of literature. The paper is structured in three parts. The first part of the paper examines the basic laws based on which regional trade agreements are notified to the WTO and the evolution of these agreements in the period 1958-2013. The second part of the paper is devoted to the analysis of competition policy in regional trade agreements. In this part of the paper, to highlight the patterns of competition policy adopted under these agreements was analyzed by three case studies of competition policy in the EU, ASEAN and NAFTA. The three case studies have revealed that the three preferential trade agreements present regional competition policies with varying degrees of integration. The most complex form of competition policy is found in the European Union, because we are talking about a centralized model of competition policy. ASEAN presents a partially decentralized model, while NAFTA scrolls with a decentralized model of competition policy. The last part of the paper presents the characteristics of the four models of competition policy identified in the preferential trade agreements in force. It should be emphasized that if the initial preferential trade agreements have not put a great emphasis on the rules of competition policy, practice has shown the importance

76 FR 54235 - Supplement to the FY2010 Single-Source Cooperative Agreement With the World Health Organization...

Science.gov (United States)

2011-08-31

...''. BARDA currently funds the development of vaccine manufacturing capacity in ten developing and emerging-economy countries worldwide via a cooperative agreement with the World Health Organization (WHO). The... Research and Development Authority was developed and has been operational [[Page 54236

International trade agreements challenge tobacco and alcohol control policies.

Science.gov (United States)

Zeigler, Donald W

2006-11-01

This report reviews aspects of trade agreements that challenge tobacco and alcohol control policies. Trade agreements reduce barriers, increase competition, lower prices and promote consumption. Conversely, tobacco and alcohol control measures seek to reduce access and consumption, raise prices and restrict advertising and promotion in order to reduce health and social problems. However, under current and pending international agreements, negotiated by trade experts without public health input, governments and corporations may challenge these protections as constraints on trade. Advocates must recognise the inherent conflicts between free trade and public health and work to exclude alcohol and tobacco from trade agreements. The Framework Convention on Tobacco Control has potential to protect tobacco policies and serve as a model for alcohol control.

Determinants of agreement between self-reported and parent-assessed quality of life for children in Germany-results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS

Directory of Open Access Journals (Sweden)

Ellert Ute

2011-11-01

Full Text Available Abstract Background The aim of this study is to quantify the level of agreement between self-reporting and proxy-assessment of children's health-related quality of life using KINDL-R in a large population based study in Germany and to identify factors which are associated with agreement. Methods The German Health Interview and Examination Survey for Children and Adolescents included the KINDL-R questionnaire on health-related quality of life. 6388 children and adolescents filled in the questionnaire while their parents answered the proxy version. Means and standard deviation for the self- and proxy ratings, and also the Pearson und Intra-Class correlation coefficients for the absolute agreement were calculated. The relationship between other variables and parent-child agreement were determined by means of logistic regression. Results In the 'Physical', 'Self-esteem' and 'School' dimension and for the 'Total' score, the parents significantly overestimated the quality of life of their child. In contrast, the quality of life of the children in the dimensions 'Psychological well-being' and 'Family' were considerably underestimated by the parents. The proportion of parent-child ratings in agreement (difference Conclusions Our study shows that parental reports cannot adequately replace self-assessment for 11-17 year olds. In view of the different underlying perspectives, the parental assessments should where possible only be regarded as providing supplementary information.

Level of agreement between patient and proxy responses to the EQ-5D health questionnaire 12 months after injury.

Science.gov (United States)

Gabbe, Belinda J; Lyons, Ronan A; Sutherland, Ann M; Hart, Melissa J; Cameron, Peter A

2012-04-01

Health-related quality of life represents a patient's experiences and expectations and should be collected from the patient. In trauma, collection of information from the patient can be challenging, particularly for subgroups where cognitive impairment is prevalent, increasing reliance on proxy reporting. This study assessed the agreement between patient and proxy reporting of health-related quality of life 12 months after injury. The Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry collect EQ-5D data at 12 months after injury. Cases where data were collected from the patient and proxy were extracted. Agreement between patient and proxy responses was compared using kappa (K) coefficients for the individual EQ-5D items, and Bland-Altman plots and Wilcoxon signed-rank tests for the EQ-5D summary score and visual analog scale (VAS). Agreement between patient and proxy respondents was substantial for the mobility (K = 0.61) and personal care items (K = 0.67) and moderate for the usual activities (K = 0.50), pain/discomfort (K = 0.42), and anxiety/depression items (K = 0.47). The mean difference between proxy and patient-reported scores for the VAS (0.74, 95% confidence interval: -2.73, 4.21) and the EQ-5D summary score (-0.02, 95% confidence interval: -0.07, 0.03) was small, but the limits of agreement were wide (-34.22 to 35.71 for VAS and -0.55 to 0.51 for summary score), suggesting no systematic bias. Although proxy and patient responses for the EQ-5D VAS may differ, the differences show random variability rather than systematic bias. Group comparisons using proxy responses are unlikely to be biased, but proxy responses should be used with caution when assessing individual patient recovery.

International trade agreements: a threat to tobacco control policy.

Science.gov (United States)

Shaffer, E R; Brenner, J E; Houston, T P

2005-08-01

International covenants establish a role for governments in ensuring the conditions for human health and wellbeing, which has been recognised as a central human right. International trade agreements, conversely, prioritize the rights of corporations over health and human rights. International trade agreements are threatening existing tobacco control policies and restrict the possibility of implementing new controls. This situation is unrecognised by many tobacco control advocates in signatory nations, especially those in developing countries. Recent agreements on eliminating various trade restrictions, including those on tobacco, have expanded far beyond simply international movement of goods to include internal tobacco distribution regulations and intellectual property rules regulating advertising and labelling. Our analysis shows that to the extent trade agreements protect the tobacco industry, in itself a deadly enterprise, they erode human rights principles and contribute to ill health. The tobacco industry has used trade policy to undermine effective barriers to tobacco importation. Trade negotiations provide an unwarranted opportunity for the tobacco industry to assert its interests without public scrutiny. Trade agreements provide the industry with additional tools to obstruct control policies in both developed and developing countries and at every level. The health community should become involved in reversing these trends, and help promote additional measures to protect public health.

A Comparative Study on Safeguards Implementation under Bilateral Nuclear Cooperation Agreements and the IAEA Comprehensive Safeguards Agreement

Energy Technology Data Exchange (ETDEWEB)

Jeon, Jihye; Kim, Ki-Hyun; Lee, Young Wook [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

2016-10-15

A Nuclear Cooperation Agreement (NCA) requires several conditions, so-called obligations, on the items under the agreement such as: 1) peaceful use, 2) retransfer consent, 3) consent prior to reprocessing or enrichment and 4) safeguards and security. These obligations of the NCAs are imposed by the supplier country. The Comprehensive Safeguards Agreement (CSA) between the International Atomic Energy Agency (IAEA) and its member states require similar activities. However, there is a significant gap in nuclear material accountancy between safeguards implementation under the NCA and CSA. The difference of those two frameworks is compared herein, focusing on the unique features of the NCA safeguards and its implications are presented. In this study, the NCAs between the ROK and Canada, Australia and US were analyzed since each of them is one of the ROK’s major nuclear trading partners. The safeguards implementation under the NCA is usually specified in an Administrative Arrangement (AA) under the Agreement. The ROK has two AAs in force with Canada and Australia among 29 countries with NCA. Recently, the AA with Canada was revised in December 2015, with those concepts mentioned above. The AA with the US is currently under discussion. Cooperation in nuclear energy between two countries could be further enhanced through reliable implementation of the NCA undertakings. Taking into account the unique features of the NCA, we need to establish effective strategy for fulfilling the obligation under the Agreement.

Protocol to monitor trade agreement food-related aspects: the Fiji case study.

Science.gov (United States)

Ravuvu, Amerita; Friel, Sharon; Thow, Anne Marie; Snowdon, Wendy; Wate, Jillian

2017-04-26

Despite the growing rates of obesity and diet-related non-communicable diseases, globally, public health attention has only relatively recently turned to the links between trade agreements and the nutritional risks associated with it. Specific trade agreements appear to have played an influential role in the volume and types of foods entering different countries, yet there is currently no systematic and objective monitoring of trade agreements for their impacts on food environments. Recently, INFORMAS was set up to monitor and benchmark food environments, government policies and private sector actions within countries and globally. One of its projects/modules focuses on trade policy and in particular the food-related aspects of trade agreements. This paper describes the INFORMAS trade protocol, an approach to collecting food-related information about four domains of trade: trade in goods; trade in services and foreign direct investment; domestic supports, and policy space. Specifically, the protocol is tested in Fiji. The development and testing of this protocol in Fiji represents the first effort to set out a framework and process for objectively monitoring trade agreements and their impacts on national food supply and the wider food environment. It has shown that entry into WTO trade agreements contributed to the nutrition transition in Fiji through the increased availability of imported foods with varying nutritional quality. We observed an increase in imports of both healthy and less healthy foods. The application of the monitoring protocol also highlights challenges for data collection associated with each trade domain that should be considered for future data collection and analysis in other low and middle income countries. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Study on the strategy of negotiation for Korea-Euratom Nuclear Cooperation Agreement

Energy Technology Data Exchange (ETDEWEB)

Soo, Ryu Jae; Lee, Gwang Seok; Lee, Hanmyung; Jun, Eunju; Lee, Dong Hoon

2012-09-15

We suggested the draft of Korea-EURATOM nuclear cooperation agreement that is expected to conclude in the near future by analyzing status and policy on the nuclear development and nuclear cooperation agreement in EURATOM. We expect that results of this study will propose basic strategy and direction of negotiations for Korea-EURATOM nuclear cooperation agreement in the near future.

7 CFR 301.91-6 - Compliance agreement and cancellation thereof.

Science.gov (United States)

2010-01-01

... Plant Health Inspection Service, Plant Protection and Quarantine, Domestic and Emergency Operations... agreement shall be a written agreement between a person engaged in such a business and Plant Protection and... PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE DOMESTIC QUARANTINE NOTICES European Larch...

[Innovative medicines and market access agreements].

Science.gov (United States)

Toumi, M; Zard, J; Duvillard, R; Jommi, C

2013-09-01

Market Access Agreements (MAA) for drugs have emerged in response to the need to control health expenditures, as well as to the uncertainty about the true benefit of a drug. It is possible to group MAA in two types of agreements: financial agreements and outcome-based agreements. MAA is a growing trend and is shifting towards conditional access. However, the willingness to use these contracts and their implementation differ across countries, and some are still resistant to put them in place. The MAA challenges to overcome encompass the complexity of the schemes, the administrative burden and the difficulty of evaluating MAA. It is likely that these agreements might experience further evolution in the future to become a faster pathway for therapeutic innovations, at a fair price. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study.

Science.gov (United States)

McArdle, Patrick F; Kittner, Steven J; Ay, Hakan; Brown, Robert D; Meschia, James F; Rundek, Tatjana; Wassertheil-Smoller, Sylvia; Woo, Daniel; Andsberg, Gunnar; Biffi, Alessandro; Brenner, David A; Cole, John W; Corriveau, Roderick; de Bakker, Paul I W; Delavaran, Hossein; Dichgans, Martin; Grewal, Raji P; Gwinn, Katrina; Huq, Mohammed; Jern, Christina; Jimenez-Conde, Jordi; Jood, Katarina; Kaplan, Robert C; Katschnig, Petra; Katsnelson, Michael; Labovitz, Daniel L; Lemmens, Robin; Li, Linxin; Lindgren, Arne; Markus, Hugh S; Peddareddygari, Leema R; Pedersén, Annie; Pera, Joanna; Redfors, Petra; Roquer, Jaume; Rosand, Jonathan; Rost, Natalia S; Rothwell, Peter M; Sacco, Ralph L; Sharma, Pankaj; Slowik, Agnieszka; Sudlow, Cathie; Thijs, Vincent; Tiedt, Steffen; Valenti, Raffaella; Worrall, Bradford B

2014-10-28

The objective of this study was to assess the level of agreement between stroke subtype classifications made using the Trial of Org 10172 Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Study subjects included 13,596 adult men and women accrued from 20 US and European genetic research centers participating in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN). All cases had independently classified TOAST and CCS stroke subtypes. Kappa statistics were calculated for the 5 major ischemic stroke subtypes common to both systems. The overall agreement between TOAST and CCS was moderate (agreement rate, 70%; κ = 0.59, 95% confidence interval [CI] 0.58-0.60). Agreement varied widely across study sites, ranging from 28% to 90%. Agreement on specific subtypes was highest for large-artery atherosclerosis (κ = 0.71, 95% CI 0.69-0.73) and lowest for small-artery occlusion (κ = 0.56, 95% CI 0.54-0.58). Agreement between TOAST and CCS diagnoses was moderate. Caution is warranted when comparing or combining results based on the 2 systems. Replication of study results, for example, genome-wide association studies, should utilize phenotypes determined by the same classification system, ideally applied in the same manner. © 2014 American Academy of Neurology.

Systematic reviews need to consider applicability to disadvantaged populations: inter-rater agreement for a health equity plausibility algorithm.

Science.gov (United States)

Welch, Vivian; Brand, Kevin; Kristjansson, Elizabeth; Smylie, Janet; Wells, George; Tugwell, Peter

2012-12-19

Systematic reviews have been challenged to consider effects on disadvantaged groups. A priori specification of subgroup analyses is recommended to increase the credibility of these analyses. This study aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations (only relative effect measures were addressed). A health equity plausibility algorithm was developed using clinimetric methods with three items based on literature review, key informant interviews and methodology studies. The three items dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: 1) patient characteristics; 2) intervention delivery (i.e., implementation); and 3) comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. We assessed inter-rater reliability using Fleiss multi-rater kappa. The proportion agreement was 66% for patient characteristics (95% confidence interval: 61%-71%), 67% for intervention delivery (95% confidence interval: 62% to 72%) and 55% for the comparator (95% confidence interval: 50% to 60%). Inter-rater kappa, assessed with Fleiss kappa, ranged from 0 to 0.199, representing very low agreement beyond chance. Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this

42 CFR 137.336 - What is the difference between fixed-price and cost-reimbursement agreements?

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What is the difference between fixed-price and cost-reimbursement agreements? 137.336 Section 137.336 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND...-reimbursement agreements? (a) Cost-reimbursement agreements generally have one or more of the following...

Agreement among the Productivity Components of Eight Presenteeism Tests in a Sample of Health Care Workers.

Science.gov (United States)

Thompson, Angus H; Waye, Arianna

2018-06-01

Presenteeism (reduced productivity at work) is thought to be responsible for large economic costs. Nevertheless, much of the research supporting this is based on self-report questionnaires that have not been adequately evaluated. To examine the level of agreement among leading tests of presenteeism and to determine the inter-relationship of the two productivity subcategories, amount and quality, within the context of construct validity and method variance. Just under 500 health care workers from an urban health area were asked to complete a questionnaire containing the productivity items from eight presenteeism instruments. The analysis included an examination of test intercorrelations, separately for amount and quality, supplemented by principal-component analyses to determine whether either construct could be described by a single factor. A multitest, multiconstruct analysis was performed on the four tests that assessed both amount and quality to test for the relative contributions of construct and method variance. A total of 137 questionnaires were completed. Agreement among tests was positive, but modest. Pearson r ranges were 0 to 0.64 (mean = 0.32) for Amount and 0.03 to 0.38 (mean = 0.25) for Quality. Further analysis suggested that agreement was influenced more by method variance than by the productivity constructs the tests were designed to measure. The results suggest that presenteeism tests do not accurately assess work performance. Given their importance in the determination of policy-relevant conclusions, attention needs to be given to test improvement in the context of criterion validity assessment. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Stool frequency recording in severe acute malnutrition ('StoolSAM'); an agreement study comparing maternal recall versus direct observation using diapers.

Science.gov (United States)

Voskuijl, Wieger; Potani, Isabel; Bandsma, Robert; Baan, Anne; White, Sarah; Bourdon, Celine; Kerac, Marko

2017-06-07

Approximately 50% of the deaths of children under the age of 5 can be attributed to undernutrition, which also encompasses severe acute malnutrition (SAM). Diarrhoea is strongly associated with these deaths and is commonly diagnosed solely based on stool frequency and consistency obtained through maternal recall. This trial aims to determine whether this approach is equivalent to a 'directly observed method' in which a health care worker directly observed stool frequency using diapers in hospitalised children with complicated SAM. This study was conducted at 'Moyo' Nutritional Rehabilitation Unit, Queen Elizabeth Central Hospital, Malawi. Participants were children aged 5-59 months admitted with SAM. We compared 2 days of stool frequency data obtained with next-day maternal-recall versus a 'gold standard' in which a health care worker observed stool frequency every 2 h using diapers. After study completion, guardians were asked their preferred method and their level of education. We found poor agreement between maternal recall and the 'gold standard' of directly observed diapers. The sensitivity to detect diarrhoea based on maternal recall was poor, with only 75 and 56% of diarrhoea cases identified on days 1 and 2, respectively. However, the specificity was higher with more than 80% of children correctly classified as not having diarrhoea. On day 1, the mean stool frequency difference between the two methods was -0.17 (SD; 1.68) with limits of agreement (of stool frequency) of -3.55 and 3.20 and, similarly on day 2, the mean difference was -0.2 (SD; 1.59) with limits of agreement of -3.38 and 2.98. These limits extend beyond the pre-specified 'acceptable' limits of agreement (±1.5 stool per day) and indicate that the 2 methods are non-equivalent. The higher the stool frequency, the more discrepant the two methods were. Most primary care givers strongly preferred using diapers. This study shows lack of agreement between the assessment of stool frequency in SAM

48 CFR 1652.204-74 - Large provider agreements.

Science.gov (United States)

2010-10-01

... FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CLAUSES AND FORMS CONTRACT CLAUSES Texts of FEHBP... Large Provider Agreement; and (ii) Not less than 60 days before exercising a renewal or other option, or... exercising a simple renewal or other option contemplated by a Large Provider Agreement that OPM previously...

42 CFR 416.30 - Terms of agreement with CMS.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Terms of agreement with CMS. 416.30 Section 416.30... of agreement with CMS. As part of the agreement under § 416.26 the ASC must agree to the following... in subpart C of this part and to report promptly to CMS any failure to do so. (b) Limitation on...

42 CFR 137.362 - May construction project agreements be amended?

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May construction project agreements be amended? 137... of the Secretary in Establishing and Implementing Construction Project Agreements § 137.362 May construction project agreements be amended? Yes, the Self-Governance Tribe, at its discretion, may request the...

Agreements

International Nuclear Information System (INIS)

2001-01-01

These columns summarize the different bilateral and multilateral agreements concluded recently between the different OECD countries and concerning the nuclear energy domain: Argentina - Australia: Agreement concerning Co-operation in the Peaceful Uses of Nuclear Energy (2001). Argentina - Brazil: Joint Declaration regarding the Creation of the Argentinean-Brazilian Agency for Nuclear Energy Applications (2001). Australia - Czech Republic / Australia - Hungary: Agreements on Co-operation in Peaceful Uses of Nuclear Energy and the Transfer of Nuclear Material (2001). Australia - Indonesia: Arrangement Concerning Co-operation on Nuclear Safeguards and Related Matters (2001). Austria - Switzerland: Agreement on the Early Exchange of Information in the Field of Nuclear Safety and Radiation. Brazil - United States: Extension of the Agreement concerning Research and Development in Nuclear Material Control, Accountancy, Verification, Physical Protection, and Advanced Containment and Surveillance Technologies for International Safeguards Applications (2001). Czech Republic - Republic of Korea: Agreement for Co-operation in the Peaceful Uses of Nuclear Energy (2001). European Union- Russian Federation: Agreements on Nuclear Safety and Controlled Nuclear Fusion (2001). France - United States: Agreement for Co-operation in Advanced Nuclear Reactor Science and Technology (2001). Japan - United Kingdom: Co-operation Agreement on Advanced Nuclear Fuel Cycle, Fast Breeder Reactor and Other Related Technologies (2001). Republic OF Korea - United States: Annex IV Joint Project on Cintichem Technology (2000). Morocco - United States: Protocol amending the Co-operation Agreement on the Peaceful Uses of Nuclear Energy (2001). Multilateral Agreements: Agreement for Information Exchange on Radiological Surveillance in Northern Europe (2001). Status of Conventions in the Field of Nuclear Energy. (author)

Nutrition issues in Codex: health claims, nutrient reference values and WTO agreements: a conference report.

Science.gov (United States)

Aggett, Peter J; Hathcock, John; Jukes, David; Richardson, David P; Calder, Philip C; Bischoff-Ferrari, Heike; Nicklas, Theresa; Mühlebach, Stefan; Kwon, Oran; Lewis, Janine; Lugard, Maurits J F; Prock, Peter

2012-03-01

Codex documents may be used as educational and consensus materials for member governments. Also, the WTO SPS Agreement recognizes Codex as the presumptive international authority on food issues. Nutrient bioavailability is a critical factor in determining the ability of nutrients to provide beneficial effects. Bioavailability also influences the quantitative dietary requirements that are the basis of nutrient intake recommendations and NRVs. Codex, EFSA and some national regulatory authorities have established guidelines or regulations that will permit several types of health claims. The scientific basis for claims has been established by the US FDA and EFSA, but not yet by Codex. Evidence-based nutrition differs from evidence-based medicine, but the differences are only recently gaining recognition. Health claims on foods may provide useful information to consumers, but many will interpret the information to mean that they can rely upon the food or nutrient to eliminate a disease risk. NRVs are designed to provide a quantitative basis for comparing the nutritive values of foods, helping to illustrate how specific foods fit into the overall diet. The INL-98 and the mean of adult male and female values provide NRVs that are sufficient when used as targets for individual intakes by most adults. WTO recognizes Codex as the primary international authority on food issues. Current regulatory schemes based on recommended dietary allowances are trade restrictive. A substantial number of decisions by the EFSA could lead to violation of WTO agreements.

Main meal frequency measures in the Health Behaviour in School-aged Children study

DEFF Research Database (Denmark)

Pedersen, Trine Pagh; Holstein, Bjørn E; Laursen, Bjarne

2015-01-01

OBJECTIVES: To estimate agreement between questionnaire-based frequency measures from the Health Behaviour in School-aged Children study (HBSC) and 7-day 24-h recall measures of breakfast, lunch and evening meals among 11-15-year-olds, and examine whether disagreement between the two methods varied...... for the breakfast measure: per cent agreement 0.70-0.87, kappa 0.43-0.65. Fair agreement for the lunch measure: per cent agreement 0.53-0.84, kappa 0.26-0.54. High per cent agreement for the evening meal measure (0.83-0.95) but poor kappa agreement (0.14-0.19). Being immigrant predicted disagreement between the two...... methods for week day breakfast OR (95 % CI) 2.17 (1.16-4.04) and lunch 2.44 (1.33-4.48). CONCLUSIONS: We found good to moderate agreement between frequency and 7-day 24-h recall measures for breakfast, a fair agreement for lunch and for evening meal the two agreement methods provided different results...

Potential Accession to the WTO Government Procurement Agreement: A Case-Study on India

OpenAIRE

Sangeeta Khorana; Sujitha Subramanian

2012-01-01

The World Trade Organization (WTO) Government Procurement Agreement (GPA) is a voluntary plurilateral agreement applicable to WTO members that choose to be Parties to the Agreement. Most developing countries, including India, are not members of the GPA. This case study presents an insight into India's current procurement framework, evaluates the prospects for, and comments on the principal constraints and challenges to India's GPA accession. The findings suggest that, though the Indian procur...

Ex-ante Study of a Possible Modernisation of the EU-Chile Association Agreement

NARCIS (Netherlands)

Henry de Frahan, Bruno; Hartwell, Christopher; Kuik, O.J.; Lirette, Paul; Mirecka, Katarzyna; Nolan Garcia, Kimberly; Pellandra, Andrea; Polanco, Rodrigo; Schmidt-Hebbel, Klaus; Shuvaieva, Iryna; Sidlo, Kataryna; Teresinski, Jan; Torrent, Ramon; Valdes, Albert

This study provides an ex-ante impact assessment of the possible modernisation of the EU-Chile Association Agreement. Since the current agreement entered into force in 2003, Chilean exports of agricultural/food products and services to the EU have nearly tripled while EU exports to Chile have

Good agreement between questionnaire and administrative databases for health care use and costs in patients with osteoarthritis

Directory of Open Access Journals (Sweden)

Robertson M Clare

2011-04-01

Full Text Available Abstract Background Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representation of health care costs; however the validity and feasibility of such methods have not been firmly established. This study was conducted to assess the validity and feasibility of using a patient-completed questionnaire to capture health care use and costs for patients with osteoarthritis, and to compare the research costs of the data-capture methods. Methods We designed a patient questionnaire and applied it in a clinical trial. We captured equivalent data from four administrative databases. We evaluated aspects of the questionnaire's validity using sensitivity and specificity, Lin's concordance correlation coefficient (ρc, and Bland-Altman comparisons. Results The questionnaire's response rate was 89%. Acceptable sensitivity and specificity levels were found for all types of health care use. The numbers of visits and the majority of medications reported by patients were in agreement with the database-derived estimates (ρc > 0.40. Total cost estimates from the questionnaire agreed with those from the databases. Patient-reported co-payments agreed with administrative records with respect to GP office transactions, but not pharmaceutical co-payments. Research costs for the questionnaire-based method were less than one-third of the costs for the databases method. Conclusion A patient-completed questionnaire is feasible for capturing health care use and costs for patients with osteoarthritis, and data collected using it mostly agree with administrative databases. Caution should be exercised when applying unit costs and collecting co-payment data.

CHARACTERISTICS OF MANAGED ENTRY AGREEMENTS IN AUSTRALIA.

Science.gov (United States)

Robinson, Maxine F; Mihalopoulos, Cathrine; Merlin, Tracy; Roughead, Elizabeth

2018-01-01

Australia relies on managed entry agreements (MEAs) for many medicines added to the national Pharmaceutical Benefits Scheme (PBS). Previous studies of Australian MEAs examined public domain documents and were not able to provide a comprehensive assessment of the types and operation of MEAs. This study used government documents approved for release to examine the implementation and administration of MEAs implemented January 2012 to May 2016. We accessed documents for medicines with MEAs on the PBS between January 2012 and May 2016. Data were extracted on Anatomical Therapeutic Classification (ATC), type of MEA (financial, financial with outcomes, outcomes, and subcategories within each group), implementation and administration methods, source of MEA recommendation, and type of economic analysis. Of all medication indication pairs (MIPs) recommended for listing, one-third had MEAs implemented. Our study of eighty-seven MIPs had 170 MEAs in place. The Government's expert health technology assessment (HTA) committee recommended MEAs for 90 percent of the eighty-seven MIPs. A total of 81 percent of MEAs were simple financial agreements: the majority either discounts (32 percent) or reimbursement caps (43 percent). Outcome-based MEAs were least common (5 percent). Ninety-two percent of MEAs were implemented and operated through legal agreements. Approximately half of the MIPs were listed on the basis of accepted claims of cost-minimization. Forty-nine percent of medicines were in ATC L group. Advice from HTA evaluations strongly influences the implementation of ways to manage uncertainties while providing access to medicines. The government relied primarily on simple financial agreements for the managed entry of medicines for which there were perceived risks.

International standards and agreements in food irradiation

International Nuclear Information System (INIS)

Cetinkaya, N.

2004-01-01

The economies of both developed and developing countries have been effected by their exported food and agricultural products. Trading policies of food and agricultural products are governed by international agreement as well as national regulations. Trade in food and agricultural commodities may be affected by both principal Agreements within the overall World Trade Organization (WTO) Agreement, though neither specifically refers to irradiation or irradiated foods. The principal Agreements are the Technical Barriers to Trade (TBT) Agreement and the Sanitary and Phyto sanitary (SPS) Agreement. The SPS of the WTO requires governments to harmonize their sanitary and phyto sanitary measures on as wide basis as possible. Related standards, guidelines and recommendations of international standard setting bodies such as the Codex Alimentarius Commission (food safety); the International Plant Protection Convention (IPPC) (plant health and quarantine); and International Office of Epizootic (animal health and zoo noses) should be used in such a harmonization. International Standards for Phyto sanitary Measures (ISPM) no.18 was published under the IPPC by FAO (April 2003, Rome-Italy). ISPM standard provides technical guidance on the specific procedure for the application of ionizing radiation as a phyto sanitary treatment for regulated pests or articles. Moreover, Codex Alimentarius Commission, Codex General Standard for Irradiated Foods (Stand 106-1983) and Recommended International Code of Practice were first published in 1983 and revised in March 2003. Scope of this standard applies to foods processed by ionizing radiation that is used in conjunction with applicable hygienic codes, food standards and transportation codes. It does not apply to foods exposed to doses imparted by measuring instruments used for inspection purposes. Codex documents on Principles and Guidelines for the Import/Export Inspection and Certification of Foods have been prepared to guide international

Poor agreement between operators on grading of the placenta.

LENUS (Irish Health Repository)

Moran, M

2011-01-01

Abnormal placental grading is associated with poor pregnancy outcome. The aim of this study was to measure intra- and interobserver variability in placental grading. Five expert sonographers independently graded 90 images on two occasions, each viewing separated by 1 week. A number of measures were employed to standardise assessment and minimise potential for variation: prior agreement was established between observers on the classifications for placental grading; a controlled viewing laboratory was used for all viewings; ambient lighting was optimal and monitors were calibrated to the GSDF standard. Kappa (κ) analysis was used to measure observer agreement. Substantial variations between individuals\\' scores were observed. A mean κ-value of 0.34 (range from 0.19 to 0.50) indicated fair interobserver agreement over the two occasions and only nine of the 90 images were graded the same by all five observers. Intraobserver agreement had a moderate mean κ-value of 0.52, with individual comparisons ranging from 0.45 to 0.66. This study demonstrates that, despite standardised viewing conditions, Grannum grading of the placenta is not a reliable technique even among expert observers. The need for new methods to assess placental health is required and work is ongoing to develop 2D and 3D software-based methods.

Interjudge agreement in videofluoroscopic studies of swallowing.

Science.gov (United States)

Wilcox, F; Liss, J M; Siegel, G M

1996-02-01

Videofluoroscopic swallowing examinations of 3 patients with dysphagia were reviewed independently by 10 speech-language pathologists. Prior to viewing each video, clinicians were provided with information about the patient's history, the results of a bedside swallow examination, and oral-facial and oral motor control examinations. Clinicians completed a swallowing observation protocol as they viewed each video. They then recommended, from a list of treatment strategies, intervention techniques that would be most appropriate for each patient. Interjudge agreement was calculated by determining how many clinicians observed a given swallowing event or deficit, and how many recommended a given treatment strategy. Results suggest that the level of interjudge agreement for videofluoroscopic evaluations is not encouragingly high.

Health behavior-related indicator of lifestyle: application in the ELSA-Brasil study.

Science.gov (United States)

Patrão, Ana Luísa; Almeida, Maria-da-Conceição C; Alvim, Sheila; Chor, Dora; Aquino, Estela M L

2018-05-01

Various behaviors are considered health enhancing. Nevertheless, according to the current scientific literature, four health behaviors are considered particularly risky in view of their association with a group of chronic diseases: 1) smoking; 2) excessive alcohol consumption; 3) poor diet; and 4) lack of physical activity. Theoretically, it should be possible to make improvements to one's health by maximizing the number of healthy behaviors and minimizing the unhealthy ones. However, in reality, the different behaviors interconnect to create more complex lifestyles. Therefore, the objective of this paper is to present the construction of a lifestyle indicator based on health behaviors selected in the ELSA-Brazil study. This indicator revealed two lifestyles: less healthy and healthier lifestyles. The model proved adequate and was confirmed using latent class analysis (LCA). Agreement was 83.2 between the indicator and the LCA results, with a kappa coefficient of 0.65. Women were more likely to have a healthier lifestyle than men, reinforcing the scientific consistency of the indicator, since this finding is in agreement with data from the scientific literature. The indicator created to define lifestyle was found to have scientific consistency and validity; therefore, its use can be recommended for future population-based studies concerning the promotion of health and healthy lifestyles.

What principles should govern the use of managed entry agreements?

Science.gov (United States)

Klemp, Marianne; Frønsdal, Katrine B; Facey, Karen

2011-01-01

To ensure rapid access to new potentially beneficial health technologies, obtain best value for money, and ensure affordability, healthcare payers are adopting a range of innovative reimbursement approaches that may be called Managed Entry Agreements (MEAs). The Health Technology Assessment International (HTAi) Policy Forum sought to identify why MEAs might be used, issues associated with implementation and develop principles for their use. A 2-day deliberative workshop discussed key papers, members' experiences, and collectively addressed four policy questions that resulted in this study. MEAs are used to give access to new technologies where traditional reimbursement is deemed inappropriate. Three different forms of MEAs have been identified: management of budget impact, management of uncertainty relating to clinical and/or cost-effectiveness, and management of utilization to optimize performance. The rationale for using these approaches and their advantages and disadvantages differ. However, all forms of MEA should take the form of a formal written agreement among stakeholders, clearly identifying the rationale for the agreement, aspects to be assessed, methods of data collection and review, and the criteria for ending the agreement. MEAs should only be used when HTA identifies issues or concerns about key outcomes and/or costs and/or organizational/budget impacts that are material to a reimbursement decision. They provide patient access and can be useful to manage technology diffusion and optimize use. However, they are administratively complex and may be difficult to negotiate and their effectiveness has yet to be evaluated.

Tennessee health studies agreement. Annual report for year 5, January 1 - December 31, 1996

International Nuclear Information System (INIS)

1997-05-01

This report summarizes the Oak Ridge Health Studies project for the period January 1, 1996, to December 31, 1996. Attention is focused on dose reconstruction which is comprised of seven separate tasks. They are: Task 1, investigation of radioiodine from radioactive lanthanum processing; Task 2, investigation of mercury releases from lithium enrichment; Task 3, investigation of releases of PCBs from Oak Ridge facilities; Task 4, investigation of releases of radionuclides from White Oak Creek to the Clinch River; Task 5, plan to perform a systematic document search; Task 6, investigation of the quality of historical uranium effluent monitoring of Oak Ridge facilities; and Task 7, additional screening of materials not evaluated in the dose reconstruction feasibility study

Tennessee health studies agreement. Annual report for year 5, January 1--December 31, 1996

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-05-01

This report summarizes the Oak Ridge Health Studies project for the period January 1, 1996, to December 31, 1996. Attention is focused on dose reconstruction which is comprised of seven separate tasks. They are: Task 1, investigation of radioiodine from radioactive lanthanum processing; Task 2, investigation of mercury releases from lithium enrichment; Task 3, investigation of releases of PCBs from Oak Ridge facilities; Task 4, investigation of releases of radionuclides from White Oak Creek to the Clinch River; Task 5, plan to perform a systematic document search; Task 6, investigation of the quality of historical uranium effluent monitoring of Oak Ridge facilities; and Task 7, additional screening of materials not evaluated in the dose reconstruction feasibility study.

Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study.

Science.gov (United States)

Wang, Jiana; Liu, Li; Wu, Hui; Yang, Xiaoshi; Wang, Yang; Wang, Lie

2014-04-15

Most studies about informant agreements on adolescents' emotional and behavioral problems have been conducted in Western countries, but this subject has not been well researched in China. The aim of this study was to evaluate the pattern of parent-adolescent agreement on adolescents' problems and its associated factors among school-age adolescents in China. This cross-sectional study was conducted in November and December of 2010. A questionnaire including the Child Behavior Checklist (CBCL), the Youth Self-Report (YSR), the Family Environment Scale (FES) and the characteristics of the child (age and gender), parents (parent-adolescent relationship and parental expectations) and family (family structure, negative life events) was distributed to our study population. A total of 2,199 Chinese adolescents (aged 11-18) from 15 public schools in Liaoning Province, who completed the questionnaire, became our final participants. Pearson's correlation coefficient was used to assess parent-adolescent agreement, and linear regression analysis was used to explore the associated factors of parent-adolescent discrepancies on emotional and behavioral problems. The parent-adolescent agreement on emotional and behavioral problems was high (mean r = 0.6). The scores of YSR were higher than those of CBCL. Factors that increased informant discrepancies on emotional and behavioral problems were boys, older age, the experience of negative life events, low levels of cohesion and organization, and high levels of conflict in the family. A high level of parent-adolescent agreement on emotional and behavioral problems was found. Adolescents reported more problems than their parents did. Family environment is an important factor to be considered when interpreting informant discrepancies on the mental health of Chinese adolescents.

International Fisheries Agreements

DEFF Research Database (Denmark)

Pintassilgo, Pedro; Kronbak, Lone Grønbæk; Lindroos, Marko

2015-01-01

This paper surveys the application of game theory to the economic analysis of international fisheries agreements. The relevance of this study comes not only from the existence of a vast literature on the topic but especially from the specific features of these agreements. The emphasis of the survey...... is on coalition games, an approach that has become prominent in the fisheries economics literature over the last decade. It is shown that coalition games were first applied to international fisheries agreements in the late 1990s addressing cooperative issues under the framework of characteristic function games...... and stability of international fisheries agreements. A key message that emerges from this literature strand is that self-enforcing cooperative management of internationally shared fish stocks is generally difficult to achieve. Hence, the international legal framework and regulations play a decisive role...

Exploring rater agreement: configurations of agreement and disagreement

Directory of Open Access Journals (Sweden)

ALEXANDER VON EYE

2006-03-01

Full Text Available At the level of manifest categorical variables, a large number of coefficients and models for the examination of rater agreement has been proposed and used for descriptive and explanatory purposes. This article focuses on exploring rater agreement. Configural Frequency Analysis (CFA is proposed as a method of exploration of cross-classifications of raters’ judgements. CFA allows researchers to (1 examine individual cells and sets of cells in agreement tables; (2 examine cells that indicate disagreement; and (3 explore agreement and disagreement among three or more raters. Four CFA base models are discussed. The first is the model of rater agreement that is also used for Cohen’s (1960  (kappa. This model proposes independence of raters’ judgements. Deviations from this model suggest agreement or disagreement beyond chance. The second CFA model is based on a log-linear null model. This model is also used for Brennan and Prediger’s (1981 n. It proposes a uniform distribution of ratings. The third model is that of Tanner and Young (1985. This model proposes equal weights for agreement cases and independence otherwise. The fourth model is the quasi-independence model. This model allows one to blank out agreement cells and thus to focus solely on patterns of disagreement. Examples use data from applicant selection.

Development of a diagnostic test set to assess agreement in breast pathology: practical application of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS).

Science.gov (United States)

Oster, Natalia V; Carney, Patricia A; Allison, Kimberly H; Weaver, Donald L; Reisch, Lisa M; Longton, Gary; Onega, Tracy; Pepe, Margaret; Geller, Berta M; Nelson, Heidi D; Ross, Tyler R; Tosteson, Aanna N A; Elmore, Joann G

2013-02-05

Diagnostic test sets are a valuable research tool that contributes importantly to the validity and reliability of studies that assess agreement in breast pathology. In order to fully understand the strengths and weaknesses of any agreement and reliability study, however, the methods should be fully reported. In this paper we provide a step-by-step description of the methods used to create four complex test sets for a study of diagnostic agreement among pathologists interpreting breast biopsy specimens. We use the newly developed Guidelines for Reporting Reliability and Agreement Studies (GRRAS) as a basis to report these methods. Breast tissue biopsies were selected from the National Cancer Institute-funded Breast Cancer Surveillance Consortium sites. We used a random sampling stratified according to woman's age (40-49 vs. ≥50), parenchymal breast density (low vs. high) and interpretation of the original pathologist. A 3-member panel of expert breast pathologists first independently interpreted each case using five primary diagnostic categories (non-proliferative changes, proliferative changes without atypia, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma). When the experts did not unanimously agree on a case diagnosis a modified Delphi method was used to determine the reference standard consensus diagnosis. The final test cases were stratified and randomly assigned into one of four unique test sets. We found GRRAS recommendations to be very useful in reporting diagnostic test set development and recommend inclusion of two additional criteria: 1) characterizing the study population and 2) describing the methods for reference diagnosis, when applicable.

Bilateral agreements

International Nuclear Information System (INIS)

1998-01-01

Ten bilateral agreements are presented. These are: 1) Co-operation agreement relating to the peaceful uses of nuclear energy between Argentina and EURATOM (1996); 2) Agreement on co-operation in the peaceful uses of nuclear energy between Argentina and Greece (1997); 3) Implementing arrangement for technical exchange and co-operation in the area of peaceful uses of nuclear energy between Argentina and the United States (1997); 4) Agreement concerning co-operation in nuclear science and technology between Australia and Indonesia (1997); 5) Implementation of the 1985 Agreement for co-operation concerning the peaceful uses of nuclear energy between the People's Republic of China and the United States (1998); 6) Protocol of co-operation between France and Lithuania (1997); 7) Agreement on co-operation in energy research, science and technology, and development between Germany and the United States (1998); 8) Agreement on early notification of a nuclear accident and exchange of information on nuclear facilities between Greece and Romania (1997); 9) Agreement on early notification of nuclear accidents and co-operation in the field of nuclear safety between Hungary and the Ukraine (1997); 10) Agreement in the field of radioactive waste management between Switzerland and the United States (1997). (K.A.)

CFE-DOE agreement for the study of Mexican geothermal fields

International Nuclear Information System (INIS)

Le Bert, G.

1990-01-01

The Commission Federal de Electricidad (CFE) is the public utility in Mexico in charge of electric energy service, as well as harnessing geothermal resources. An agreement of mutual benefit to achieve a thorough understanding of the nature of geothermal reservoirs was signed on April 17, 1986 with the United State Department of Energy (DOE). The major objective of this agreement was to investigate how geothermal resources can best be explored and exploited. The duration of the agreement was for 3 years, but as happens in many long-term research programs, new topics and problems appear. Thus an extension of 5 years was foreseen. A brief discussion on the results of the main tasks is presented in this paper, as well as of the new tasks and scopes for the 5-year extension of the agreement

Individual differences in compliance and agreement for sleep logs and wrist actigraphy: A longitudinal study of naturalistic sleep in healthy adults.

Directory of Open Access Journals (Sweden)

Steven M Thurman

Full Text Available There is extensive laboratory research studying the effects of acute sleep deprivation on biological and cognitive functions, yet much less is known about naturalistic patterns of sleep loss and the potential impact on daily or weekly functioning of an individual. Longitudinal studies are needed to advance our understanding of relationships between naturalistic sleep and fluctuations in human health and performance, but it is first necessary to understand the efficacy of current tools for long-term sleep monitoring. The present study used wrist actigraphy and sleep log diaries to obtain daily measurements of sleep from 30 healthy adults for up to 16 consecutive weeks. We used non-parametric Bland-Altman analysis and correlation coefficients to calculate agreement between subjectively and objectively measured variables including sleep onset time, sleep offset time, sleep onset latency, number of awakenings, the amount of wake time after sleep onset, and total sleep time. We also examined compliance data on the submission of daily sleep logs according to the experimental protocol. Overall, we found strong agreement for sleep onset and sleep offset times, but relatively poor agreement for variables related to wakefulness including sleep onset latency, awakenings, and wake after sleep onset. Compliance tended to decrease significantly over time according to a linear function, but there were substantial individual differences in overall compliance rates. There were also individual differences in agreement that could be explained, in part, by differences in compliance. Individuals who were consistently more compliant over time also tended to show the best agreement and lower scores on behavioral avoidance scale (BIS. Our results provide evidence for convergent validity in measuring sleep onset and sleep offset with wrist actigraphy and sleep logs, and we conclude by proposing an analysis method to mitigate the impact of non-compliance and measurement

International standards and agreements in food irradiation

International Nuclear Information System (INIS)

Cetinkaya, N.

2004-01-01

Full text: The economies of both developed and developing countries have been effected by their exported food and agricultural products. Trading policies of food and agricultural products are governed by international agreement as well as national regulations. Trade in food and agricultural commodities may be affected by both principal Agreements within the overall World Trade Organization (WTO) Agreement, though neither specifically refers to irradiation or irradiated foods. The principal Agreements are the Technical Barriers to Trade (TBT) Agreement and the Sanitary and Phyto sanitary (SPS) Agreement. The SPS of the WTO requires governments to harmonize their sanitary and phyto sanitary measures on as wide basis as possible. Related standards, guidelines and recommendations of international standard setting bodies such as the Codex Alimentarius Commission (food safety); the International Plant Protection Convention (IPPC) (plant health and quarantine); and International Office of Epizootic (animal health and zoo noses) should be used in such a harmonization. International Standards for Phyto sanitary Measures (ISPM) no.18 was published under the IPPC by FAO (April 2003, Rome-Italy). ISPM standard provides technical guidance on the specific procedure for the application of ionizing radiation as a phyto sanitary treatment for regulated pests or articles. Moreover, Codex Alimentarius Commission, Codex General Standard for Irradiated Foods (Stand 106-1983) and Recommended International Code of Practice were first published in 1983 and revised in March 2003. Scope of this standard applies to foods processed by ionizing radiation that is used in conjunction with applicable hygienic codes, food standards and transportation codes. It does not apply to foods exposed to doses imparted by measuring instruments used for inspection purposes. Codex documents on Principles and Guidelines for the Import/Export Inspection and Certification of Foods have been prepared to guide

Unwrapping Court-Connected Mediation Agreements

DEFF Research Database (Denmark)

Adrian, Lin; Mykland, Solfrid

2018-01-01

Court-connected mediated agreements seem to both fulfil and fail the ideal of self-determination in mediation theory. In a study of 134 agreements from court-connected mediation, we found that the majority of agreements contain creative elements and display great variation in the provisions...... and understand them. The judicial language is well known for the drafters of the agreement but not the parties. Thus, court-connected mediation seems to fail aspects of self-determination when it comes to drafting agreements. We draw on new-institutional theory when we explore and explain this apparent...... they contain. These results indicate that the parties play an important role in crafting the substance of their agreements. However, we also found that the wording of the agreements is characterised by legal and bureaucratic language to the extent that people without legal training find it difficult to read...

Canadian seismic agreement

International Nuclear Information System (INIS)

Wetmiller, R.J.; Lyons, J.A.; Shannon, W.E.; Munro, P.S.; Thomas, J.T.; Andrew, M.D.; Lamontagne, M.; Wong, C.; Anglin, F.M.; Plouffe, M.; Lapointe, S.P.; Adams, J.; Drysdale, J.A.

1990-04-01

This is the twenty-first progress report under the agreement entitled Canadian Seismic Agreement between the US Nuclear Regulatory Commission (NRC) and the Canadian Commercial Corporation. Activities undertaken by the Geophysics Division of the Geological Survey of Canada (GD/GSC) during the period from July 01, 1988 to June 30, 1989 and supported in part by the NRC agreement are described below under four headings; Eastern Canada Telemetred Network and local network developments, Datalab developments, strong motion network developments and earthquake activity. In this time period eastern Canada experienced its largest earthquake in over 50 years. This earthquake, which has been christened the Saguenay earthquake, has provided a wealth of new data pertinent to earthquake engineering studies in eastern North America and is the subject of many continuing studies, which are presently being carried out at GD and elsewhere. 41 refs., 21 figs., 7 tabs

Co-Development Agreements | NCI Technology Transfer Center | TTC

Science.gov (United States)

The National Cancer Institute's TTC uses three different co-development agreements to help industry and academia interact and partner with National Institutes of Health laboratories and scientists to support technology development activities.

[Diagnostic agreement between two glycosylated a1b hemoglobin methods in Primary Care].

Science.gov (United States)

Villar-del-Campo, M C; Rodríguez-Caravaca, G; Gil-Yonte, P; Cidoncha-Calderón, E; García-Cruces Méndez, J; Donnay-Pérez, S

2014-01-01

Several methods are available for measuring glycosylated A1c hemoglobin (HbA1c), all rapid methods for point of care use in a clinical or laboratory setting. This study attempts to compare the diagnostic agreement between two methods for detection of HbA1c. A descriptive cross-sectional study of diagnostic agreement was carried out in the Los Carmenes Health Centre. Two groups of patients -with and without type 2 diabetes- were consecutively included. A method for point-of-care use in a Primary Care Clinic setting (DCA(TM) Systems Siemens(®)) was compared with a laboratory test (chromatographic analysis). An analysis was made of the mean concentration of HbA1c, the agreement between methods, using the intra-class correlation coefficient (CCLA1) and the Bland-Altman method. A total of 102 patients were included, 62 diabetic (60.8%) and 40 non-diabetic (39.2%). The overall mean HbA1c was 6.46% (SD=0.88) in the analysis using capillary blood in the clinic with the DCA™ system, and 6.44% (SD=0.86) using the laboratory test (P>.05). The degree of agreement between the two tests was 0.975 (95% CI: 0.963-0.983). The mean of the differences between the results of the two assessed tests was 0.024 (SD=0.27). The percentage of points outside the limits of optimal agreement, as defined in the Bland-Altman graph, was 2.5%. Diagnostic agreement between a method for point-of-care use in a Primary Health Care Clinic and a laboratory test was very high. Detection at the point-of-care allows a quick and simple assessment of HbA1c. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Health economic value of an innovation: delimiting the scope and framework of future market entry agreements.

Science.gov (United States)

Launois, Robert; Navarrete, Lucia Fiestas; Ethgen, Olivier; Le Moine, Jean-Gabriel; Gatsinga, René

2014-01-01

The objective of our paper is to offer a new, payer-friendly taxonomy of market entry agreements (MEAs) that aims to twin contracts with their methodological designs in an effort to clarify the distinction between contracts that are based on performance and those that are based on demonstrated effect. Our analysis proceeds in two stages: First, we delimit the scope and framework of pay for performance (P4P) and pay for demonstrated effect (P4E) agreements. Second, we distinguish the methodological designs supporting the implementation of each of these contracts. We elucidate why P4P contracts prevent the payer from funding the true effectiveness of an innovation by expanding on their limitations. These include: 1) the normative nature of comparisons, 2) the impossibility of true effect imputability for each individual, and 3) the use of intermediary outcome measures. We then explore three main criticisms that payers must take into account when reasoning in terms of performance rather than in terms of the product effectiveness. The potential effect that performance-based reimbursements may have on dissociating the components of the cost-effectiveness ratio constitutes an obstacle to a true health economic reasoning.

Anticollusion Attack Noninteractive Security Hierarchical Key Agreement Scheme in WHMS

Directory of Open Access Journals (Sweden)

Kefei Mao

2016-01-01

Full Text Available Wireless Health Monitoring Systems (WHMS have potential to change the way of health care and bring numbers of benefits to patients, physicians, hospitals, and society. However, there are crucial barriers not only to transmit the biometric information but also to protect the privacy and security of the patients’ information. The key agreement between two entities is an essential cryptography operation to clear the barriers. In particular, the noninteractive hierarchical key agreement scheme becomes an attractive direction in WHMS because each sensor node or gateway has limited resources and power. Recently, a noninteractive hierarchical key agreement scheme has been proposed by Kim for WHMS. However, we show that Kim’s cryptographic scheme is vulnerable to the collusion attack if the physicians can be corrupted. Obviously, it is a more practical security condition. Therefore, we proposed an improved key agreement scheme against the attack. Security proof, security analysis, and experimental results demonstrate that our proposed scheme gains enhanced security and more efficiency than Kim’s previous scheme while inheriting its qualities of one-round communication and security properties.

Congruence in reported frequency of parent-adolescent sexual health communication: A study from Mexico.

Science.gov (United States)

Atienzo, Erika E; Ortiz-Panozo, Eduardo; Campero, Lourdes

2015-08-01

Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents' or children's reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication. The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics. A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study. The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents. Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (pcongruence between parents' and adolescents' reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.

Análisis jurídico del convenio entre la SSA y la industria tabacalera: estudio de caso Legal analysis of the agreement between the Ministry of Health and the tobacco industry: a case study

Directory of Open Access Journals (Sweden)

Alejandro Madrazo-Lajous

2007-01-01

Full Text Available Tras la ratificación del Convenio Marco para el Control del Tabaco de la OMS, de junio de 2004 a diciembre de 2006, la regulación del tabaco por el gobierno mexicano estuvo determinada por un convenio suscrito entre las autoridades federales del sector salud y las principales tabacaleras de México (al que en este análisis se le llamará Convenio. Este Convenio fijó la regulación federal del control al tabaquismo bajo un esquema en el que su modificación requería la anuencia de las tabacaleras. Asimismo, estableció una aportación monetaria de las tabacaleras a favor del gobierno, determinada directamente en función del volumen de ventas de tabaco en el país. A fin de contribuir a la cabal comprensión de las implicaciones del Convenio, este estudio procura deslindar con toda claridad sus implicaciones desde una perspectiva estrictamente jurídica. Por una parte se identifican los problemas de regularidad jurídica del Convenio a la luz de la normatividad aplicable y, por la otra, se identifican aquellos elementos materiales y formales del Convenio que efectivamente se ajustan a la misma. El texto se divide en cuatro apartados: i el primero expone claramente los términos del Convenio; ii el segundo identifica los elementos que resultan contrarios al derecho nacional e internacional; iii el tercero, identifica los elementos que resultan acordes al derecho nacional e internacional y, finalmente; iv el cuarto plantea conclusiones del análisis realizado.In the aftermath of Mexico’s ratification of the Framework Convention on Tobacco Control, from June 2004 through December 2006, tobacco regulation by Mexico’s government came to be shaped by an agreement between the health authorities and the leading tobacco companies in Mexico. This agreement set federal tobacco control regulation, subjecting it to the approval of tobacco companies themselves. In addition, it established a donation by tobacco companies to the health authorities to be

Voluntary agreements between government and business - a scoping review of the literature with specific reference to the Public Health Responsibility Deal.

Science.gov (United States)

Bryden, Anna; Petticrew, Mark; Mays, Nicholas; Eastmure, Elizabeth; Knai, Cecile

2013-05-01

A scoping review was conducted to synthesise the findings of evaluations of voluntary agreements between business and government. It aimed to summarise the types of agreements that exist, how they work in practice, the conditions for their success and how they had been evaluated. Voluntary agreements were included if they involved a transparent signing-up process and where businesses agreed to carry out specific actions or to achieve specific outcomes. Studies of any design published in English were included. 47 studies were identified. Voluntary agreements may help to improve relationships between government and business, and can help both parties agree on target-setting and data-sharing. Governments may also use the experience to help develop subsequent legislation. For voluntary agreements to be successful, targets should be ambitious and clearly defined, with robust independent monitoring. Public knowledge of agreements can help encourage participation and ensure compliance. If properly implemented and monitored, voluntary agreements can be an effective policy approach, though there is little evidence on whether they are more effective than compulsory approaches. Some of the most effective voluntary agreements include substantial disincentives for non-participation and sanctions for non-compliance. Many countries are moving towards these more formal approaches to voluntary agreements. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Rater agreement in lung scintigraphy

International Nuclear Information System (INIS)

Christiansen, F.; Andersson, T.; Rydman, H.; Qvarner, N.; Maare, K.

1996-01-01

Purpose: The PIOPED criteria in their original and revised forms are today's standards in the interpretation of ventilation-perfusion scintigraphy. When the PIOPED criteria are used by experienced raters with training in consensus interpretation, the agreement rates have been demonstrated to be excellent. Our purpose was to investigate the rates of agreement between 2 experienced raters from different hospitals who had no training in consensus interpretation. Material and Methods: The 2 raters investigated a population of 195 patients. This group included 72 patients from a previous study who had an intermediate probability of pulmonary embolism and who had also been examined by pulmonary angiography. Results: The results demonstrated moderate agreement rates with a kappa value of 0.54 (0.45-0.63 in a 95% confidence interval), which is similar to the kappa value of the PIOPED study but significantly lower than the kappa values of agreement rates among consensus-trained raters. There was a low consistency in the intermediate probability category, with a proportional agreement rate of 0.39 between the experienced raters. Conclusion: The moderate agreement rates between raters from different hospitals make it difficult to compare study populations of a certain scintigraphic category in different hospitals. Further investigations are mandatory for accurate diagnosis when the scintigrams are in the category of intermediate probability of pulmonary embolism. (orig.)

48 CFR 1604.7201 - FEHB Program Large Provider Agreements.

Science.gov (United States)

2010-10-01

... FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Large Provider... into any Large Provider Agreement; and (ii) Not less than 60 days before exercising renewals or other...

Some views on agreement to be used in content analysis studies

NARCIS (Netherlands)

Popping, Roel

2010-01-01

In content analysis studies texts might be coded three times or more, certainly in the training part. With respect to reliability several views on agreement can be used now, as these are found in the literature. These views are presented, and this is followed by a discussion resulting in the opinion

Why the (dis)agreement? Family context and child-parent perspectives on health-related quality of life and psychological problems in paediatric asthma.

Science.gov (United States)

Silva, N; Crespo, C; Carona, C; Bullinger, M; Canavarro, M C

2015-01-01

Children's health-related quality of life (HrQoL) and psychological problems are important outcomes to consider in clinical decision making in paediatric asthma. However, children's and parents' reports often differ. The present study aimed to examine the levels of agreement/disagreement between children's and parents' reports of HrQoL and psychological problems and to identify socio-demographic, clinical and family variables associated with the extent and direction of (dis)agreement. The sample comprised 279 dyads of Portuguese children with asthma who were between 8 and 18 years of age (M = 12.13; SD = 2.56) and one of their parents. The participants completed self- and proxy-reported questionnaires on paediatric generic HrQoL (KIDSCREEN-10), chronic-generic HrQoL (DISABKIDS-37) and psychological problems (Strengths and Difficulties Questionnaire). Children's and parents' perceptions of family relationships were measured with the Family Environment Scale and the caregiving burden was assessed using the Revised Burden Measure. The child-parent agreement on reported HrQoL and psychological problems was poor to moderate (intraclass correlation coefficients between 0.32 and 0.47). The rates of child-parent discrepancies ranged between 52.7% (psychological problems) and 68.8% (generic HrQoL), with 50.5% and 31.5% of the parents reporting worse generic and chronic-generic HrQoL, respectively, and 33.3% reporting more psychological problems than their children. The extent and direction of disagreement were better explained by family factors than by socio-demographic and clinical variables: a greater caregiving burden was associated with increased discrepancies in both directions and children's and parents' perceptions of less positive family relationships were associated with discrepancies in different directions. Routine assessment of paediatric HrQoL and psychological problems in healthcare and research contexts should include self- and parent-reported data as

Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE).

Science.gov (United States)

Kowal, Paul; Chatterji, Somnath; Naidoo, Nirmala; Biritwum, Richard; Fan, Wu; Lopez Ridaura, Ruy; Maximova, Tamara; Arokiasamy, Perianayagam; Phaswana-Mafuya, Nancy; Williams, Sharon; Snodgrass, J Josh; Minicuci, Nadia; D'Este, Catherine; Peltzer, Karl; Boerma, J Ties

2012-12-01

Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).

A study on the establishment of a standard nuclear cooperation agreement and the revision of existing nuclear cooperation agreements in Korea

Energy Technology Data Exchange (ETDEWEB)

Oh, Keun Bae; Lee, K S; Lee, D J; Lee, B Y; Cho, I H; Ko, H S

1997-04-01

The objectives of this study are to suggest a standard nuclear cooperation agreement (SNCA) as a model for new nuclear cooperation agreements (NCA`s) which are expected to be concluded in the near future and to suggest a proposal text and strategy for the revision of existing NCA`s with advanced countries such as the United States. To accomplish the objectives, this study: First, establishes a framework for a NCA through clarifying the basic concept of NCA and identifying key elements of NCA. Second, draws implications for a standard NCA and revision of existing NCA`s through analyzing by comparison those NCA`s between other countries. Third, clarifies the purpose and underlying philosophy for the SNCA, determines the elements to be included in the SNCA, and suggests a final draft of the SNCA. And fourth, clarifies general concepts of the revision of NCA`s, analyzes the needs of the revision of the Korea-U.S. NCA, and assesses the position of the United States on the matter. (author). 28 refs., 5 tabs., 2 figs.

Public involvement and risk communiction for the Rocky Flats health studies

International Nuclear Information System (INIS)

Zoda, S.M.; Lockhart, A.J.

1993-01-01

In 1990, the State of Colorado and the U.S. Department of Energy entered into an Agreement in Principle that provides funding for state studies and monitoring of the Rocky Flats Nuclear Weapons Plant. The Colorado Department of Health initiated a two-phase study to identify releases of radioactive and other contaminants from the year 1952, when Rocky Flats opened, through 1989, and to estimate the potential offsite exposures and health effects. Because one of the main goals for the study is to answer citizen questions about past operations and impacts from the Rocky Flats Plant, the Department of Health designed an open study process featuring a multi-faceted program for public involvement and two-way communication. To provide independent scientific oversight and increase public accountability, Governor Roy Romer appointed a 12-member Health Advisory Panel that includes local and national technical experts and community members. This paper describes the study process and the public involvement and risk communication program designed to address citizen concerns, foster understanding and build credibility

The Subaxial Cervical Spine Injury Classification System: an external agreement validation study

NARCIS (Netherlands)

Middendorp, J.J. van; Audige, L.; Bartels, R.H.M.A.; Bolger, C.; Deverall, H.; Dhoke, P.; Diekerhof, C.H.; Govaert, G.A.; Guimera, V.; Koller, H.; Morris, S.A.; Setiobudi, T.; Hosman, A.J.F.

2013-01-01

BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

The Subaxial Cervical Spine Injury Classification System : an external agreement validation study

NARCIS (Netherlands)

van Middendorp, Joost J.; Audige, Laurent; Bartels, Ronald H.; Bolger, Ciaran; Deverall, Hamish; Dhoke, Priyesh; Diekerhof, Carel H.; Govaert, Geertje A. M.; Guimera, Vicente; Koller, Heiko; Morris, Stephen A. C.; Setiobudi, Tony; Hosman, Allard J. F.

BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement.

Science.gov (United States)

Thow, Anne Marie; Snowdon, Wendy; Labonté, Ronald; Gleeson, Deborah; Stuckler, David; Hattersley, Libby; Schram, Ashley; Kay, Adrian; Friel, Sharon

2015-01-01

The Trans Pacific Partnership Agreement (TPPA) is one of a new generation of 'deep' preferential trade and investment agreements that will extend many of the provisions seen in previous agreements. This paper presents a prospective policy analysis of the likely text of the TPPA, with reference to nutrition policy space. Specifically, we analyse how the TPPA may constrain governments' policy space to implement the 'policy options for promoting a healthy diet' in the World Health Organization's Global Action Plan for Prevention and Control of Noncommunicable Diseases (NCDs) 2013-2020. This policy analysis suggests that if certain binding commitments are made under the TPPA, they could constrain the ability of governments to protect nutrition policy from the influence of vested interests, reduce the range of interventions available to actively discourage consumption of less healthy food (and to promote healthy food) and limit governments' capacity to implement these interventions, and reduce resources available for nutrition education initiatives. There is scope to protect policy space by including specific exclusions and/or exceptions during negotiation of trade and investment agreements like the TPPA, and by strengthening global health frameworks for nutrition to enable them to be used as reference during disputes in trade fora. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

42 CFR 1007.9 - Relationship to, and agreement with, the Medicaid agency.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Relationship to, and agreement with, the Medicaid... AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.9 Relationship to, and agreement with, the Medicaid agency. (a) The unit must be separate and distinct from the Medicaid agency. (b...

Diagnostic agreement between panoramic radiographs and color doppler images of carotid atheroma

Directory of Open Access Journals (Sweden)

Claudia Maria Romano-Sousa

2009-02-01

Full Text Available The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.

Community-based naming agreement, familiarity, image agreement and visual complexity ratings among adult Indians

Directory of Open Access Journals (Sweden)

George Annamma

2007-01-01

Full Text Available The validity of Snodgrass and Vanderwart pictures and their norms derived on a western population on naming, familiarity, imageability and visual-complexity, is not established on a population with cultural background different from the west. We developed, therefore, a set of culturally appropriate pictures for and derived norms on Indians. Line-drawings of 103 concepts (67 from Snodgrass and Vanderwart, 36 new from 10 semantic-categories were normed on 200 community-based older subjects. Only 31% of the Snodgrass and Vanderwart items showed a concept-agreement on the Indians comparable to western norms. Naming, familiarity and image-agreement mutually correlated but not with visual-complexity. Low-education and rural-residence tended to reduced concept-agreement. The output of this study will be of use in national and cross-national studies.

Analysis of international negotiations and trade agreements

OpenAIRE

Górriz Gonzalo, Verónica

2014-01-01

This study aims to analyze international trade agreements and negotiations. For that purpose, two agreements made by the United States are chosen to be analyzed. In the first place, the North America Free Trade Agreement (NAFTA) agreement, that was signed by the United States, Canada and Mexico in 1994 in order to create a free trade area. In addition, the Transatlantic Trade and Investment Partnership (TTIP) will be analyze, an agreement that is still being negotiated between the United Stat...

A prospective study assessing agreement and reliability of a geriatric evaluation

OpenAIRE

Locatelli, Isabella; Monod, St?fanie; Cornuz, Jacques; B?la, Christophe J.; Senn, Nicolas

2017-01-01

Background The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. Method...

12 CFR 533.5 - Related agreements considered a single agreement.

Science.gov (United States)

2010-01-01

... DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS § 533.5 Related agreements considered a single agreement... entered into within the same 12-month period; and (3) Are each in fulfillment of the CRA. (b... in fulfillment of the CRA, if the contracts were negotiated in a coordinated fashion and a NGEP is a...

12 CFR 35.5 - Related agreements considered a single agreement.

Science.gov (United States)

2010-01-01

... DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS § 35.5 Related agreements considered a single agreement... into within the same 12-month period; and (3) Are each in fulfillment of the CRA. (b) Substantively... the CRA, if the contracts were negotiated in a coordinated fashion and a NGEP is a party to each...

Client/consultant model services agreement

CERN Document Server

International Federation of Consulting Engineers

2006-01-01

The terms of the Client Consultant Model Services agreement (The White Book) have been prepared by the Fédération Internationale des Ingénieurs-Conseils (FIDIC) and are recommended for general use for the purposes of pre-investment and feasibility studies, designs and administration of construction and project management, where proposals for such services are invited on an international basis. They are equally adaptable for domestic agreements. - See more at: http://fidic.org/books/clientconsultant-model-services-agreement-4th-ed-2006-white-book#sthash.3Uxy5qT3.dpuf

Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group

DEFF Research Database (Denmark)

Nielsen, Merete Willemoes; Søndergaard, Birthe; Kjøller, Mette

2008-01-01

OBJECTIVE: This study compared national self-reported data on medicine use and national prescription records at the individual level. STUDY DESIGN AND SETTING: Data from the nationally representative Danish health survey conducted in 2000 (n=16,688) were linked at the individual level to national...... prescription records covering 1999-2000. Kappa statistics and 95% confidence intervals were calculated. RESULTS: Applying the legend time method to medicine groups used mainly on a chronic basis revealed good to very good agreement between the two data sources, whereas medicines used as needed showed fair...... to moderate agreement. When a fixed-time window was applied for analysis, agreement was unchanged for medicines used mainly on a chronic basis, whereas agreement increased somewhat compared to the legend time method when analyzing medicines used as needed. CONCLUSION: Agreement between national self...

MULTILATERAL ENVIRONMENTAL AGREEMENTS AND THE TRADE MEASURES CONTAINED IN THESE AGREEMENTS

Directory of Open Access Journals (Sweden)

Margareta Timbur

2012-06-01

Full Text Available The environmental problems which the society is facing, ozone depletion, biodiversity loss, the spread of persistent organic pollutants, are a result of human activity with a worldwide impact, requiring immediate resolution. In this context, negotiation, signing and implementation of several multilateral environmental agreements (MEAs are one of the best solutions, affordable and reliable. The aim of this study is to analyze the commercial measures, which to some extent, ensure stability, security, and expansion of MEAs. The paper discusses, also, the efficiency, necessity and the influences of trade measures in MEAs and the WTO role in signing these agreements.

Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India

Directory of Open Access Journals (Sweden)

Binod Kumar Patro

2015-01-01

Full Text Available Background: Primary care physicians (PCPs encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4 was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting.

Science.gov (United States)

Di Bella, Alexandra; Blake, Claire; Young, Adrienne; Pelecanos, Anita; Brown, Teresa

2018-02-01

The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening. This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher-led screening and intra-rater reliability between an initial and a repeat patient screening. This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample). Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test-retest screening, and patient acceptability. Percent and chance-corrected agreement (Cohen's kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with "almost perfect" chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with "almost perfect" chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided

Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda

Directory of Open Access Journals (Sweden)

Vasan Ashwin

2009-08-01

Full Text Available Abstract Background The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers and physicians in their decisions as to whether to start therapy. Methods We conducted the study at 12 government antiretroviral therapy sites in three regions of Uganda, all of which had staff trained in delivery of antiretroviral therapy using the WHO Integrated Management of Adult and Adolescent Illness guidelines for chronic HIV care. We collected seven key variables to measure patient assessment and the decision as to whether to start antiretroviral therapy, the primary variable of interest being the Final Antiretroviral Therapy Recommendation. Patients saw either a clinical officer or nurse first, and then were screened identically by a blinded physician during the same clinic visit. We measured inter-rater agreement between the decisions of the non-physician health workers and physicians in the antiretroviral therapy assessment variables using simple and weighted Kappa analysis. Results Two hundred fifty-four patients were seen by a nurse and physician, while 267 were seen by a clinical officer and physician. The majority (> 50% in each arm of the study were in World Health Organization Clinical Stages I and II and therefore not currently eligible for antiretroviral therapy according to national antiretroviral therapy guidelines. Nurses and clinical officers both showed moderate to almost perfect agreement with physicians in their Final Antiretroviral Therapy Recommendation (unweighted κ = 0.59 and κ = 0.91, respectively. Agreement was also substantial for nurses versus physicians for assigning World Health Organization Clinical

The quid-pro-quo of environmental agreements: Reflections on industrial energy efficiency agreements from five countries

Energy Technology Data Exchange (ETDEWEB)

Helby, Peter

2001-10-01

This workshop paper reflects on the exchange of values between the government side and the business side, which is a core logic of environmental agreements. The reflections refer to case studies of industrial energy efficiency agreements from Denmark, France, Germany, Netherlands and Sweden, originating from the VAIE project (Voluntary Agreements, Implementation and Efficiency). The government bargaining chips discussed are monetary rewards, help to gain competitive advantage, regulatory flexibility and political protection. The business side bargaining chips are emission limits, organisational change, investments, information, submission to control and political pain reduction. The discussion underlines the need for substantial commitments by the government side, as a precondition for achieving effective agreements.

Psychosocial health and quality of life among children with cardiac diagnoses: agreement and discrepancies between parent and child reports.

Science.gov (United States)

Patel, Bhavika J; Lai, Lillian; Goldfield, Gary; Sananes, Renee; Longmuir, Patricia E

2017-05-01

Psychosocial health issues are common among children with cardiac diagnoses. Understanding parent and child perceptions is important because parents are the primary health information source. Significant discrepancies have been documented between parent/child quality-of-life data but have not been examined among psychosocial diagnostic instruments. This study examined agreement and discrepancies between parent and child reports of psychosocial health and quality of life in the paediatric cardiology population. Children (n=50, 6-14 years) with diagnoses of CHDs (n=38), arrhythmia (n=5), cardiomyopathy (n=4), or infectious disease affecting the heart (n=3) were enrolled, completing one or more outcome measures. Children and their parents completed self-reports and parent proxy reports of quality of life - Pediatric Quality of Life Inventory - and psychosocial health - Behavioral Assessment Scale for Children (Version 2). Patients also completed the Multidimensional Anxiety Scale for Children. Associations (Pearson's correlations, Intraclass Correlation Coefficients) and differences (Student's t-tests) between parent proxy reports and child self-reports were evaluated. Moderate parent-child correlations were found for physical (R=0.33, p=0.03), school (R=0.43, pParent-child reports of externalising behaviour problems, for example aggression, were strongly correlated (R=0.70, pparent-child associations were found for emotional quality of life (R=0.25, p=0.10), internalising problems (R=0.17, p=0.56), personal adjustment/adaptation skills (R=0.23, p=0.42), or anxiety (R=0.07, p=0.72). Our data suggest that clinicians caring for paediatric cardiac patients should assess both parent and child perspectives, particularly in relation to domains such as anxiety and emotional quality of life, which are more difficult to observe.

Analyzing rater agreement manifest variable methods

CERN Document Server

von Eye, Alexander

2014-01-01

Agreement among raters is of great importance in many domains. For example, in medicine, diagnoses are often provided by more than one doctor to make sure the proposed treatment is optimal. In criminal trials, sentencing depends, among other things, on the complete agreement among the jurors. In observational studies, researchers increase reliability by examining discrepant ratings. This book is intended to help researchers statistically examine rater agreement by reviewing four different approaches to the technique.The first approach introduces readers to calculating coefficients that allow one to summarize agreements in a single score. The second approach involves estimating log-linear models that allow one to test specific hypotheses about the structure of a cross-classification of two or more raters'' judgments. The third approach explores cross-classifications or raters'' agreement for indicators of agreement or disagreement, and for indicators of such characteristics as trends. The fourth approach compa...

The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

Science.gov (United States)

Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

2013-03-01

The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective

Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

Science.gov (United States)

Bouwense, Stefan A; van Brunschot, Sandra; van Santvoort, Hjalmar C; Besselink, Marc G; Bollen, Thomas L; Bakker, Olaf J; Banks, Peter A; Boermeester, Marja A; Cappendijk, Vincent C; Carter, Ross; Charnley, Richard; van Eijck, Casper H; Freeny, Patrick C; Hermans, John J; Hough, David M; Johnson, Colin D; Laméris, Johan S; Lerch, Markus M; Mayerle, Julia; Mortele, Koenraad J; Sarr, Michael G; Stedman, Brian; Vege, Santhi Swaroop; Werner, Jens; Dijkgraaf, Marcel G; Gooszen, Hein G; Horvath, Karen D

2017-08-01

Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor. We hypothesized that for the revised Atlanta classification, interobserver agreement will be better. An international, interobserver agreement study was performed among expert and nonexpert radiologists (n = 14), surgeons (n = 15), and gastroenterologists (n = 8). Representative computed tomographies of all stages of acute pancreatitis were selected from 55 patients and were assessed according to the revised Atlanta classification. The interobserver agreement was calculated among all reviewers and subgroups, that is, expert and nonexpert reviewers; interobserver agreement was defined as poor (≤0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), or very good (0.81-1.00). Interobserver agreement among all reviewers was good (0.75 [standard deviation, 0.21]) for describing the type of acute pancreatitis and good (0.62 [standard deviation, 0.19]) for the type of peripancreatic collection. Expert radiologists showed the best and nonexpert clinicians the lowest interobserver agreement. Interobserver agreement was good for the revised Atlanta classification, supporting the importance for widespread adaption of this revised classification for clinical and research communications.

42 CFR 403.322 - Termination of agreements for Medicare recognition of State systems.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Termination of agreements for Medicare recognition of State systems. 403.322 Section 403.322 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Recognition of State...

46 CFR 298.38 - Partnership agreements and limited liability company agreements.

Science.gov (United States)

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Partnership agreements and limited liability company... liability company agreements. Partnership and limited liability company agreements must be in form and...) Duration of the entity; (b) Adequate partnership or limited liability company funding requirements and...

The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the electric power generation sector under the Paris Agreement: a modelling study

Directory of Open Access Journals (Sweden)

Wenjia Cai, PhD

2018-04-01

Full Text Available Summary: Background: Except for comparing the implementation costs of the Paris Agreement with potential health benefits at the national levels, previous studies have not explored the health impacts of the nationally determined contributions (NDCs by countries and in regional details. In this Lancet Countdown study, we aimed to estimate and monetise the health benefits of China's NDCs in the electric power generation sector, and then compare them with the implementation costs, both at the national and regional levels. Methods: In this modelling study, we linked the Multi-regional model for Energy Supply system and their Environmental ImpaCts, the Multi-resolution Emission Inventory for China model, the offline-coupled Weather Research and Forecasting model, the Community Multiscale Air Quality model, and the Integrated Health Impact Assessment model with a time scope from 2010 to 2050. We calculated the PM2·5 concentrations and compared the health impacts and implementation costs between two scenarios that reflect CO2 and air pollutant emissions—the reference (REF scenario (no climate policy and the NDC scenario (100% realisation of NDC targets: CO2 emission intensity needs to be about 40% below 2010 emissions by 2030 [roughly 35% below 2030 emissions in REF], and about 90% below 2010 emissions by 2050 [roughly 96% below 2050 emissions in REF]. Findings: Under a comparatively optimistic health benefits valuation condition, at the national level, 18–62% of implementation costs could be covered by the health benefits in 2030. In 2050, the overall health benefits would substantially increase to 3–9 times of the implementation costs. However, northwest China would require the highest implementation costs and will also have more premature deaths because of a more carbon-intensive energy structure than business as usual. By 2030, people in northwest China (especially in Gansu, Shaanxi, and Xinjiang provinces would need to bear worse air quality

Nuclear arbitration: Interpreting non-proliferation agreements

International Nuclear Information System (INIS)

Tzeng, Peter

2015-01-01

At the core of the nuclear non-proliferation regime lie international agreements. These agreements include, inter alia, the Nuclear Non-proliferation Treaty, nuclear co-operation agreements and nuclear export control agreements.1 States, however, do not always comply with their obligations under these agreements. In response, commentators have proposed various enforcement mechanisms to promote compliance. The inconvenient truth, however, is that states are generally unwilling to consent to enforcement mechanisms concerning issues as critical to national security as nuclear non-proliferation.3 This article suggests an alternative solution to the non-compliance problem: interpretation mechanisms. Although an interpretation mechanism does not have the teeth of an enforcement mechanism, it can induce compliance by providing an authoritative interpretation of a legal obligation. Interpretation mechanisms would help solve the non-compliance problem because, as this article shows, in many cases of alleged non-compliance with a non-proliferation agreement, the fundamental problem has been the lack of an authoritative interpretation of the agreement, not the lack of an enforcement mechanism. Specifically, this article proposes arbitration as the proper interpretation mechanism for non-proliferation agreements. It advocates the establishment of a 'Nuclear Arbitration Centre' as an independent branch of the International Atomic Energy Agency (IAEA), and recommends the gradual introduction of arbitration clauses into the texts of non-proliferation agreements. Section I begins with a discussion of international agreements in general and the importance of interpretation and enforcement mechanisms. Section II then discusses nuclear non-proliferation agreements and their lack of interpretation and enforcement mechanisms. Section III examines seven case studies of alleged non-compliance with non-proliferation agreements in order to show that the main problem in many cases

Technology Partnership Agreements | NREL

Science.gov (United States)

Partnership Agreements Technology Partnership Agreements Looking for Funding? We do not fund any projects under a technology partnership agreement. The partner provides the necessary resources and, in using technology partnership agreements. See a summary of our Fiscal Year 2017 technology partnership

A prospective study assessing agreement and reliability of a geriatric evaluation.

Science.gov (United States)

Locatelli, Isabella; Monod, Stéfanie; Cornuz, Jacques; Büla, Christophe J; Senn, Nicolas

2017-07-19

The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. Six out of nine items of the geriatric consultation described in this study (functional

Agreement processing and attraction errors in aging: evidence from subject-verb agreement in German.

Science.gov (United States)

Reifegerste, Jana; Hauer, Franziska; Felser, Claudia

2017-11-01

Effects of aging on lexical processing are well attested, but the picture is less clear for grammatical processing. Where age differences emerge, these are usually ascribed to working-memory (WM) decline. Previous studies on the influence of WM on agreement computation have yielded inconclusive results, and work on aging and subject-verb agreement processing is lacking. In two experiments (Experiment 1: timed grammaticality judgment, Experiment 2: self-paced reading + WM test), we investigated older (OA) and younger (YA) adults' susceptibility to agreement attraction errors. We found longer reading latencies and judgment reaction times (RTs) for OAs. Further, OAs, particularly those with low WM scores, were more accepting of sentences with attraction errors than YAs. OAs showed longer reading latencies for ungrammatical sentences, again modulated by WM, than YAs. Our results indicate that OAs have greater difficulty blocking intervening nouns from interfering with the computation of agreement dependencies. WM can modulate this effect.

Statistical methods for assessing agreement between continuous measurements

DEFF Research Database (Denmark)

Sokolowski, Ineta; Hansen, Rikke Pilegaard; Vedsted, Peter

Background: Clinical research often involves study of agreement amongst observers. Agreement can be measured in different ways, and one can obtain quite different values depending on which method one uses. Objective: We review the approaches that have been discussed to assess the agreement between...... continuous measures and discuss their strengths and weaknesses. Different methods are illustrated using actual data from the `Delay in diagnosis of cancer in general practice´ project in Aarhus, Denmark. Subjects and Methods: We use weighted kappa-statistic, intraclass correlation coefficient (ICC......), concordance coefficient, Bland-Altman limits of agreement and percentage of agreement to assess the agreement between patient reported delay and doctor reported delay in diagnosis of cancer in general practice. Key messages: The correct statistical approach is not obvious. Many studies give the product...

Gender equality in couples and self-rated health - A survey study evaluating measurements of gender equality and its impact on health.

Science.gov (United States)

Sörlin, Ann; Lindholm, Lars; Ng, Nawi; Ohman, Ann

2011-08-26

Men and women have different patterns of health. These differences between the sexes present a challenge to the field of public health. The question why women experience more health problems than men despite their longevity has been discussed extensively, with both social and biological theories being offered as plausible explanations. In this article, we focus on how gender equality in a partnership might be associated with the respondents' perceptions of health. This study was a cross-sectional survey with 1400 respondents. We measured gender equality using two different measures: 1) a self-reported gender equality index, and 2) a self-perceived gender equality question. The aim of comparison of the self-reported gender equality index with the self-perceived gender equality question was to reveal possible disagreements between the normative discourse on gender equality and daily practice in couple relationships. We then evaluated the association with health, measured as self-rated health (SRH). With SRH dichotomized into 'good' and 'poor', logistic regression was used to assess factors associated with the outcome. For the comparison between the self-reported gender equality index and self-perceived gender equality, kappa statistics were used. Associations between gender equality and health found in this study vary with the type of gender equality measurement. Overall, we found little agreement between the self-reported gender equality index and self-perceived gender equality. Further, the patterns of agreement between self-perceived and self-reported gender equality were quite different for men and women: men perceived greater gender equality than they reported in the index, while women perceived less gender equality than they reported. The associations to health were depending on gender equality measurement used. Men and women perceive and report gender equality differently. This means that it is necessary not only to be conscious of the methods and measurements

Effective tobacco control measures: agreement among medical students

Directory of Open Access Journals (Sweden)

Stella Regina Martins

Full Text Available ABSTRACT Objective: To determine the level of agreement with effective tobacco control measures recommended by the World Health Organization and to assess the attitudes toward, knowledge of, and beliefs regarding smoking among third-year medical students at University of São Paulo School of Medicine, located in the city of São Paulo, Brazil. Methods: Between 2008 and 2012, all third-year medical students were invited to complete a self-administered questionnaire based on the Global Health Professionals Student Survey and its additional modules. Results: The study sample comprised 556 students. The level of agreement with the World Health Organization recommendations was high, except for the components “received smoking cessation training” and “raising taxes is effective to reduce the prevalence of smoking”. Most of the students reported that they agree with banning tobacco product sales to minors (95%, believe that physicians are role models to their patients (84%, and believe that they should advise their patients to quit cigarette smoking (96% and using other tobacco products (94%. Regarding smoking cessation methods, most of the students were found to know more about nicotine replacement therapy than about non-nicotine therapies (93% vs. 53%. Only 37% of the respondents were aware of the importance of educational antismoking materials, and only 31% reported that they believe in the effectiveness of encouraging their patients, during medical visits. In our sample, the prevalence of current cigarette smoking was 5.23%; however, 43.82% of the respondents reported having experimented with water-pipe tobacco smoking. Conclusions: Our results revealed the need to emphasize to third-year medical students the importance of raising the prices of and taxes on tobacco products. We also need to make students aware of the dangers of experimenting with tobacco products other than cigarettes, particularly water-pipe tobacco smoking.

48 CFR 225.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Science.gov (United States)

2010-10-01

... Government Procurement Agreement and Free Trade Agreements. 225.403 Section 225.403 Federal Acquisition... FOREIGN ACQUISITION Trade Agreements 225.403 World Trade Organization Government Procurement Agreement and... Government Procurement Agreement, acquire only U.S.-made, qualifying country, or designated country end...

What principles should govern the use of managed entry agreements?

DEFF Research Database (Denmark)

Klemp, Marianne; Frønsdal, Katrine; Facey, Karen

2011-01-01

BACKGROUND: To ensure rapid access to new potentially beneficial health technologies, obtain best value for money, and ensure affordability, healthcare payers are adopting a range of innovative reimbursement approaches that may be called Managed Entry Agreements (MEAs). METHODS: The Health...... Technology Assessment International (HTAi) Policy Forum sought to identify why MEAs might be used, issues associated with implementation and develop principles for their use. A 2-day deliberative workshop discussed key papers, members' experiences, and collectively addressed four policy questions...... that resulted in this study. RESULTS: MEAs are used to give access to new technologies where traditional reimbursement is deemed inappropriate. Three different forms of MEAs have been identified: management of budget impact, management of uncertainty relating to clinical and/or cost...

Effects of modifications to the health and social sector's collective agreement on the objective characteristics of working hours.

Science.gov (United States)

Ropponen, Annina; Vanttola, Päivi; Koskinen, Aki; Hakola, Tarja; Puttonen, Sampsa; Härmä, Mikko

2017-08-08

This study aimed to evaluate the effects of an intervention on objective working-hour characteristics. The intervention involved making modifications to the collective agreement that would limit employees' entitlement to time off as compensation. The intervention group consisted of 493 and the control group of 2,303 health and social care shift workers, respectively. We analysed the objective pay roll-based working-hour data for 2012-2013, which we obtained from employers' records, using the repeated measures mixed model. The changes in objective working-hour characteristics were small, but systematic. The intervention had some positive effects: the amount of short recovery periods (working weeks of over 48 h decreased from 19% to 17%. The realization of employees' shift preferences increased from 18% to 20%. However, in contrast, consecutive work shifts and the number of scheduled absences increased and days off decreased, suggesting less time for recovery and thus a negative trend in shift ergonomics. When planning shifts, nursing management should avoid regulations that promote specific unhealthy shift characteristics, that is, consecutive work shifts and less days off.

76 FR 52328 - Single Source Cooperative Agreement Award for the Gorgas Memorial Institute of Health Studies

Science.gov (United States)

2011-08-22

... Crawford Gorgas, the U.S. Army physician who managed control efforts of yellow fever, malaria and other... diseases like yellow fever, malaria, measles, tuberculosis, arbovirus febrile illness, viral... GMI is a public health institution within the Ministry of Health of Panama which provides research...

Factors associated with agreement between self-perception and clinical evaluation of dental treatment needs in adults in Brazil and Minas Gerais.

Science.gov (United States)

Nascimento, Alex Rodrigues do; Andrade, Fabíola Bof de; César, Cibele Comini

2016-11-03

This study sought to describe the agreement between self-perception and clinical evaluation of dental treatment needs in adults and analyze associated factors. The sample comprised adult individuals who took part in SBBrazil 2010 and SBMinas Gerais 2012. The study's outcome was agreement between self-perception and clinical evaluation of dental treatment needs. We used multiple Poisson regression in order to determine the factors associated with the outcome. Agreement between self-perception and clinical evaluation was 78.8% in Brazil and 73.8% in Minas Gerais. Clinical and self-reported oral health conditions that affect function and quality of life were associated with a higher agreement, while a recent visit to the dentist was associated with a lower agreement. Identifying associated factors may enable the development of questionnaires that favor correct self-perception regarding treatment needs.

The high price of "free" trade: U.S. trade agreements and access to medicines.

Science.gov (United States)

Lopert, Ruth; Gleeson, Deborah

2013-01-01

The United States' pursuit of increasingly TRIPS-Plus levels of intellectual property protection for medicines in bilateral and regional trade agreements is well recognized. Less so, however, are U.S. efforts through these agreements to influence and constrain the pharmaceutical coverage programs of its trading partners. Although arguably unsuccessful in the Australia- U.S. Free Trade Agreement (AUSFTA), the U.S. nevertheless succeeded in its bilateral FTA with South Korea (KORUS) in establishing prescriptive provisions pertaining to the operation of coverage and reimbursement programs for medicines and medical devices, which have the potential to adversely impact future access in that country. More recently, draft texts leaked from the current Trans Pacific Partnership Agreement (TPPA) negotiations show that U.S. objectives include not only AUSFTA-Plus and KORUS-Plus IP provisions but also ambitious inroads into the domestic health programs of its TPPA partners. This highlights the apparent conflict between trade goals - pursued through multilateral legal instruments to promote economic "health"- and public health objectives, such as the development of treatments for neglected diseases, the pursuit of efficiency and equity in priority setting, and the procurement of medicines at prices that reflect their therapeutic value and facilitate affordable access. © 2013 American Society of Law, Medicine & Ethics, Inc.

Oak Ridge Health Studies phase 1 report, Volume 1: Oak Ridge Phase 1 overview

International Nuclear Information System (INIS)

Yarbrough, M.I.; Van Cleave, M.L.; Turri, P.; Daniel, J.

1993-09-01

In July 1991, the State of Tennessee initiated the Health Studies Agreement with the United States Department of Energy to carry out independent studies of possible adverse health effects in people living in the vicinity of the Oak Ridge Reservation. The health studies focus on those effects that could have resulted or could result from exposures to chemicals and radioactivity released at the Reservation since 1942. The major focus of the first phase was to complete a Dose Reconstruction Feasibility Study. This study was designed to find out if enough data exist about chemical and radionuclide releases from the Oak Ridge Reservation to conduct a second phase. The second phase will lead to estimates of the actual amounts or the ''doses'' of various contaminants received by people as a result of off-site releases. Once the doses of various contaminants have been estimated, scientists and physicians will be better able to evaluate whether adverse health effects could have resulted from the releases

Oak Ridge Health Studies phase 1 report, Volume 1: Oak Ridge Phase 1 overview

Energy Technology Data Exchange (ETDEWEB)

Yarbrough, M.I.; Van Cleave, M.L.; Turri, P.; Daniel, J.

1993-09-01

In July 1991, the State of Tennessee initiated the Health Studies Agreement with the United States Department of Energy to carry out independent studies of possible adverse health effects in people living in the vicinity of the Oak Ridge Reservation. The health studies focus on those effects that could have resulted or could result from exposures to chemicals and radioactivity released at the Reservation since 1942. The major focus of the first phase was to complete a Dose Reconstruction Feasibility Study. This study was designed to find out if enough data exist about chemical and radionuclide releases from the Oak Ridge Reservation to conduct a second phase. The second phase will lead to estimates of the actual amounts or the ``doses`` of various contaminants received by people as a result of off-site releases. Once the doses of various contaminants have been estimated, scientists and physicians will be better able to evaluate whether adverse health effects could have resulted from the releases.

Voluntary agreements, implementation and efficiency. European relevance of case study results. Reflections on transferability to voluntary agreement schemes at the European level

Energy Technology Data Exchange (ETDEWEB)

Helby, Peter

2000-04-01

As a policy instrument, voluntary agreements often fascinate policy-makers.This is fuelled by a number of assumed advantages, such as the opportunity for co-operation rather than confrontation, speed and flexibility and the cost-effectiveness. Some advantages might even be accentuated at the European level: Co-operation has added advantage at the European level where the culture of consensus decision is strong. Flexibility is extra attractive for policy makers dealing with an economy less homogeneous than the average national economy. Speed is certainly welcomed by policy-makers otherwise faced with the slow-winding European legislative process. Cost-effectiveness is eagerly sought by European policy makers facing tight administrative budgets and staff limits. This report examines lessons from the VAIE case studies that may be useful to policy makers engaged in the development of voluntary approaches at the European level. These case studies are about voluntary agreement schemes for industrial energy efficiency deployed in Denmark, France, Germany, Netherlands, and Sweden. For a summary of these case studies, please refer to the the VAIE final report. More detailed information is available in the VAIE national reports. It needs to be emphasised that the empirical base is very narrow. The 'lessons' presented can only be hypotheses, based on an inductive leap from a very narrow experience. The reader will need to check these hypotheses against her own broader experience and personal judgement. According to the principle of subsidiarity, voluntary agreements should be implemented at the European level only if that would have significant advantage over national action. Action at the European level, rather than the national level, would have these potential advantages: Being more consistent with the development of the single market; Allowing higher demands on energy efficiency without negative effect on competitiveness and employment; Stimulating company

Shareholders' agreements in Denmark

DEFF Research Database (Denmark)

Werlauff, Erik

2010-01-01

’ agreements”) cannot bind the company within the sense of company law under the new state of law, and voting rights agreements, agreements on right of pre-emption etc. will therefore only apply at the level of contract law between the parties to the agreement. This article for European Business Law Review......The article warns that with effect from 1 March 2010, the new Danish Companies Act (on public and private limited companies) has seriously weakened the effect of shareholders’ agreements which have been entered into on Danish companies. These agreements (in the act’s new terminology: “owners...... analyses the consequences of this. Rights and duties in the owners’ agreements must now be reiterated to the greatest possible extent in the company’s articles of association so that the precepts become binding on the company and its management. Whether the parties to the owners’ agreement can be required...

Interobserver agreement in the histologic diagnosis of colorectal polyps. the experience of the multicenter adenoma colorectal study (SMAC).

Science.gov (United States)

Costantini, Massimo; Sciallero, Stefania; Giannini, Augusto; Gatteschi, Beatrice; Rinaldi, Paolo; Lanzanova, Giuseppe; Bonelli, Luigina; Casetti, Tino; Bertinelli, Elisabetta; Giuliani, Orietta; Castiglione, Guido; Mantellini, Paola; Naldoni, Carlo; Bruzzi, Paolo

2003-03-01

Current clinical practice guidelines for patients with colorectal polyps are mainly based on the histologic characteristics of their lesions. However, interobserver variability in the assessment of specific polyp characteristics was evaluated in very few studies. The purpose of this study was to evaluate the interobserver agreement of four pathologists in the diagnosis of histologic type of colorectal polyps and in the degree of dysplasia and of infiltrating carcinoma in adenomas. A stratified random sample of 100 polyps was obtained from the 4,889 polyps resected within the Multicentre Adenoma Colorectal Study (SMAC), and the slides were blindly reviewed by the four pathologists. Agreement was analyzed using kappa statistics. A median kappa of 0.89 (range 0.79-1.0) was estimated for the interobserver agreement for the diagnosis of hyperplastic polyp vs. adenoma. The agreement in the diagnosis of tubular, tubulovillous, and villous type, was given by median kappa values of 0.50, 0.15, and 0.36, respectively. The median kappa for the diagnosis of infiltrating carcinoma was 0.78 (range 0.73-0.84). Agreement on diagnosis of adenoma histologic subtypes, degrees of dysplasia, or infiltrating carcinoma in adenoma was moderate. A simpler classifications might help to better identify patients at different risk of colorectal cancer.

A Simulation Study of Rater Agreement Measures with 2x2 Contingency Tables

Science.gov (United States)

Ato, Manuel; Lopez, Juan Jose; Benavente, Ana

2011-01-01

A comparison between six rater agreement measures obtained using three different approaches was achieved by means of a simulation study. Rater coefficients suggested by Bennet's [sigma] (1954), Scott's [pi] (1955), Cohen's [kappa] (1960) and Gwet's [gamma] (2008) were selected to represent the classical, descriptive approach, [alpha] agreement…

Measuring agreement between decision support reminders: the cloud vs. the local expert.

Science.gov (United States)

Dixon, Brian Edward; Simonaitis, Linas; Perkins, Susan M; Wright, Adam; Middleton, Blackford

2014-04-10

A cloud-based clinical decision support system (CDSS) was implemented to remotely provide evidence-based guideline reminders in support of preventative health. Following implementation, we measured the agreement between preventive care reminders generated by an existing, local CDSS and the new, cloud-based CDSS operating on the same patient visit data. Electronic health record data for the same set of patients seen in primary care were sent to both the cloud-based web service and local CDSS. The clinical reminders returned by both services were captured for analysis. Cohen's Kappa coefficient was calculated to compare the two sets of reminders. Kappa statistics were further adjusted for prevalence and bias due to the potential effects of bias in the CDS logic and prevalence in the relative small sample of patients. The cloud-based CDSS generated 965 clinical reminders for 405 patient visits over 3 months. The local CDSS returned 889 reminders for the same patient visit data. When adjusted for prevalence and bias, observed agreement varied by reminder from 0.33 (95% CI 0.24 - 0.42) to 0.99 (95% CI 0.97 - 1.00) and demonstrated almost perfect agreement for 7 of the 11 reminders. Preventive care reminders delivered by two disparate CDS systems show substantial agreement. Subtle differences in rule logic and terminology mapping appear to account for much of the discordance. Cloud-based CDSS therefore show promise, opening the door for future development and implementation in support of health care providers with limited resources for knowledge management of complex logic and rules.

The Lancet Countdown on PM2·5 pollution-related health impacts of China's projected carbon dioxide mitigation in the electric power generation sector under the Paris Agreement: a modelling study.

Science.gov (United States)

Cai, Wenjia; Hui, Jingxuan; Wang, Can; Zheng, Yixuan; Zhang, Xin; Zhang, Qiang; Gong, Peng

2018-04-01

Except for comparing the implementation costs of the Paris Agreement with potential health benefits at the national levels, previous studies have not explored the health impacts of the nationally determined contributions (NDCs) by countries and in regional details. In this Lancet Countdown study, we aimed to estimate and monetise the health benefits of China's NDCs in the electric power generation sector, and then compare them with the implementation costs, both at the national and regional levels. In this modelling study, we linked the Multi-regional model for Energy Supply system and their Environmental ImpaCts, the Multi-resolution Emission Inventory for China model, the offline-coupled Weather Research and Forecasting model, the Community Multiscale Air Quality model, and the Integrated Health Impact Assessment model with a time scope from 2010 to 2050. We calculated the PM 2·5 concentrations and compared the health impacts and implementation costs between two scenarios that reflect CO 2 and air pollutant emissions-the reference (REF) scenario (no climate policy) and the NDC scenario (100% realisation of NDC targets: CO 2 emission intensity needs to be about 40% below 2010 emissions by 2030 [roughly 35% below 2030 emissions in REF], and about 90% below 2010 emissions by 2050 [roughly 96% below 2050 emissions in REF]). Under a comparatively optimistic health benefits valuation condition, at the national level, 18-62% of implementation costs could be covered by the health benefits in 2030. In 2050, the overall health benefits would substantially increase to 3-9 times of the implementation costs. However, northwest China would require the highest implementation costs and will also have more premature deaths because of a more carbon-intensive energy structure than business as usual. By 2030, people in northwest China (especially in Gansu, Shaanxi, and Xinjiang provinces) would need to bear worse air quality, and 10 083 (95% CI 3419-16 138) more premature

REAL ESTATE PURCHASE AGREEMENTS

Directory of Open Access Journals (Sweden)

Bujorel FLOREA

2016-12-01

Full Text Available The study presented herein represents a field with good present and future perspectives, especially because real estate property is not under the incidence of a single normative act regarding the sale-purchase agreement of such goods, and given the fact that there are specific legal provisions with respect to various real estate categories and the localization of such property. The article deals with the sale-purchase agreement of various real estate categories, such as fields, buildings, the correspondent lots, urban area, farm, and forests fields, focusing on some particularities. A special care is attributed to examining the applicable laws with regard to the purchase agreements of field lands, the special conditions to be taken into account, the persons that may act as buyers, including foreigners, those without citizenship, and legal persons of a nationality other than Romanian. Finally, a special concern is given to the formalities required for legally exerting the pre-emptive right and the applicable sanctions in that respect.

78 FR 48342 - Consultation Agreements: Proposed Changes to Consultation Procedures

Science.gov (United States)

2013-08-08

... clarify the high priority enforcement cases when OSHA may initiate a non-programmed inspection at those.... OSHA-2010-0010] RIN 1218-AC32 Consultation Agreements: Proposed Changes to Consultation Procedures AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Withdrawal of proposed rule...

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Science.gov (United States)

2010-10-01

... GRANTS GRANTS FOR CONSTRUCTION OF TEACHING FACILITIES, EDUCATIONAL IMPROVEMENTS, SCHOLARSHIPS AND STUDENT LOANS Loan Guarantees and Interest Subsidies to Assist in Construction of Teaching Facilities for Health Profession Personnel § 57.1514 Loan guarantee and interest subsidy agreements. For each application for a...

Low agreement among 24 doctors using the Neer-classification; only moderate agreement on displacement, even between specialists

DEFF Research Database (Denmark)

Brorson, S; Bagger, J; Sylvest, A

2002-01-01

Twenty-four orthopaedic surgeons classified 42 pairs of radiographs according to the Neer system for proximal humeral fractures. Mean kappa value for inter-observer agreement was 0.27 (95% CI 0.26-0.28) with no clinically significant difference between orthopaedic residents ( n=9), fellows ( n=6)......) and specialists ( n=9). Mean kappa for agreement of displacement versus non-displacement was 0.41 (95% CI 0.39-0.43) overall, and 0.50 (95% CI 0.45-0.56) within the specialist group. The agreement found in our study is unsatisfactory from a clinical perspective....

Freshness-Preserving Non-Interactive Hierarchical Key Agreement Protocol over WHMS

Directory of Open Access Journals (Sweden)

Hyunsung Kim

2014-12-01

Full Text Available The digitization of patient health information (PHI for wireless health monitoring systems (WHMSs has brought many benefits and challenges for both patients and physicians. However, security, privacy and robustness have remained important challenges for WHMSs. Since the patient’s PHI is sensitive and the communication channel, i.e., the Internet, is insecure, it is important to protect them against unauthorized entities, i.e., attackers. Otherwise, failure to do so will not only lead to the compromise of a patient’s privacy, but will also put his/her life at risk. This paper proposes a freshness-preserving non-interactive hierarchical key agreement protocol (FNKAP for WHMSs. The FNKAP is based on the concept of the non-interactive identity-based key agreement for communication efficiency. It achieves patient anonymity between a patient and physician, session key secrecy and resistance against various security attacks, especially including replay attacks.

Freshness-Preserving Non-Interactive Hierarchical Key Agreement Protocol over WHMS

Science.gov (United States)

Kim, Hyunsung

2014-01-01

The digitization of patient health information (PHI) for wireless health monitoring systems (WHMSs) has brought many benefits and challenges for both patients and physicians. However, security, privacy and robustness have remained important challenges for WHMSs. Since the patient's PHI is sensitive and the communication channel, i.e., the Internet, is insecure, it is important to protect them against unauthorized entities, i.e., attackers. Otherwise, failure to do so will not only lead to the compromise of a patient's privacy, but will also put his/her life at risk. This paper proposes a freshness-preserving non-interactive hierarchical key agreement protocol (FNKAP) for WHMSs. The FNKAP is based on the concept of the non-interactive identity-based key agreement for communication efficiency. It achieves patient anonymity between a patient and physician, session key secrecy and resistance against various security attacks, especially including replay attacks. PMID:25513824

How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada.

Directory of Open Access Journals (Sweden)

Aisha Lofters

Full Text Available CONTEXT: Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities. METHODS: We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities. RESULTS: There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1% than for the three statements that attributed inequalities to the plight of the poor (58.3% or the eight statements that attributed inequalities to the privilege of the rich (58.7%. DISCUSSION: A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support

The bilateral trade agreements and export performance of South Asian nations with special reference to India Sri Lanka Free Trade Agreement

Directory of Open Access Journals (Sweden)

Suhail P

2011-12-01

Full Text Available The regional trade agreements (RTA have been one of the important developments in the world trading system in 1990s. There are number of studies on the effects trade agreements in different contexts. This study is an attempt to analyse the effects of bilateral trade agreements in the intraregional trade in the SAARC region with special reference to the Free Trade Agreements (FTA between India Sri Lanka. The study uses a panel regression analysis by using balance panel data. The study concludes that the FTA between India and Sri Lanka has brought positive results in the trade between these two nations by improving the bilateral trade in goods. The results of the study are important in the context of looking for the prospects of a free trade area in the region by member nations.

Bilateral agreements

International Nuclear Information System (INIS)

Anon.

2004-01-01

The bilateral agreements concern Brazil with United States relative to the co operation in nuclear energy, Germany with Russian Federation relative to the elimination and disposal of nuclear weapons; The multilateral agreements concerns the signature of the Protocols to amend the Paris and Brussels Conventions, the multilateral nuclear environmental programme in the Russian Federation, the status of Conventions in the field of nuclear energy. (N.C.)

Chernobyl Studies Project - working group 7.0 environmental transport and health effects

International Nuclear Information System (INIS)

Hendrickson, S.M.

1994-01-01

The DOE-funded Chernobyl Studies Project was begun as part of a cooperative agreement between the US and the former USSR, (quote) To develop jointly methods to project rapidly the health effects of any future reactor accident (quote). Most of the initial tasks for this project are completed or near completion. The focus has now turned primarily to the issue of health effects from the Chernobyl accident. Currently, we are extensively engaged in case-control and cohort studies of thyroid diseases among Belarussian children and in the Ukraine. A major part of the effort is providing methods and applications of dose reconstruction and providing support and equipment for the medical teams. This document contains reports on progress in the following task areas: Management; External Dose; Hydrological Transport; Chromosome Painting Dosimetry; Stochastic Effects; Thyroid Studies; and Leukemia Studies

48 CFR 25.403 - World Trade Organization Government Procurement Agreement and Free Trade Agreements.

Science.gov (United States)

2010-10-01

... Government Procurement Agreement and Free Trade Agreements. 25.403 Section 25.403 Federal Acquisition... 25.403 World Trade Organization Government Procurement Agreement and Free Trade Agreements. (a... in 25.402(a)(1). The WTO GPA and FTAs specify procurement procedures designed to ensure fairness (see...

Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study.

Science.gov (United States)

Batra, Manu; Shah, Aasim Farooq; Virtanen, Jorma I

2018-01-01

Early childhood caries (ECC) continues to affect children worldwide. In India, primary health centers (PHCs) comprises the primary tier where Accredited Social Health Activist (ASHA) provide integrated curative and preventive health care. The aim of the study was to pilot test the integration of oral health in primary health care through motivational interviewing (MI) for mothers of young children provided by ASHAs. The pilot study was conducted in Kashipur, Uttarakhand. From the six PHCs in Kashipur, three were randomly selected, one each was assigned to MI group, traditional health education group, and control group. From 60 mothers with 8-12 months child, ASHAs of all three groups gathered mother's knowledge regarding child's oral health using close-ended questionnaire and diagnosed clinical risk markers of ECC in children and ASHAs of Group A and B imparted the oral health education as per their training. The comparison of ASHA's performances on the MI training competency pre- and post-test showed an overall average of 74% improvement in post-test scores. Interexaminer reliability of the parallel clinical measurements by 6 ASHAs and the investigator for the maxillary central incisors showed 93% of agreement for both dental plaque and dental caries assessment with 0.86 and 0.89 kappa values, respectively. The health education through MI is feasible and can be cost-effective by utilization of ASHAs at PHCs to provide the oral health education to mothers which will in turn improve the oral health status of children.

78 FR 35319 - Solicitation for a Cooperative Agreement-Curriculum Development: Planning and Implementing...

Science.gov (United States)

2013-06-12

... jails and extensive experience in working with local jails on issues related to inmate mental health... mental illness. Scope of Work: The cooperative agreement awardee will draft a curriculum on (1) the key...--Curriculum Development: Planning and Implementing Effective Mental Health Services in Jails AGENCY: National...

Nuclear cooperation agreements

International Nuclear Information System (INIS)

Nuclear cooperation agreements are reviewed in tabular form, especially agreements with developing countries. The reporting countries are the USA, the Federal Republic of Germany, Canada, Australia, Japan, and France. A separate EURATOM list is annexed

Canada-United States air quality agreement: Making progress

International Nuclear Information System (INIS)

1992-01-01

The Canada-USA Air Quality Agreement was signed in March 1991. Canada's commitment under the agreement is to reduce emissions of SO 2 in the seven easternmost provinces to 2.3 million tonnes/y by 1994 and to cap these emissions at 3.2 million tonnes/y by 2000; in addition, Canada agrees to reduce nitrogen oxide emissions from stationary sources by 100,000 tonnes/y by 2000 and to implement more stringent nitrogen oxide emission standards for vehicles from 1994-96. The USA agrees to reduce SO 2 emissions by ca 10 million tons/y below 1980 levels by 2000, to achieve a permanent cap of 8.95 million tons/y for electric utilities by 2010, to ensure that industrial emissions do not exceed 5.6 million tons, and to reduce total nitrogen oxide emissions by ca 2 million tons/y below 1980 levels, primarily through new regulations for power plants and automobiles. In Canada, SO 2 emissions are now within 16% of target, with control efforts centered around metal smelters and power plants. In the USA, considerable progress has been made in promulgating regulations that will implement the acid rain control provisions of the agreement. Both countries are sharing information, are continuing a variety of scientific and technical activities, and cooperating in areas such as emission inventorying, atmospheric modelling, deposition monitoring, effects research and monitoring, human health studies, and control technologies. In the USA, market based incentives are being used in controlling acid emissions and are being assessed for their potential use in Canada. 13 figs., 3 tabs

How needs and preferences of employees influence participation in health promotion programs: a six-month follow-up study.

Science.gov (United States)

Rongen, Anne; Robroek, Suzan J W; van Ginkel, Wouter; Lindeboom, Dennis; Pet, Martin; Burdorf, Alex

2014-12-15

Low participation in health promotion programs (HPPs) might hamper their effectiveness. A potential reason for low participation is disagreement between needs and preferences of potential participants and the actual HPPs offered. This study aimed to investigate employees' need and preferences for HPPs, whether these are matched by what their employers provide, and whether a higher agreement enhanced participation. Employees of two organizations participated in a six-month follow-up study (n = 738). At baseline, information was collected on employees' needs and preferences for the topic of the HPP (i.e. physical activity, healthy nutrition, smoking cessation, stress management, general health), whether they favored a HPP via their employer or at their own discretion, and their preferred HPP regarding three components with each two alternatives: mode of delivery (individual vs. group), intensity (single vs. multiple meetings), and content (assignments vs. information). Participation in HPPs was assessed at six-month follow-up. In consultation with occupational health managers (n = 2), information was gathered on the HPPs the employers provided. The level of agreement between preferred and provided HPPs was calculated (range: 0-1) and its influence on participation was studied using logistic regression analyses. Most employees reported needing a HPP addressing physical activity (55%) and most employees preferred HPPs organized via their employer. The mean level of agreement between the preferred and offered HPPs ranged from 0.71 for mode of delivery to 0.84 for intensity, and was 0.47 for all three HPP components within a topic combined. Employees with a higher agreement on mode of delivery (OR: 1.72, 95% CI: 0.87-3.39) and all HPP components combined (OR: 2.36, 95% CI: 0.68-8.17) seemed to be more likely to participate in HPPs, but due to low participation these associations were not statistically significant. HPPs aimed at physical activity were most needed by

The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration?

Science.gov (United States)

Azzopardi-Muscat, Natasha; Schroder-Bäck, Peter; Brand, Helmut

2017-01-01

The Joint Procurement Agreement (JPA) is an innovative instrument for multi-country procurement of medical countermeasures against cross-border health threats. This paper aims to assess its potential performance. A literature review was conducted to identify key features of successful joint procurement programmes. Documentary analysis and a key informants' interview were carried out to analyse the European Union (EU) JPA. Ownership, equity, transparency, stable central financing, standardisation, flexibility and gradual development were identified as important prerequisites for successful establishment of multi-country joint procurement programmes in the literature while security of supply, favourable prices, reduction of operational costs and administrative burden and creation of professional expert networks were identified as desirable outcomes. The EU JPA appears to fulfil the criteria of ownership, transparency, equity, flexibility and gradual development. Standardisation is only partly fulfilled and central EU level financing is not provided. Security of supply is an important outcome for all EU Member States (MS). Price savings, reduction in administrative burden and creation of professional networks may be particularly attractive for the smaller MS. The JPA has the potential to increase health system collaboration and efficiency at EU level provided that the incentives for sustained commitment of larger MS are sufficiently attractive.

Effects of modifications to the health and social sector’s collective agreement on the objective characteristics of working hours

Science.gov (United States)

ROPPONEN, Annina; VANTTOLA, Päivi; KOSKINEN, Aki; HAKOLA, Tarja; PUTTONEN, Sampsa; HÄRMÄ, Mikko

2017-01-01

This study aimed to evaluate the effects of an intervention on objective working-hour characteristics. The intervention involved making modifications to the collective agreement that would limit employees’ entitlement to time off as compensation. The intervention group consisted of 493 and the control group of 2,303 health and social care shift workers, respectively. We analysed the objective pay roll-based working-hour data for 2012–2013, which we obtained from employers’ records, using the repeated measures mixed model. The changes in objective working-hour characteristics were small, but systematic. The intervention had some positive effects: the amount of short recovery periods (working weeks of over 48 h decreased from 19% to 17%. The realization of employees’ shift preferences increased from 18% to 20%. However, in contrast, consecutive work shifts and the number of scheduled absences increased and days off decreased, suggesting less time for recovery and thus a negative trend in shift ergonomics. When planning shifts, nursing management should avoid regulations that promote specific unhealthy shift characteristics, that is, consecutive work shifts and less days off. PMID:28420807

Public participation for women's health: strange bedfellows or partners in a cause?

Science.gov (United States)

Thurston, Wilfreda E; Vollman, Ardene Robinson; Meadows, Lynn M; Rutherford, Erin

2005-05-01

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide women's health services through the Grace Women's Health Centre, a major part of the region's women's health program. We present a case study exploring the process and final agreement and the impact of this agreement on women's participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which women's health as a priority could be discussed in a context where the forces against gender equity talk are strong.

Job coding (PCS 2003): feedback from a study conducted in an Occupational Health Service

Science.gov (United States)

Henrotin, Jean-Bernard; Vaissière, Monique; Etaix, Maryline; Malard, Stéphane; Dziurla, Mathieu; Lafon, Dominique

2016-10-19

Aim: To examine the quality of manual job coding carried out by occupational health teams with access to a software application that provides assistance in job and business sector coding (CAPS). Methods: Data from a study conducted in an Occupational Health Service were used to examine the first-level coding of 1,495 jobs by occupational health teams according to the French job classification entitled “PSC- Professions and socio-professional categories” (INSEE, 2003 version). A second level of coding was also performed by an experienced coder and the first and second level codes were compared. Agreement between the two coding systems was studied using the kappa coefficient (κ) and frequencies were compared by Chi2 tests. Results: Missing data or incorrect codes were observed for 14.5% of social groups (1 digit) and 25.7% of job codes (4 digits). While agreement between the first two levels of PCS 2003 appeared to be satisfactory (κ=0.73 and κ=0.75), imbalances in reassignment flows were effectively noted. The divergent job code rate was 48.2%. Variation in the frequency of socio-occupational variables was as high as 8.6% after correcting for missing data and divergent codes. Conclusions: Compared with other studies, the use of the CAPS tool appeared to provide effective coding assistance. However, our results indicate that job coding based on PSC 2003 should be conducted using ancillary data by personnel trained in the use of this tool.

42 CFR 137.329 - What environmental considerations must be included in the construction project agreement?

Science.gov (United States)

2010-10-01

... must be included in the construction project agreement? The construction project agreement must include..., and (d) An assurance that no action will be taken on the construction phase of the project that would... 42 Public Health 1 2010-10-01 2010-10-01 false What environmental considerations must be included...

Are physicians and patients in agreement? Exploring dyadic concordance.

Science.gov (United States)

Coran, Justin J; Koropeckyj-Cox, Tanya; Arnold, Christa L

2013-10-01

Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance-the extent of agreement in physician and patient responses regarding patient information (education, self-rated health, pain); and interactional concordance-the extent of physician-patient agreement regarding the patient's level of confidence and trust in the physician and the perceived quality of explanations concerning diagnosis and treatment. Using a convenience sample of physicians and patients (N = 50 dyads), a paired survey method was tested, which measured and compared physician and patient reports to identify informational and interactional concordances. Factors potentially related to dyadic concordance were also measured, including demographic characteristics (patient race, gender, age, and education) and clinical factors (whether this was a first visit and physician specialty in family medicine or oncology). The paired survey showed informational discordances, as physicians tended to underestimate patients' pain and overestimate patient education. Interactional discordances included overestimating patients' understanding of diagnosis and treatment explanations and patients' level of confidence and trust. Discordances were linked to patient dissatisfaction with physician listening, having unanswered questions, and feeling the physician had not spent enough time. The paired survey method effectively identified physician-patient discordances that may interfere with effective medical practice; this method may be used in various settings to identify potential areas of improvement in health communication and education.

Understanding parent-teacher agreement of the Strengths and Difficulties Questionnaire (SDQ): Comparison across seven European countries.

Science.gov (United States)

Cheng, Sabrina; Keyes, Katherine M; Bitfoi, Adina; Carta, Mauro Giovanni; Koç, Ceren; Goelitz, Dietmar; Otten, Roy; Lesinskiene, Sigita; Mihova, Zlatka; Pez, Ondine; Kovess-Masfety, Viviane

2018-03-01

Assessments of child psychopathology are often derived from parental and teacher reports, yet there is substantial disagreement. This study utilized data from 7 European countries to examine parent-teacher agreement and possible explanatory factors for parent-teacher disagreement such as child and family characteristics, parenting dimensions, and maternal distress were explored. Parent-teacher agreement of the Strengths and Difficulties Questionnaire were assessed using a cross-sectional survey of 4,894 school aged children 6-11 from the School Children Mental Health Europe Project. Parent-teacher agreement was low to moderate (Pearson correlation ranging from .24 (Prosocial) to .48 (Hyperactivity) for the 5 subscales across 7 countries); kappa coefficient ranged from .01 (Turkey) to .44 (Italy) for internalizing problems and .19(Romania) to .44(Italy) for externalizing problems. Child's gender and age, mother's employment status, single parent home, number of children in household, and selected parenting dimension were found to be explanatory of informant disagreement. This study not only serves to advance our understanding of parent-teacher agreement of the Strengths and Difficulties Questionnaire in 7 European countries but provides a novel approach to examining the factors that contribute to informant disagreement. Copyright © 2017 John Wiley & Sons, Ltd.

Effect of patient age awareness on diagnostic agreement of chronic or aggressive periodontitis between clinicians; a pilot study.

Science.gov (United States)

Oshman, Sarah; El Chaar, Edgard; Lee, Yoonjung Nicole; Engebretson, Steven

2016-07-25

The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

42 CFR 137.55 - What is the term of a funding agreement?

Science.gov (United States)

2010-10-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Funding Agreements Term of A... term mutually agreed to by the parties. Absent notification from an Indian Tribe that it is withdrawing...

The simple economics of risk-sharing agreements between the NHS and the pharmaceutical industry.

Science.gov (United States)

Barros, Pedro Pita

2011-04-01

The introduction of new (and expensive) pharmaceutical products is one of the major challenges for health systems. The search for new institutional arrangements is natural. The use of the so-called risk-sharing agreements is one example. Recent discussions have somewhat neglected the economic fundamentals underlying risk-sharing agreements. We argue here that risk-sharing agreements, although attractive due to the principle of paying by results, also entail risks. Too many patients may be put under treatment. Prices are likely to be adjusted upward, in anticipation of future risk-sharing agreements between the pharmaceutical company and the third-party payer. An available instrument is a verification cost per patient treated, which allows obtaining the first-best allocation of patients to the new treatment, under the agreement. Overall, the welfare effects of risk-sharing agreements are ambiguous, and caution is urged regarding their use. Copyright © 2010 John Wiley & Sons, Ltd.

Framing of mobility items: a source of poor agreement between preference-based health-related quality of life instruments in a population of individuals receiving assisted ventilation.

Science.gov (United States)

Hannan, Liam M; Whitehurst, David G T; Bryan, Stirling; Road, Jeremy D; McDonald, Christine F; Berlowitz, David J; Howard, Mark E

2017-06-01

To explore the influence of descriptive differences in items evaluating mobility on index scores generated from two generic preference-based health-related quality of life (HRQoL) instruments. The study examined cross-sectional data from a postal survey of individuals receiving assisted ventilation in two state/province-wide home mechanical ventilation services, one in British Columbia, Canada and the other in Victoria, Australia. The Assessment of Quality of Life 8-dimension (AQoL-8D) and the EQ-5D-5L were included in the data collection. Graphical illustrations, descriptive statistics, and measures of agreement [intraclass correlation coefficients (ICCs) and Bland-Altman plots] were examined using index scores derived from both instruments. Analyses were performed on the full sample as well as subgroups defined according to respondents' self-reported ability to walk. Of 868 individuals receiving assisted ventilation, 481 (55.4%) completed the questionnaire. Mean index scores were 0.581 (AQoL-8D) and 0.566 (EQ-5D-5L) with 'moderate' agreement demonstrated between the two instruments (ICC = 0.642). One hundred fifty-nine (33.1%) reported level 5 ('I am unable to walk about') on the EQ-5D-5L Mobility item. The walking status of respondents had a marked influence on the comparability of index scores, with a larger mean difference (0.206) and 'slight' agreement (ICC = 0.386) observed when the non-ambulant subgroup was evaluated separately. This study provides further evidence that between-measure discrepancies between preference-based HRQoL instruments are related in part to the framing of mobility-related items. Longitudinal studies are necessary to determine the responsiveness of preference-based HRQoL instruments in cohorts that include non-ambulant individuals.

Agreements/disagreements about the inclusive process in Higher Education: an exploratory study

Directory of Open Access Journals (Sweden)

Lígia da Silva Marques

2014-06-01

Full Text Available With the intention to characterize the teachers agreement about the inclusion of students with deficiencies, global disorders development and giftedness in college; as well as the evaluation that the teachers themselves do as the professional and institutional capacity necessary to this process; this study investigated 20 teachers in a federal university of Minas Gerais, they answered a questionnaire about the investigate thematic. After data quantitative analysis, the following results were obtained: the teachers were aware of the necessity to establish an effective inclusive scene in the institution and confirmed the necessity of physical and employees’ preparation to do it; therefore, they didn’t feel capable enough to do it. In relation to the concordance of the inclusion of people with sensory deficiencies, it was evident that teachers reflect total or partial agreement; now in case of necessities linked with behaviors disorders, intellectual deficit or multiples deficiency, they disagree. This seems to denote that higher the necessity of commitments and differentiated professional actions, such as pedagogical and curriculum adaptations; less is the agreement with the inclusion, mostly for the teachers who teach in exact science area. As final consideration, we emphasize the necessity to move forward for discussion and educational practices which support the inclusive professional action, considered by the teachers their competence and responsibility; understanding this, which provides the introduction and the fortification of actions that ensure attitudinal, pedagogical and institutional conditions could support the construction a university wirh the intention of providing access, permanence and development to all the students.

12 CFR 346.5 - Related agreements considered a single agreement.

Science.gov (United States)

2010-01-01

... STATEMENTS OF GENERAL POLICY DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS § 346.5 Related agreements...; (2) Were entered into within the same 12-month period; and (3) Are each in fulfillment of the CRA. (b... in fulfillment of the CRA, if the contracts were negotiated in a coordinated fashion and a NGEP is a...

Constant round group key agreement protocols: A comparative study

NARCIS (Netherlands)

Makri, E.; Konstantinou, Elisavet

2011-01-01

The scope of this paper is to review and evaluate all constant round Group Key Agreement (GKA) protocols proposed so far in the literature. We have gathered all GKA protocols that require 1,2,3,4 and 5 rounds and examined their efficiency. In particular, we calculated each protocol’s computation and

Studies in support of an SNM cutoff agreement: The PUREX exercise

International Nuclear Information System (INIS)

Stanbro, W.D.; Libby, R.; Segal, J.

1995-01-01

On September 23, 1993, President Clinton, in a speech before the United Nations General Assembly, called for an international agreement banning the production of plutonium and highly enriched uranium for nuclear explosive purposes. A major element of any verification regime for such an agreement would probably involve inspections of reprocessing plants in Nuclear Nonproliferation Treaty weapons states. Many of these are large facilities built in the 1950s with no thought that they would be subject to international inspection. To learn about some of the problems that might be involved in the inspection of such large, old facilities, the Department of Energy, Office of Arms Control and Nonproliferation, sponsored a mock inspection exercise at the PUREX plant on the Hanford Site. This exercise examined a series of alternatives for inspections of the PUREX as a model for this type of facility at other locations. A series of conclusions were developed that can be used to guide the development of verification regimes for a cutoff agreement at reprocessing facilities

Validation of the Parental-Caregiver Perceptions Questionnaire: agreement between parental and child reports.

Science.gov (United States)

Barbosa, Taís de Souza; Gavião, Maria Beatriz Duarte

2015-01-01

To test the validity and reliability of Brazilian Portuguese version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) (Aim 1) and to assess the agreement between parents and children concerning the child's oral health-related quality of life (OHRQoL) (Aim 2). The P-CPQ and the Brazilian Portuguese versions of the Child Perceptions Questionnaires (CPQ8-10 and CPQ11-14 ) were used. Objective 1 addressed in the study that involved 210 (validity and internal reliability) and 20 (test-retest reliability) parents and Objective 2 in the study that involved 210 pairs of parents and children. Construct validity was calculated using the Spearman's correlation and the Mann-Whitney/Kruskal-Wallis tests. Reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Agreement between overall and subscale scores derived from the P-CPQ and CPQ was assessed in comparison and correlation analyses. The P-CPQ discriminated among the categories of malocclusion and dmft. The P-CPQ showed good construct validity, good internal consistency reliability, and excellent test-retest reliability. There was systematic under- and overreporting in parents' assessments for younger and older children, respectively. However, the magnitude of the directional differences was just small. At individual level, agreement between parents and children was excellent. However, it ranged from excellent to moderate or substantial in subscales for CPQ8-10 and CPQ11-14 groups, respectively. The Portuguese version of P-CPQ is valid and reliable. Some parents have limited knowledge about child OHRQoL. Given that parental and child reports measure different realities concerning the child's OHRQoL, information provided by parents can complement the child's evaluation. © 2015 American Association of Public Health Dentistry.

Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement

NARCIS (Netherlands)

de Winter, A. F.; Jans, M. P.; Scholten, R. J.; Devillé, W.; van Schaardenburg, D.; Bouter, L. M.

1999-01-01

To assess the interobserver agreement on the diagnostic classification of shoulder disorders, based on history taking and physical examination, and to identify the determinants of diagnostic disagreement. Consecutive eligible patients with shoulder pain were recruited in various health care settings

A juridical review of partnership agreements that have the elements of work agreements in Indonesia

Science.gov (United States)

Nugroho, A.; Sulistyowati, E.; Hikmah, N.

2018-01-01

The Partnership Agreements place the parties in an equal position each party has something as the bargaining power. In some cases, employers prefer to use Partnership Agreements to some individuals to complete the work in their company than Work agreements. Practicality and the absence of obligations to fulfil workers’ rights such as the right to join a Union and to get social security are some of the reasons why employers use the Partnership Agreements. Sometimes Partnership Agreement contains jobs, wages and orders which is the characteristic of work agreement. Based on the fact above, the legal issues arise whether the Partnership Agreement can be considered as the Work Agreement or not and which court is authorized to hear in the event of a dispute. To analyze the above legal issues, this research uses normative legal research type with the statute approach. The technique of legal material analysis uses prescriptive techniques to assess the issue and make recommendations. Based on the analysis, it can be concluded that the Partnership Agreement, of which the elements are: wages and orders can be categorized as Work Agreement and therefore in the event of a dispute, the authorized court is Industrial Relations Court.

Constitutional rights to health, public health and medical care: the status of health protections in 191 countries.

Science.gov (United States)

Heymann, Jody; Cassola, Adèle; Raub, Amy; Mishra, Lipi

2013-07-01

United Nations (UN) member states have universally recognised the right to health in international agreements, but protection of this right at the national level remains incomplete. This article examines the level and scope of constitutional protection of specific rights to public health and medical care, as well as the broad right to health. We analysed health rights in the constitutions of 191 UN countries in 2007 and 2011. We examined how rights protections varied across the year of constitutional adoption; national income group and region; and for vulnerable groups within each country. A minority of the countries guaranteed the rights to public health (14%), medical care (38%) and overall health (36%) in their constitutions in 2011. Free medical care was constitutionally protected in 9% of the countries. Thirteen per cent of the constitutions guaranteed children's right to health or medical care, 6% did so for persons with disabilities and 5% for each of the elderly and the socio-economically disadvantaged. Valuable next steps include regular monitoring of the national protection of health rights recognised in international agreements, analyses of the impact of health rights on health outcomes and longitudinal multi-level studies to assess whether specific formulations of the rights have greater impact.

Governance processes and change within organizational participants of multi-sectoral community health care alliances: the mediating role of vision, mission, strategy agreement and perceived alliance value.

Science.gov (United States)

Hearld, Larry R; Alexander, Jeffrey A

2014-03-01

Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their 'home' organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.

42 CFR 137.327 - May multiple projects be included in a single construction project agreement?

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May multiple projects be included in a single construction project agreement? 137.327 Section 137.327 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF...-GOVERNANCE Construction Project Assumption Process § 137.327 May multiple projects be included in a single...

Integration of oral health in primary health care through motivational interviewing for mothers of young children: A pilot study

Directory of Open Access Journals (Sweden)

Manu Batra

2018-01-01

Full Text Available Introduction: Early childhood caries (ECC continues to affect children worldwide. In India, primary health centers (PHCs comprises the primary tier where Accredited Social Health Activist (ASHA provide integrated curative and preventive health care. The aim of the study was to pilot test the integration of oral health in primary health care through motivational interviewing (MI for mothers of young children provided by ASHAs. Subjects and Methods: The pilot study was conducted in Kashipur, Uttarakhand. From the six PHCs in Kashipur, three were randomly selected, one each was assigned to MI group, traditional health education group, and control group. From 60 mothers with 8–12 months child, ASHAs of all three groups gathered mother's knowledge regarding child's oral health using close-ended questionnaire and diagnosed clinical risk markers of ECC in children and ASHAs of Group A and B imparted the oral health education as per their training. Results: The comparison of ASHA's performances on the MI training competency pre- and post-test showed an overall average of 74% improvement in post–test scores. Interexaminer reliability of the parallel clinical measurements by 6 ASHAs and the investigator for the maxillary central incisors showed 93% of agreement for both dental plaque and dental caries assessment with 0.86 and 0.89 kappa values, respectively. Conclusion: The health education through MI is feasible and can be cost-effective by utilization of ASHAs at PHCs to provide the oral health education to mothers which will in turn improve the oral health status of children.

Voluntary agreements in environmental policy

International Nuclear Information System (INIS)

Torvanger, Asbjoern

2001-01-01

A typically voluntary agreement is signed between the authorities and an industrial sector in order to reduce the emission of environmentally harmful substances. There are many different types of agreements. Voluntary agreements are not strictly voluntary, since in the background there is often some kind of ''threat'' about taxation or fees if the industry is unwilling to cooperate. This type of agreements has become popular in many OECD countries during the last decades. In Norway there are only a few agreements of this type. Experience with the use of voluntary agreements as well as research show that they are less cost-effective than market-based instruments such as taxes and quota systems. If there are great restrictions on the use of taxes and quota systems because of information- or measurement problems, or because these instruments are not politically acceptable, then voluntary agreements may be an interesting alternative. Thus, voluntary agreements are best used as a supplement to other instruments in some niche areas of the environmental policy. In some cases, voluntary agreements may be used between two countries or at a regional level, for example within the EU

Women's mental health before, during, and after pregnancy: a population-based controlled cohort study.

Science.gov (United States)

van Bussel, Johan C H; Spitz, Bernard; Demyttenaere, Koen

2006-12-01

Common mental health disorders like depressive and anxiety disorders are frequent in antenatal and postpartum women. However, no agreement about the prevalence of these disorders and the course of women's mental health during the transition to motherhood exists. This study compared women's mental health before, during, and after pregnancy with a control group of nonpregnant women. Three hundred and twenty-four women were assessed before, during, and after their pregnancy with the 12-item version of the General Health Questionnaire (GHQ-12). A control group of 324 women who did not deliver during 3 subsequent years was assessed with the GHQ-12 at corresponding time-points. No differences in GHQ-12 mean scores, prevalence, and incidence of common mental health disorders between the study and control groups were found. No differences in prevalence and incidence rates within each group were found. The presence of a common mental health disorder before pregnancy or in early pregnancy predicted common mental health disorders in the postpartum period. Common mental health disorders are frequent during pregnancy and the postpartum period, but pregnant or postpartum women are not more at risk than those who are not pregnant or who did not deliver.

76 FR 68189 - Healthcare Technology Holdings, Inc.; Analysis of Proposed Agreement Containing Consent Orders To...

Science.gov (United States)

2011-11-03

... FEDERAL TRADE COMMISSION [File No. 111 0097] Healthcare Technology Holdings, Inc.; Analysis of... Technology Holdings, Inc. (``Healthcare Technology''), subject to final approval, an Agreement Containing... Healthcare Technology's proposed acquisition of SDI Health LLC (``SDI'') from SDI Health Holdings LLC (``SDI...

Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology.

Science.gov (United States)

McAlinden, Colm; Khadka, Jyoti; Pesudovs, Konrad

2011-07-01

The ever-expanding choice of ocular metrology and imaging equipment has driven research into the validity of their measurements. Consequently, studies of the agreement between two instruments or clinical tests have proliferated in the ophthalmic literature. It is important that researchers apply the appropriate statistical tests in agreement studies. Correlation coefficients are hazardous and should be avoided. The 'limits of agreement' method originally proposed by Altman and Bland in 1983 is the statistical procedure of choice. Its step-by-step use and practical considerations in relation to optometry and ophthalmology are detailed in addition to sample size considerations and statistical approaches to precision (repeatability or reproducibility) estimates. Ophthalmic & Physiological Optics © 2011 The College of Optometrists.

Object attraction effects during subject-verb agreement in Persian.

Science.gov (United States)

Feiz, Aazam; Cowles, Wind

2018-04-01

Subject-verb agreement provides insight into how grammatical and semantic features interact during sentence production, and prior studies have found attraction errors when an intervening local noun is grammatically part of the subject. Two major types of theories have emerged from these studies: control based and competition-based. The current study used an subject-object-verb language with optional subject-verb agreement, Persian, to test the competition-based hypothesis that intervening object nouns may also cause attraction effects, even though objects are not part of the syntactic relationship between the subject and verb. Our results, which did not require speakers to make grammatical errors, show that objects can be attractors for agreement, but this effect appears to be dependent on the type of plural marker on the object. These results support competition-based theories of agreement production, in which agreement may be influenced by attractors that are outside the scope of the subject-verb relationship.

Predicting word sense annotation agreement

DEFF Research Database (Denmark)

Martinez Alonso, Hector; Johannsen, Anders Trærup; Lopez de Lacalle, Oier

2015-01-01

High agreement is a common objective when annotating data for word senses. However, a number of factors make perfect agreement impossible, e.g. the limitations of the sense inventories, the difficulty of the examples or the interpretation preferences of the annotations. Estimating potential...... agreement is thus a relevant task to supplement the evaluation of sense annotations. In this article we propose two methods to predict agreement on word-annotation instances. We experiment with a continuous representation and a three-way discretization of observed agreement. In spite of the difficulty...

Agreement between death-certificate and autopsy diagnoses among atomic-bomb survivors

International Nuclear Information System (INIS)

Ron, E.; Carter, R.L.; Jablon, S.; Mabuchi, Kiyohiko.

1993-11-01

Using the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5000 autopsies, we examined death-certificate accuracy for several disease categories and assessed the effect of potential modifying factors on this accuracy. For 12 cause-of-death categories, the overall percent agreement between death-certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate (on the death certificate) in the study, still almost 25% of cancers diagnosed at autopsy were missed on the death certificate. Only for neoplasms and external causes of death were confirmation and detection rates above 70%. Confirmation rates were between 50% and 70% for infectious and parasitic diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious and parasitic, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all but the cerebrovascular disease category. Overall agreement decreased with increasing age of the decedents and was lower for deaths occurring outside of hospital vs those occurring in a hospital. There was some suggestion that agreement rates were higher for more-recent deaths but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical-examination program influenced agreement. Because the inaccuracy of death-certificate diagnoses can have major implications for many aspects of health research and planning, it is important to be aware that death-certificate accuracy is low and can vary widely depending on the patient's age at death and the place of death. (J.P.N.)

Characteristics and allowed behaviors of gay male couples' sexual agreements.

Science.gov (United States)

Mitchell, Jason W

2014-01-01

Research has shown that gay male couples' sexual agreements may affect their risk for HIV. Few U.S. studies have collected dyadic data nationally from gay male couples to assess what sexual behaviors they allow to occur by agreement type and the sequence of when certain behaviors occur within their relationships. In our cross-sectional study, dyadic data from a convenience sample of 361 male couples were collected electronically throughout the United States by using paid Facebook ads. Findings revealed that couples discussed their HIV status before having unprotected anal intercourse (UAI) but established their agreement some time after having UAI. About half of the couples (N = 207) concurred about having an agreement. Among these couples, 58% concurred about explicitly discussing their agreement, 84% concurred about having the same type of agreement, and 54% had both men adhering to it. A variety of sexual behaviors were endorsed and varied by agreement type. Concordance about aspects of couples' agreements varied, suggesting the need to engage couples to be more explicit and detailed when establishing and communicating about their agreements. The allowed behaviors and primary reasons for establishing and breaking sexual agreements further highlight the need to bolster HIV prevention for gay male couples.

An international Delphi study examining health promotion and health education in nursing practice, education and policy.

Science.gov (United States)

Whitehead, Dean

2008-04-01

To arrive at an expert consensus in relation to health promotion and health education constructs as they apply to nursing practice, education and policy. Nursing has often been maligned and criticized, both inside and outside of the profession, for its ability to understand and conduct effective health promotion and health education-related activities. In the absence of an expert-based consensus, nurses may find it difficult to progress beyond the current situation. In the absence of any previously published nursing-related consensus research, this study seeks to fill that knowledge-gap. A two-round Delphi technique via email correspondence. A first-round qualitative questionnaire used open-ended questions for defining health promotion and health education. This was both in general terms and as participants believed these concepts related to the clinical, theoretical (academic/educational) and the policy (political) setting in nursing. Line-by-line qualitative content and thematic analysis of the first-round data generated 13 specific categories. These categories contained 134 statement items. The second-round questionnaire comprised the identified 134 statements. Using a five-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree) participants scored and rated their level of agreement/disagreement against the listed items. Data from the second-round was descriptively analysed according to distribution and central tendency measures. An expert consensus was reached on 65 of the original 134 statements. While some minor contradiction was demonstrated, strong consensus emerged around the issues of defining health promotion and health education and the emergence of a wider health promotion and health education role for nursing. No consensus was reached on only one of the 13 identified topic categories - that of 'nurses working with other disciplines and agencies in a health education and health promotion role.' This study provides a hitherto

Self-Other Agreement Between Employees on their Need for Achievement, Power, and Affiliation: A Social Relations Study

OpenAIRE

Doeze Jager-van Vliet, Sandra; Born, Marise; Molen, Henk

2017-01-01

textabstractThe present study focused on self-other agreement between employees on their Need for Achievement, Need for Power and Need for Affiliation, which needs are relevant for performance and wellbeing at work. The Social Relations Model was used to examine consensus between other-raters, self-other agreement and assumed similarity (seeing others as one sees oneself) on these needs. Data were collected among 168 employees from a Dutch non-profit organization, with four employees in each ...

42 CFR 137.338 - Must funds from other sources be incorporated into a construction project agreement?

Science.gov (United States)

2010-10-01

... SELF-GOVERNANCE Construction Project Assumption Process § 137.338 Must funds from other sources be... 42 Public Health 1 2010-10-01 2010-10-01 false Must funds from other sources be incorporated into a construction project agreement? 137.338 Section 137.338 Public Health PUBLIC HEALTH SERVICE...

Financing petroleum agreements

International Nuclear Information System (INIS)

Robson, C.J.V.

1994-01-01

This chapter describes the typical type of financing agreements which are currently used to finance North Sea petroleum projects whether they are in the cause of development or have been developed and are producing. It deals with the agreements which are entered into to finance borrowings for petroleum projects on a non-resource or limited resource basis. (UK)

Agreement Workflow Tool (AWT)

Data.gov (United States)

Social Security Administration — The Agreement Workflow Tool (AWT) is a role-based Intranet application used for processing SSA's Reimbursable Agreements according to SSA's standards. AWT provides...

Exploring academics' views on designs, methods, characteristics and outcomes of inclusive health research with people with intellectual disabilities: a modified Delphi study

Science.gov (United States)

Frankena, T K; Naaldenberg, J; Cardol, M; Meijering, J V; Leusink, G; van Schrojenstein Lantman-de Valk, H M J

2016-01-01

Background The British Medical Journal's (BMJ's) patient revolution strives for collaboration with patients in healthcare and health research. This paper studies collaboration with people with intellectual disabilities (ID) in health research, also known as inclusive health research. Currently, transparency and agreement among academics is lacking regarding its main aspects, preventing upscaling of the patient revolution. Objective This study aims to gain agreement among academics on 3 aspects of inclusive health research for people with ID: (1) designs and methods, (2) most important characteristics and (3) outcomes. Design A Delphi study was conducted with academics with experience in inclusive (health) research and on people with ID. The study consisted of 2 sequential questionnaire rounds (n=24; n=17), followed by in-depth interviews (n=10). Results Academics agreed on (1) a collaborative approach to be most suitable to inclusive health research, (2) characteristics regarding the accessibility and facilitation of inclusive health research, and (3) several outcomes of inclusive health research for people with ID and healthcare. Other characteristics agreed on included: atmosphere, relationship, engagement, partnership and power. It was stressed that these characteristics ensure meaningful inclusion. Interviewed academics voiced the need for a tool supporting the facilitation and evaluation of inclusive health research. There was ambiguity as to what this tool should comprise and the extent to which it was possible to capture the complex process of inclusive health research. Discussion and conclusions This study underlines the need for transparency, facilitation and evaluation of inclusive health research. The need for in-depth interviews after 2 Delphi rounds underlines its complexity and context dependence. To increase process transparency, future research should focus on gaining insight into inclusive health research in its context. A tool could be developed

WTO agreements and public health: a joint study by the WHO and the WTO Secretariat

National Research Council Canada - National Science Library

2002-01-01

... policymakers can benefit from closer cooperation to ensure coherence between their different areas of responsibilities. In both the WHO and the WTO questions of trade and public health feature high on the agenda, and significant advances have been made in the recent past. The endorsement by the international community of the Doha Declaration on...

Cryptanalysis and Enhancement of Anonymity Preserving Remote User Mutual Authentication and Session Key Agreement Scheme for E-Health Care Systems.

Science.gov (United States)

Amin, Ruhul; Islam, S K Hafizul; Biswas, G P; Khan, Muhammad Khurram; Li, Xiong

2015-11-01

The E-health care systems employ IT infrastructure for maximizing health care resources utilization as well as providing flexible opportunities to the remote patient. Therefore, transmission of medical data over any public networks is necessary in health care system. Note that patient authentication including secure data transmission in e-health care system is critical issue. Although several user authentication schemes for accessing remote services are available, their security analysis show that none of them are free from relevant security attacks. We reviewed Das et al.'s scheme and demonstrated their scheme lacks proper protection against several security attacks such as user anonymity, off-line password guessing attack, smart card theft attack, user impersonation attack, server impersonation attack, session key discloser attack. In order to overcome the mentioned security pitfalls, this paper proposes an anonymity preserving remote patient authentication scheme usable in E-health care systems. We then validated the security of the proposed scheme using BAN logic that ensures secure mutual authentication and session key agreement. We also presented the experimental results of the proposed scheme using AVISPA software and the results ensure that our scheme is secure under OFMC and CL-AtSe models. Moreover, resilience of relevant security attacks has been proved through both formal and informal security analysis. The performance analysis and comparison with other schemes are also made, and it has been found that the proposed scheme overcomes the security drawbacks of the Das et al.'s scheme and additionally achieves extra security requirements.

Grading system for migrated lumbar disc herniation on sagittal magnetic resonance imaging. An agreement study

Energy Technology Data Exchange (ETDEWEB)

Ahn, Y.; Jeong, T.S. [Gachon University Gil Medical Center, Department of Neurosurgery, Incheon (Korea, Republic of); Lim, T.; Jeon, J.Y. [Gachon University Gil Medical Center, Department of Radiology, Incheon (Korea, Republic of)

2018-01-15

Migrated lumbar disc herniations (LDHs) in the sagittal plane are common. Disc migration grading can be applied as a useful measurement tool in the diagnosis, treatment, and outcome evaluation of migrated LDH. No study has evaluated the reliability of migrated LDH grading. We evaluated the reliability and functionality of the current magnetic resonance imaging (MRI) grading system for migrated LDH. We assessed a six-level grading system developed based on sagittal MRI and graded according to the direction (rostral and caudal) and degree (low, high, and very high) of disc migration. One-hundred and one migrated LDHs treated with minimally invasive endoscopic discectomy were analyzed independently by two experienced radiologists. Intraobserver and interobserver agreements were assessed by kappa statistics. The most common migrated LDH grade was grade 4 (30.94%; caudal, low-grade migration). Rostral and caudal migrations were more common in the upper and lower lumbar levels, respectively. Interobserver agreement in the grading of migrated LDH was good at both the first (kappa = 0.737) and second assessment (kappa = 0.657). The intraobserver agreement for reader 1 was very good (kappa = 0.827) and for reader 2 was good (kappa = 0.620). The current grading system for migrated LDH was found to be reliable and functional with good interobserver and intraobserver agreement. It may be useful in the interpretation of disc migration patterns and outcomes of various minimally invasive surgical procedures. (orig.)

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

Directory of Open Access Journals (Sweden)

Tropp Hans

2005-06-01

Full Text Available Abstract Background The tissue origin of low back pain (LBP or referred lower extremity symptoms (LES may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216 with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement

Agreement Between Actual and Perceived Body Weight in Adolescents and Their Weight Control Behaviors

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Sun Mi Shin

2017-06-01

Full Text Available Background : To investigate the agreements between actual and perceived body weight status among adolescents and to identify the associations of disagreements with their weight control behaviors. Methods : This study used the secondary data of a sample survey (n=13,871 of the Seoul Student Health Examination among middle and high schools in 2010. Agreements between actual (underweight, normal, overweight, and obese, according to 2007 Korean National Growth Charts and perceived body weight status (underweight, normal, overweight, and obese were examined using Chi-square and Cohen’s kappa agreement, and then multinomial logistic regression including gender, grade, and attempt of weight control or method of weight control was done. Results : Agreements between actual and perceived body weight status were only 45.2%, and disagreements were up to 54.8%, including mild over- (20.4%, severe over- (1.8%, mild under- (29.5%, and severe under-estimation (3.1%. The kappa coefficient of agreement was only 0.19. The odds ratios on severe over-estimated perception were 1.59 (95% CI, 1.22-2.07 in female subjects, 1.78 (95% CI, 1.36-2.34 in diet control behaviors, and 1.53 (95% CI, 1.18-2.00 in exercise. The odds ratios on severe under-estimated perception were only 0.40 (95% CI, 0.32–0.50 in female subjects but 5.77 (95% CI, 3.68-9.06 in taking medication. Conclusion : There were associations of body weight control behaviors with disagreements of actual and perceived weight status. Therefore, further study is needed to identify the weight disagreement-related factors and to promote the desired weight control behaviors for adolescents.

Validation of Interobserver Agreement in Lung Cancer Assessment: Hematoxylin-Eosin Diagnostic Reproducibility for Non–Small Cell Lung Cancer

Science.gov (United States)

Grilley-Olson, Juneko E.; Hayes, D. Neil; Moore, Dominic T.; Leslie, Kevin O.; Wilkerson, Matthew D.; Qaqish, Bahjat F.; Hayward, Michele C.; Cabanski, Christopher R.; Yin, Xiaoying; Socinski, Mark A.; Stinchcombe, Thomas E.; Thorne, Leigh B.; Allen, Timothy Craig; Banks, Peter M.; Beasley, Mary B.; Borczuk, Alain C.; Cagle, Philip T.; Christensen, Rebecca; Colby, Thomas V.; Deblois, Georgean G.; Elmberger, Göran; Graziano, Paolo; Hart, Craig F.; Jones, Kirk D.; Maia, Diane M.; Miller, C. Ryan; Nance, Keith V.; Travis, William D.; Funkhouser, William K.

2018-01-01

Context Precise subtype diagnosis of non–small cell lung carcinoma is increasingly relevant, based on the availability of subtype-specific therapies, such as bevacizumab and pemetrexed, and based on the subtype-specific prevalence of activating epidermal growth factor receptor mutations. Objectives To establish a baseline measure of inter-observer reproducibility for non–small cell lung carcinoma diagnoses with hematoxylin-eosin for the current 2004 World Health Organization classification, to estimate interobserver reproducibility for the therapeutically relevant squamous/nonsquamous subsets, and to examine characteristics that improve interobserver reproducibility. Design Primary, resected lung cancer specimens were converted to digital (virtual) slides. Based on a single hematoxylin-eosin virtual slide, pathologists were asked to assign a diagnosis using the 2004 World Health Organization classification. Kappa statistics were calculated for each pathologist-pair for each slide and were summarized by classification scheme, pulmonary pathology expertise, diagnostic confidence, and neoplastic grade. Results The 12 pulmonary pathology experts and the 12 community pathologists each independently diagnosed 48 to 96 single hematoxylin-eosin digital slides derived from 96 cases of non–small cell lung carcinoma resection. Overall agreement improved with simplification from the comprehensive 44 World Health Organization diagnoses (κ = 0.25) to their 10 major header subtypes (κ = 0.48) and improved again with simplification into the therapeutically relevant squamous/nonsquamous dichotomy (κ = 0.55). Multivariate analysis showed that higher diagnostic agreement was associated with better differentiation, better slide quality, higher diagnostic confidence, similar years of pathology experience, and pulmonary pathology expertise. Conclusions These data define the baseline diagnostic agreement for hematoxylin-eosin diagnosis of non–small cell lung carcinoma

The Danish agreements on energy efficiency

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-05-01

CO{sub 2}-taxes for industry were introduced in 1993. In 1996, the taxes were increased and an agreement system for energy-intensive companies was implemented. The main purpose of the agreement system has been to allow energy-intensive industry to pay a reduced tax rate, while at the same time improving energy efficiency. The evaluation of the energy tax system has shown that it has been possible to establish an energy tax that has led to a decrease in CO{sub 2}-emissions, without causing a decrease in the competitiveness of trade, industry and services. The agreement system has been a very important element in that it has improved energy efficiency in companies in which taxes would not have been a realistic instrument. In the case of companies with agreements, several studies suggest improvements of approximately 2.7% of the total energy use per agreement (three years). The three sources (concrete projects, special investigation and energy management) contribute approximately one third of this reduction each. The values for special investigation and energy management must be used with great care. It is also predicted that a continuation of the agreement system by 2005, relative to a situation without agreements, can lead to a decrease in CO{sub 2}-emissions corresponding to 6% of total emissions in industry and trade. Of this reduction, the highest amount is due to energy management. However, maintaining the positive effects of energy management systems will require that companies give higher priority to the managerial part of the system and not only focus on energy accounting. Some companies have argued that it is costly to carry out energy audits and to have to audits verified. Therefore, consideration should be given to possibilities for reducing the administrative costs of entering into an agreement, without this causing reduced efforts to save energy. A means of achieving these objectives could be to reduce the requirement for energy audits and verification

Self-Other Agreement Between Employees on their Need for Achievement, Power, and Affiliation: A Social Relations Study

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Sandra Doeze Jager

2017-10-01

Full Text Available The present study focused on self-other agreement between employees on their Need for Achievement, Need for Power and Need for Affiliation, which needs are relevant for performance and wellbeing at work. The Social Relations Model was used to examine consensus between other-raters, self-other agreement and assumed similarity (seeing others as one sees oneself on these needs. Data were collected among 168 employees from a Dutch non-profit organization, with four employees in each of 42 teams. Consensus between other-raters occurred for all needs. Self-other agreement existed for the Needs for Achievement and Power, but not for Affiliation. Assumed similarity occurred for the Need for Achievement, but not for the other needs. Findings for the Need for Achievement demonstrate a traditional rating pattern exhibiting consensus, self-other agreement and assumed similarity. The absence of assumed similarity for the Need of Power implies that employees are able to distinguish between their own and their peers’ needs to have influence at work. The lack of self-other agreement for the Need for Affiliation may imply that improving others’ awareness of one’s need to connect is necessary to enhance one’s well-being at work. Our findings may be useful to organizations, as being knowledgeable about one’s employees’ needs is important to improve the fit between their needs and the job.

Why are Trade Agreements Regional?

OpenAIRE

Zissimos, Ben

2007-01-01

This paper shows how distance may be used to coordinate on a unique equilibrium in which trade agreements are regional. Trade agreement formation is modeled as coalition formation. In a standard trade model with no distance between countries, a familiar problem of coordination failure arises giving rise to multiple equilibria; any one of many possible trade agreements can form. With distance between countries, and through strategic interaction in tariff setting, regional trade agreements gene...

Correlates of Agreement between Accelerometry and Self-reported Physical Activity

DEFF Research Database (Denmark)

Cerin, Ester; Cain, Kelli L; Oyeyemi, Adewale L

2016-01-01

PURPOSE: Understanding factors that influence accurate assessment of physical activity (PA) and sedentary behavior (SB) is important to measurement development, epidemiologic studies, and interventions. This study examined agreement between self-reported (International Physical Activity Questionn......PURPOSE: Understanding factors that influence accurate assessment of physical activity (PA) and sedentary behavior (SB) is important to measurement development, epidemiologic studies, and interventions. This study examined agreement between self-reported (International Physical Activity...... Questionnaire - Long Form, IPAQ-LF) and accelerometry-based estimates of PA and SB across six countries, and identified correlates of between-method agreement. METHODS: Self-report and objective (accelerometry-based) PA and SB data were collected in 2002-2011 from 3,865 adult participants in eight cities from......-demographic characteristics and PA patterns were examined as correlates of between-method agreement. RESULTS: Observed relative agreement (relationships of IPAQ-LF with accelerometry-based PA and SB variables) was small to moderate (r=0.05-0.37) and was moderated by socio-demographic (age, sex, weight status, education...

Monitoring the impact of trade agreements on national food environments: trade imports and population nutrition risks in Fiji.

Science.gov (United States)

Ravuvu, Amerita; Friel, Sharon; Thow, Anne-Marie; Snowdon, Wendy; Wate, Jillian

2017-06-13

Trade agreements are increasingly recognised as playing an influential role in shaping national food environments and the availability and nutritional quality of the food supply. Global monitoring of food environments and trade policies can strengthen the evidence base for the impact of trade policy on nutrition, and support improved policy coherence. Using the INFORMAS trade monitoring protocol, we reviewed available food supply data to understand associations between Fiji's commitments under WTO trade agreements and food import volume trends. First, a desk review was conducted to map and record in one place Fiji's commitments to relevant existing trade agreements that have implications for Fiji's national food environment under the domains of the INFORMAS trade monitoring protocol. An excel database was developed to document the agreements and their provisions. The second aspect of the research focused on data extraction. We began with identifying food import volumes into Fiji by country of origin, with a particular focus on a select number of 'healthy and unhealthy' foods. We also developed a detailed listing of transnational food corporations currently operating in Fiji. The study suggests that Fiji's WTO membership, in conjunction with associated economic and agricultural policy changes have contributed to increased availability of both healthy and less healthy imported foods. In systematically monitoring the import volume trends of these two categories of food, the study highlights an increase in healthy foods such as fresh fruits and vegetables and whole-grain refined cereals. The study also shows that there has been an increase in less healthy foods including fats and oils; meat; processed dairy products; energy-dense beverages; and processed and packaged foods. By monitoring the trends of imported foods at country level from the perspective of trade agreements, we are able to develop appropriate and targeted interventions to improve diets and health. This

Systems management of facilities agreements

International Nuclear Information System (INIS)

Blundell, A.

1998-01-01

The various types of facilities agreements, the historical obstacles to implementation of agreement management systems and the new opportunities emerging as industry is beginning to make an effort to overcome these obstacles, are reviewed. Barriers to computerized agreement management systems (lack of consistency, lack of standards, scarcity of appropriate computer software) are discussed. Characteristic features of a model facilities agreement management system and the forces driving the changing attitudes towards such systems (e.g. mergers) are also described

The role of veterinary epidemiology and veterinary services in complying with the World Trade Organization SPS agreement.

Science.gov (United States)

Zepeda, C; Salman, M; Thiermann, A; Kellar, J; Rojas, H; Willeberg, P

2005-02-01

The agreement on the application of sanitary and phytosanitary measures (SPS agreement) was one of the major products of the GATT's Uruguay round of multilateral trade negotiations, signed in Marrakesh on 15 April 1994. This agreement and others are part of the treaty that established the World Trade Organization (WTO). The WTO superseded the GATT as the umbrella organization for international trade (WTO, 1998a). The SPS agreement's main intent is to provide guidelines and provisions to member countries to facilitate trade while taking measures to protect human, animal or plant life or health. The agreement dictates that all sanitary measures must be scientifically based and not more restrictive than required to avoid the risk identified. The agreement recommends the use of international standards from the World Organization for Animal Health (OIE), Codex Alimentarius (CAC) and the International Plant Protection Convention (IPPC) as the basis for import requirements. If a country chooses to apply more restrictive measures than those in the international standards, it has to justify its position through a risk analysis, thus avoiding the use of sanitary and phytosanitary measures as unjustified barriers to trade. More than ever, veterinary services worldwide are faced with having to fulfill a crucial role in protecting their country's animal health status, provide sound surveillance information on the occurrence of diseases within their territories, and conduct scientifically valid risk analyses to establish justified import requirements. During the past two decades, most countries have experienced resource reduction in their veterinary services. The effect of these policies has been severe, in many cases leading to an inability of veterinary services to conduct their disease prevention and control duties. There is a clear inconsistency between the demands placed on veterinary services and the current level of funding and support they are receiving, particularly in

Agreement of physical activity questionnaire with cardiorespiratory fitness

Directory of Open Access Journals (Sweden)

Maria Fatima Glaner

2007-03-01

Full Text Available Many health benefi ts are associated with physical activity level (PAL, but no standardized approaches to measurement exist, and comparisons and surveillance are problematic. The aim of this study was to verify the level ofagreement between the results of the International Physical Activity Questionnaire (IPAQ: short and the Habitual Physical Activity Questionnaire (HPAQ with true cardiorespiratory fi tness (VO2max, in order to classify young men and women ashaving PAL that is either adequate or inadequate for good health. A convenience sample was studied, composed of 105 young adults (43 male physical education students; 28 female physical education students; 34 males not studying physicaleducation. Both questionnaires were self-administered under the identical conditions. Values for VO2max were obtained using Cooper’s 12 min running test. Subjects were classifi ed as having PAL and VO2max that were adequate or inadequatefor good health. The cut off points used to defi ne adequate VO2max ≥44 ml/kg/min-1 for men and ≥33 ml/kg/min-1 for women. Agreement was assessed using a 2x2 contingency table. Percentage agreement ranged from 51.10% to 64.70% for theHPAQ and was 47.06% for the IPAQ. Agreement was higher for the HPAQ than for the IPAQ. Women overestimated their PAL by HPAQ and men underestimated their PAL by both questionnaires. The fi ndings of this study suggest that the HPAQ tends to be more accurate than the IPAQ. RESUMOMuitos benefícios à saúde são associados ao nível de atividade física (NAF, mas não existem medidas padronizadas para tal e, comparações e monitorações são difíceis. O propósito deste estudo foi verifi car a concordância do Questionário Internacional para Atividades Físicas (IPAQ – curto e do Questionário de Atividades Físicas Habituais (QAFH com a aptidão cardiorrespiratória (VO2max, para classifi car homens e mulheres jovens, com níveis de atividade física (NAF recomendado, ou não, para a sa

Achieving high value care for all and the perverse incentives of 340B price agreements.

Science.gov (United States)

Whittington, Melanie D; Campbell, Jonathan D; McQueen, R Brett

2018-04-01

Section 340B of the Public Health Service Act requires drug manufacturers to enter into price agreements with the Department of Health and Human Services. These agreements result in variation in the price paid to acquire a drug by sector, which complicates the price used in cost-effectiveness analyses. We describe the transactions and sectors in a 340B agreement using a multiple sclerosis drug. Cost-effectiveness estimates were calculated for the drug using drug prices from the manufacturer and payer perspective. We found the amount paid to the manufacturer (340B price) was a good value ($118,256 per quality-adjusted life-year); however, from the payer drug cost perspective, good value ($196,683 per quality-adjusted life-year) was not achieved. Given that emerging value frameworks incorporate cost-effectiveness, these price variations may have downstream negative consequences, including inaccurate coverage and reimbursement policy recommendations. Upcoming policy changes to the 340B program should incentivize pricing schemes hinged on transparency and value.

The leniency agreement: ananalysis of constitutional compatibility and legitimacy

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Marlon roberth sales

2015-12-01

Full Text Available The scope of this study is to analyze the institution of the Leniency Agreement, notably under the light of theAnticorruption Law provision (Law 12.846 of 2013and theRegulatory Decree 8.420 of 2015. At first, the leniency agreement will be widely studied, mainly within the North American system to, simultaneously, investigate it in the contextof the Anticorruption law. Next, its possible (in constitutionality will be refuted. Then, a parallel between Leniency Agreements and the dialogic Public Administration will be made, based on Habermas discursive theory. Finally, it will show that the Leniency Agreement constitutes a legitimate constitutional tool and, in addition, it configures as an effective consensual mechanism to fight corruption in a democratic soil.

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

Science.gov (United States)

Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM. PMID:23299226

Signalling in international environmental agreements. Using pre-agreement emission level as a signalling device

Energy Technology Data Exchange (ETDEWEB)

Steiner, U.

1997-12-31

This paper addresses the question about strategic incentives in international environmental agreements and tries to give a positive description of how the design of the agreement influences the strategic behaviour of potential participants before they enter the treaty. A common feature of the design of agreements is that the reduction obligations (RO) are made contingent on a pre-agreement or baseline emission. As it is assumed that countries posses better information about their reduction costs than does the international body in charge of deciding the RO, countries might have incentives to signal higher costs by increasing their baseline emission, and thereby reducing the costs of entering the agreement. The appropriate analytical framework is to use a signalling game approach, where the pre-agreement emission level conveys information about the privately informed country`s reduction cost. In this paper two types of agreement design are considered, one with uniform obligations, and one with differentiated obligations. This enables us to make a comparison between two different reduction regimes. The result is that the predicted outcomes vary with regard to both the environmental effectiveness and the associated expected costs for the participating countries. This means that when private information is considered, the anticipation of a given institutional framework has significant impact on the resulting distortion of the total emission level, highlighting the necessity of taking this into consideration when future designs are proposed. (au)

Signalling in international environmental agreements: Using pre-agreement emission level as a signalling device

International Nuclear Information System (INIS)

Steiner, U.

1997-01-01

This paper addresses the question about strategic incentives in international environmental agreements and tries to give a positive description of how the design of the agreement influences the strategic behaviour of potential participants before they enter the treaty. A common feature of the design of agreements is that the reduction obligations (RO) are made contingent on a pre-agreement or baseline emission. As it is assumed that countries posses better information about their reduction costs than does the international body in charge of deciding the RO, countries might have incentives to signal higher costs by increasing their baseline emission, and thereby reducing the costs of entering the agreement. The appropriate analytical framework is to use a signalling game approach, where the pre-agreement emission level conveys information about the privately informed country's reduction cost. In this paper two types of agreement design are considered, one with uniform obligations, and one with differentiated obligations. This enables us to make a comparison between two different reduction regimes. The result is that the predicted outcomes vary with regard to both the environmental effectiveness and the associated expected costs for the participating countries. This means that when private information is considered, the anticipation of a given institutional framework has significant impact on the resulting distortion of the total emission level, highlighting the necessity of taking this into consideration when future designs are proposed. (au)

38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

Science.gov (United States)

2010-07-01

... sharing agreements, contracts for scarce medical specialist services and contracts for other medical... medical specialist services and contracts for other medical services. The Under Secretary for Health is... specialist services at Department of Veterans Affairs health care facilities (including, but not limited to...

Multilateral and bilateral agreements

International Nuclear Information System (INIS)

Koponen, H.

1993-01-01

Finland has made both multilateral and bilateral agreements on the exchange of information related to radiation safety. The first arrangements for international agreements and exchange of information were made after the Chernobyl accident. In 1987, Finland joined the convention on early notification of a nuclear power accident coordinated by International Atomic Energy Agency. The convention is applied to accidents that cause of may cause emissions of radioactive substances that might affect the radiation safety of another country. Besides the convention on early notification, some other individual agreements have also been made. These include the International Nuclear Event Scale (INES) system and power companies own information exchange systems. Finland has conducted bilateral agreements with the Nordic countries and the Soviet Union on the notification of accidents and exchange of nuclear power plant information. Today, Russia answers for the Soviet Union's contractual obligations. (orig.)

If Parents Establish a No-Smoking Agreement with Their Offspring, Does This Prevent Adolescents from Smoking? Findings from Three Dutch Studies

Science.gov (United States)

den Exter Blokland, Endy A. W.; Engels, Rutger C.; Harakeh, Zeena; Hale, William W., III.; Meeus, Wim

2009-01-01

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their…

Competition for Assistance Agreements

Science.gov (United States)

It is EPA policy to promote competition in the award of assistance agreements to the maximum extent practicable.When assistance agreements are awarded competitively, it is EPA policy that the competitive process be fair and open & that no applicant receive

29 CFR 1908.10 - Cooperative Agreements.

Science.gov (United States)

2010-07-01

... CONSULTATION AGREEMENTS § 1908.10 Cooperative Agreements. (a) Who may make Agreements. The Assistant Secretary... consultation services to private sector employers. (3) Renegotiation of existing Agreements funded under this part shall be initiated within 30 days of the effective date of these revisions. (c) Contents of...

48 CFR 2831.109 - Advance agreements.

Science.gov (United States)

2010-10-01

... proposed agreement. The approved determination will be placed in the contract file. (c) All advance... the agreements. Advance agreements will be signed by both the contractor and the contracting officer, and made a part of the contract file. Copies of executed advance agreements will be distributed to the...

The Development Standard Agreement Influences on National and International Business Practices

Directory of Open Access Journals (Sweden)

Cindawati Cindawati

2016-12-01

Full Text Available The rapidly growing business traffic either nationally or internationally forces the business practices to establish a standard agreement to secure the products and to protect the buyer from any risks. The standard agreement successfully meets the demand of international trade which urgently need the high speed and the accuracy. The objective of this research is to find out how does the development of agreement affect to the commerce practices and what are the requirements of standard agreement in accordance with the right and obligation. A qualitative method is applied in searching data of business practices. This study uses a normative research which guides the rule of law or determines some business standards and norms. The finding of this study show that the development of agreement strongly affects to the commerce practices, and standar agreement is urgently needed by business practices as a guideline to perform business traffic as smooth as buyer and seller expect, then both seller and buyer should know the three alternative way used as the procedures of standard agreement, namely; contract signing, notification document agreement, and notification by bulletin board. At last, a standard agreement could be accepted as legal agreement corresponding to willingness and trustworthy.

FTA Corpus: a parallel corpus of English and Spanish Free Trade Agreements for the study of specialized collocations

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Pedro Patiño García

2013-04-01

Full Text Available This paper describes the Corpus of Free Trade Agreements (henceforth FTA, a specialized parallel corpus in English and Spanish from Europe and America and a smaller subcorpus in English-Norwegian and Spanish-Norwegian that was prepared and then aligned with Translation Corpus Aligner 2 (Hofland & Johansson, 1998. The data was taken from Free Trade Agreements. These agreements are specialized texts officially signed and ratified by several countries and blocks of countries in the last twenty years. Thus, FTAs are a rich repository for terminology and phraseology that is used in different fields of business activity throughout the world. The corpus contains around 1.37 million words in the English section and 1.48 million words in its Spanish counterpart, plus 60,000 words each in the Spanish-Norwegian and English-Norwegian subcorpus. The corpus is being used primarily to study the terms and specialized collocations that include these terms in this kind of specialized texts.Keywords: specialized collocation, specialized parallel corpus, corpus linguistics, Free Trade Agreement

Measuring agreement between decision support reminders: the cloud vs. the local expert

OpenAIRE

Dixon, Brian Edward; Simonaitis, Linas; Perkins, Susan M; Wright, Adam; Middleton, Blackford

2014-01-01

Background: A cloud-based clinical decision support system (CDSS) was implemented to remotely provide evidence-based guideline reminders in support of preventative health. Following implementation, we measured the agreement between preventive care reminders generated by an existing, local CDSS and the new, cloud-based CDSS operating on the same patient visit data. Methods: Electronic health record data for the same set of patients seen in primary care were sent to both the cloud-based web ser...

Intra-examiner repeatability and agreement in accommodative response measurements.

Science.gov (United States)

Antona, B; Sanchez, I; Barrio, A; Barra, F; Gonzalez, E

2009-11-01

Clinical measurement of the accommodative response (AR) identifies the focusing plane of a subject with respect to the accommodative target. To establish whether a significant change in AR has occurred, it is important to determine the repeatability of this measurement. This study had two aims: First, to determine the intraexaminer repeatability of AR measurements using four clinical methods: Nott retinoscopy, monocular estimate method (MEM) retinoscopy, binocular crossed cylinder test (BCC) and near autorefractometry. Second, to study the level of agreement between AR measurements obtained with the different methods. The AR of the right eye at one accommodative demand of 2.50 D (40 cm) was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18-32 years). The intraexaminer repeatability of the tests, and agreement between them, were estimated by the Bland-Altman method. We determined mean differences (MD) and the 95% limits of agreement [coefficient of repeatability (COR) and coefficient of agreement (COA)]. Nott retinoscopy and BCC offered the best repeatability, showing the lowest MD and narrowest 95% interval of agreement (Nott: -0.10 +/- 0.66 D, BCC: -0.05 +/- 0.75 D). The 95% limits of agreement for the four techniques were similar (COA = +/- 0.92 to +/-1.00 D) yet clinically significant, according to the expected values of the AR. The two dynamic retinoscopy techniques (Nott and MEM) had a better agreement (COA = +/-0.64 D) although this COA must be interpreted in the context of the low MEM repeatability (COR = +/-0.98 D). The best method of assessing AR was Nott retinoscopy. The BCC technique was also repeatable, and both are recommended as suitable methods for clinical use. Despite better agreement between MEM and Nott, agreement among the remaining methods was poor such that their interchangeable use in clinical practice is not recommended.

Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France

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Olivier Philippe

2011-10-01

Full Text Available Abstract Background For several decades, emergency departments (EDs utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43. The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61, gynaecological (kappa = 0.66 and toxicology complaints (kappa = 1.00. The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09 and hospitalization (kappa = 0.20. When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%. Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used

The Text of the Agreement of 25 February 1975 between the Agency, the Government of Monaco and the Oceanographic Institute at Monaco concerning Developmental Studies on the Effects of Radioactivity in the Sea. Extension of the Agreement

International Nuclear Information System (INIS)

1985-08-01

The Agreement of 25 February 1975 between the Agency, the Government of the Principality of Monaco and the Oceanographic Institute at Monaco, concerning developmental studies on the effects of radioactivity in the sea provided for the project to continue for a period of six years ending on 31 December 1980. Further Agreements of 5 February 1981, 1 June 1981 and 1 July 1984 extended the project to 30 June 1985, with the understanding that any party to the Agreement may terminate it by giving six months' notice.

Agreement in cardiovascular risk rating based on anthropometric parameters

International Nuclear Information System (INIS)

Dantas, Endilly Maria da Silva; Pinto, Cristiane Jordânia; Freitas, Rodrigo Pegado de Abreu; Medeiros, Anna Cecília Queiroz de

2015-01-01

To investigate the agreement in evaluation of risk of developing cardiovascular diseases based on anthropometric parameters in young adults. The study included 406 students, measuring weight, height, and waist and neck circumferences. Waist-to-height ratio and the conicity index. The kappa coefficient was used to assess agreement in risk classification for cardiovascular diseases. The positive and negative specific agreement values were calculated as well. The Pearson chi-square (χ"2) test was used to assess associations between categorical variables (p<0.05). The majority of the parameters assessed (44%) showed slight (k=0.21 to 0.40) and/or poor agreement (k<0.20), with low values of negative specific agreement. The best agreement was observed between waist circumference and waist-to-height ratio both for the general population (k=0.88) and between sexes (k=0.93 to 0.86). There was a significant association (p<0.001) between the risk of cardiovascular diseases and females when using waist circumference and conicity index, and with males when using neck circumference. This resulted in a wide variation in the prevalence of cardiovascular disease risk (5.5%-36.5%), depending on the parameter and the sex that was assessed. The results indicate variability in agreement in assessing risk for cardiovascular diseases, based on anthropometric parameters, and which also seems to be influenced by sex. Further studies in the Brazilian population are required to better understand this issue

Agreement in cardiovascular risk rating based on anthropometric parameters

Energy Technology Data Exchange (ETDEWEB)

Dantas, Endilly Maria da Silva; Pinto, Cristiane Jordânia; Freitas, Rodrigo Pegado de Abreu; Medeiros, Anna Cecília Queiroz de [Universidade Federal do Rio Grande do Norte, Natal, RN (Brazil)

2015-07-01

To investigate the agreement in evaluation of risk of developing cardiovascular diseases based on anthropometric parameters in young adults. The study included 406 students, measuring weight, height, and waist and neck circumferences. Waist-to-height ratio and the conicity index. The kappa coefficient was used to assess agreement in risk classification for cardiovascular diseases. The positive and negative specific agreement values were calculated as well. The Pearson chi-square (χ{sup 2}) test was used to assess associations between categorical variables (p<0.05). The majority of the parameters assessed (44%) showed slight (k=0.21 to 0.40) and/or poor agreement (k<0.20), with low values of negative specific agreement. The best agreement was observed between waist circumference and waist-to-height ratio both for the general population (k=0.88) and between sexes (k=0.93 to 0.86). There was a significant association (p<0.001) between the risk of cardiovascular diseases and females when using waist circumference and conicity index, and with males when using neck circumference. This resulted in a wide variation in the prevalence of cardiovascular disease risk (5.5%-36.5%), depending on the parameter and the sex that was assessed. The results indicate variability in agreement in assessing risk for cardiovascular diseases, based on anthropometric parameters, and which also seems to be influenced by sex. Further studies in the Brazilian population are required to better understand this issue.

Agreement between diagnoses of childhood lymphoma assigned in Uganda and by an international reference laboratory

Directory of Open Access Journals (Sweden)

Orem J

2012-12-01

Full Text Available Jackson Orem,1–3 Sven Sandin,1 Caroline E Weibull,1 Michael Odida,4 Henry Wabinga,4 Edward Mbidde,2,3 Fred Wabwire-Mangen,5 Chris JLM Meijer,6 Jaap M Middeldorp,6 Elisabete Weiderpass1,7,81Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 2Uganda Cancer Institute, 3School of Medicine, 4School of Biomedical Sciences, 5School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 6Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; 7Cancer Registry of Norway, Oslo; Department of Community Medicine, University of Tromsø, Tromsø, Norway; 8Samfundet Folkhälsan, Helsinki, FinlandBackground: Correct diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non-Hodgkin lymphoma (NHL assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands.Methods: The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics.Results: Clinical and pathological diagnoses from Uganda and pathological diagnosis from The Netherlands was available for 118 children. The agreement between clinical and pathological diagnoses of NHL assigned in Uganda was 91% (95% confidence interval [CI] 84–95; kappa 0.84; P < 0

Exploring academics' views on designs, methods, characteristics and outcomes of inclusive health research with people with intellectual disabilities: a modified Delphi study.

Science.gov (United States)

Frankena, T K; Naaldenberg, J; Cardol, M; Meijering, J V; Leusink, G; van Schrojenstein Lantman-de Valk, H M J

2016-08-18

The British Medical Journal's (BMJ's) patient revolution strives for collaboration with patients in healthcare and health research. This paper studies collaboration with people with intellectual disabilities (ID) in health research, also known as inclusive health research. Currently, transparency and agreement among academics is lacking regarding its main aspects, preventing upscaling of the patient revolution. This study aims to gain agreement among academics on 3 aspects of inclusive health research for people with ID: (1) designs and methods, (2) most important characteristics and (3) outcomes. A Delphi study was conducted with academics with experience in inclusive (health) research and on people with ID. The study consisted of 2 sequential questionnaire rounds (n=24; n=17), followed by in-depth interviews (n=10). Academics agreed on (1) a collaborative approach to be most suitable to inclusive health research, (2) characteristics regarding the accessibility and facilitation of inclusive health research, and (3) several outcomes of inclusive health research for people with ID and healthcare. Other characteristics agreed on included: atmosphere, relationship, engagement, partnership and power. It was stressed that these characteristics ensure meaningful inclusion. Interviewed academics voiced the need for a tool supporting the facilitation and evaluation of inclusive health research. There was ambiguity as to what this tool should comprise and the extent to which it was possible to capture the complex process of inclusive health research. This study underlines the need for transparency, facilitation and evaluation of inclusive health research. The need for in-depth interviews after 2 Delphi rounds underlines its complexity and context dependence. To increase process transparency, future research should focus on gaining insight into inclusive health research in its context. A tool could be developed to facilitate and evaluate inclusive health research. This tool

UNITED STATES/GERMAN TECHNICAL BILATERAL AGREEMENT: PAST, PRESENT & FUTURE

Science.gov (United States)

The U.S. Environmental Protection Agency (EPA) and the German Federal Ministry of Education and Research (BMBF) entered into a Bilateral Agreement in 1990 to study each country's efforts in developing and demonstrating remedial technologies. The bilateral agreement is being impl...

Environmental and occupational health research and training needs in Colombia: A Delphi study.

Science.gov (United States)

Rodríguez-Villamizar, Laura A; González, Beatriz Elena; Vera, Lina María; Patz, Jonathan; Bautista, Leonelo E

2015-08-01

Environmental factors contribute with 16% of the burden of disease in Colombia. A main obstacle in implementing national and regional environmental and occupational health policies is the limited knowledge on the local ability to study and control the impact of harmful exposures on health. To identify needs for research and training in environmental and occupational health in Colombia. We conducted a three-round hybrid Delphi study. A group of environmental and occupational health Colombian experts (n=16) from government agencies, universities, and research centers was recruited to participate in the study. Expert´s opinions on research and training needs were gathered through online questionnaires, followed by an in-person meeting. The percentage of agreement and the coefficient of variation were used to measure consensus. Air pollution and chemical products were considered the most important environmental and occupational exposures, due to their significant impact on chronic non-communicable diseases, such as respiratory diseases, cardiovascular diseases, and cancer. Research on the effects of outdoor air pollution on cardiovascular and respiratory diseases was considered of the greatest importance. Priority training areas included environmental and occupational health risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology. These findings provide a valuable input for the definition and implementation of national environmental and occupational health policies and for the development of a regional hub aimed at strengthening the capacity for research and training in Colombia.

Environmental and occupational health research and training needs in Colombia: A Delphi study

Science.gov (United States)

Rodríguez-Villamizar, Laura A.; González, Beatriz Elena; Vera, Lina María; Patz, Jonathan; Bautista, Leonelo E.

2015-01-01

Introduction Environmental factors contribute with 16% of the burden of disease in Colombia. A main obstacle in implementing national and regional environmental and occupational health policies is the limited knowledge on the local ability to study and control the impact of harmful exposures on health. Objective To identify needs for research and training in environmental and occupational health in Colombia. Materials and methods We conducted a three-round hybrid Delphi study. A group of environmental and occupational health Colombian experts (n=16) from government agencies, universities, and research centers was recruited to participate in the study. Expert’s opinions on research and training needs were gathered through online questionnaires, followed by an in-person meeting. The percentage of agreement and the coefficient of variation were used to measure consensus. Results Air pollution and chemical products were considered the most important environmental and occupational exposures, due to their significant impact on chronic non-communicable diseases, such as respiratory diseases, cardiovascular diseases, and cancer. Research on the effects of outdoor air pollution on cardiovascular and respiratory diseases was considered of the greatest importance. Priority training areas included environmental and occupational health risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology. Conclusions These findings provide a valuable input for the definition and implementation of national environmental and occupational health policies and for the development of a regional hub aimed at strengthening the capacity for research and training in Colombia. PMID:26535742

48 CFR 1642.1204 - Agreement to recognize a successor in interest (novation agreement).

Science.gov (United States)

2010-10-01

... that the corporate name of (insert old corporate name) was changed to (insert new corporate name) on... MANAGEMENT CONTRACT ADMINISTRATION Novation and Change-of-Name Agreements 1642.1204 Agreement to recognize a... corporate name) (Transferor), a corporation duly organized and existing under the laws of (insert State...

A Population-Based Assessment of the Agreement Between Grading of Goniophotographic Images and Gonioscopy in the Chinese-American Eye Study (CHES).

Science.gov (United States)

Murakami, Yohko; Wang, Dandan; Burkemper, Bruce; Lin, Shan C; Varma, Rohit

2016-08-01

To compare grading of goniophotographic images and gonioscopy in assessing the iridocorneal angle. In a population-based, cross-sectional study, participants underwent gonioscopy and goniophotographic imaging during the same visit. The iridocorneal angle was classified as closed if the posterior trabecular meshwork could not be seen. A single masked observer graded the goniophotographic images, and each eye was classified as having angle closure based on the number of closed quadrants. Agreement between the methods was analyzed by calculating kappa (κ) and first-order agreement coefficient (AC1) statistics and comparison of area under receiver operating characteristic curves (AUC). A total of 4149 Chinese Americans (3994 eyes) were included in this study. The agreement for angle closure diagnosis between gonioscopy and EyeCam was moderate to excellent (κ = 0.60, AC1 0.90, AUC 0.76-0.80). Detection of iridocorneal angle closure based on goniophotographic imaging shows moderate to very good agreement with angle closure assessment using gonioscopy.

Cooperative monitoring of regional security agreements

Energy Technology Data Exchange (ETDEWEB)

Pregenzer, A.L.; Vannoni, M.; Biringer, K.L.

1995-08-01

This paper argues that cooperative monitoring plays a critical role in the implementation of regional security agreements and confidence building measures. A framework for developing cooperative monitoring options is proposed and several possibilities for relating bilateral and regional monitoring systems to international monitoring systems are discussed. Three bilateral or regional agreements are analyzed briefly to illustrate different possibilities: (1) the demilitarization of the Sinai region between Israel and Egypt in the 1970s; (2) the 1991 quadripartite agreement for monitoring nuclear facilities among Brazil, Argentina, The Argentine-Brazilian Agency for Accounting and Control of Nuclear Materials and the International Atomic Energy Agency; and (3) a bilateral Open Skies agreement between Hungary and Romania in 1991. These examples illustrate that the relationship of regional or bilateral arms control or security agreements to international agreements depends on a number of factors: the overlap of provisions between regional and international agreements; the degree of interest in a regional agreement among the international community; efficiency in implementing the agreement; and numerous political considerations.Given the importance of regional security to the international community, regions should be encouraged to develop their own infrastructure for implementing regional arms control and other security agreements. A regional infrastructure need not preclude participation in an international regime. On the contrary, establishing regional institutions for arms control and nonproliferation could result in more proactive participation of regional parties in developing solutions for regional and international problems, thereby strengthening existing and future international regimes. Possible first steps for strengthening regional infrastructures are identified and potential technical requirements are discussed.

The Agreement between Conjoined Subjects and Predicate: Croatian Church Slavonic Corpus Analysis

Directory of Open Access Journals (Sweden)

Ana Kovačević

2017-08-01

Full Text Available The abundance of grammatical categories in Slavonic and their overlap are particularly evident in the agreement between conjoined subjects and predicate. When they are accompanied by agreement conditions, such as word order and animacy in Slavic languages, different agreement patterns, dependent also on concrete context and speaker, are to be expected. In this paper the study of the agreement between conjoined subjects and predicate is based on an analysis of the medieval Glagolitic Croatian Church Slavonic corpus. Number, gender, and person are grammatical categories, i. e., features of conjoined noun phrases and predicate agreement. The analysis includes noun phrases conjoined by coordinating and some non-coordinating conjunctions as well as noun phrases conjoined by a gradational ‛not only [. . .] but also’ structure. Comitative and reciprocal noun phrases are included as well. The research in the given corpus shows that the conjoined noun phrases with predicate agreement can be syntactic (predicate showing agreement with one conjunct or semantic (predicate showing agreement with all conjuncts. Syntactic agreement appears as the so-called contact agreement (predicate showing agreement with the closest conjunct and as distant agreement (predicate showing agreement with the most distant conjunct. Semantic agreement is applied mostly in accordance with G. G. Corbett’s resolution rules for Slavic languages. However, the analysis shows that some resolution rules for number should be revised due to dual number. Although absent from the majority of contemporary Slavic languages, it is precisely in historical Slavic idioms that dual number reveals its identity, highlighted in agreement study as well.

Post-Tobacco Master Settlement Agreement: Policy and Practice Implications for Social Workers

Science.gov (United States)

Clark, Trenette T.; Sparks, Michele Jones; McDonald, Theresa M.; Dickerson, Janet D.

2011-01-01

The 1998 Tobacco Master Settlement Agreement (MSA) was developed between states and tobacco manufacturers to settle the states' lawsuits against tobacco manufacturers and recover tobacco health-related costs. States won billions of dollars and concessions regarding how tobacco products could be advertised. The purpose of the MSA was to prevent…

High agreement on family affluence between children's and parents' reports: international study of 11-year-olds

DEFF Research Database (Denmark)

Andersen, Anette; Krølner, Rikke; Currie, Candace

2008-01-01

OBJECTIVE: To examine the agreement between parents' and children's reports on four items of family affluence: number of cars, own bedroom, number of family holidays, and number of computers, and to analyse predictors of disagreement. DESIGN: Cross sectional child-parent validation study of selec...

Government Procurement Agreements and Telecommunications Business

Directory of Open Access Journals (Sweden)

Shin-Won Kang

2001-12-01

Full Text Available The opening of the telecommunications market is acceleration due to the world trends of deregulation and privatization under the WTO basic telecommunications agreements. Diversification of services and fast and efficient equipment procurement are becoming necessary conditions for the survival of telecommunications operators. However, the issue here is that telecommunications operators are still bound by the GPA (Government Procurement Agreement based on conditions of monopoly even though the procurement market in Korean is open substantially since 1997. Under such conditions, the continued application of the GPA on telecommunications operator who is highly competitive may result in a negative impact on the telecommunications business and quality of telecommunications service by undermining the autonomy of operator and decreasing operator’s procurement competitiveness. Therefore, this study examines the GPA and the issues raised by the agreement, and also attempts to suggest revisions or means of abrogating the unfair GPA with regards to the development and deregulation of the telecommunications business.

Spine Instability Neoplastic Score: agreement across different medical and surgical specialties.

Science.gov (United States)

Arana, Estanislao; Kovacs, Francisco M; Royuela, Ana; Asenjo, Beatriz; Pérez-Ramírez, Úrsula; Zamora, Javier

2016-05-01

Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification

The Texts of The Agency's Agreements with the Republic of Austria. I. Headquarters Agreement. Amendments

Energy Technology Data Exchange (ETDEWEB)

NONE

1970-09-04

The text of the Agreement between the International Atomic Energy Agency and the Republic of Austria Amending the Agreement of 11 December 1957 Regarding the Headquarters of the International Atomic Energy Agency, which was signed on 4 June 1970, is reproduced in this document for the information of all Members. Members will be informed of the entry into force of the Amendments to the Headquarters Agreement.

The Texts of The Agency's Agreements with the Republic of Austria. I. Headquarters Agreement. Amendments

International Nuclear Information System (INIS)

1970-01-01

The text of the Agreement between the International Atomic Energy Agency and the Republic of Austria Amending the Agreement of 11 December 1957 Regarding the Headquarters of the International Atomic Energy Agency, which was signed on 4 June 1970, is reproduced in this document for the information of all Members. Members will be informed of the entry into force of the Amendments to the Headquarters Agreement

Efficient biometric authenticated key agreements based on extended chaotic maps for telecare medicine information systems.

Science.gov (United States)

Lou, Der-Chyuan; Lee, Tian-Fu; Lin, Tsung-Hung

2015-05-01

Authenticated key agreements for telecare medicine information systems provide patients, doctors, nurses and health visitors with accessing medical information systems and getting remote services efficiently and conveniently through an open network. In order to have higher security, many authenticated key agreement schemes appended biometric keys to realize identification except for using passwords and smartcards. Due to too many transmissions and computational costs, these authenticated key agreement schemes are inefficient in communication and computation. This investigation develops two secure and efficient authenticated key agreement schemes for telecare medicine information systems by using biometric key and extended chaotic maps. One scheme is synchronization-based, while the other nonce-based. Compared to related approaches, the proposed schemes not only retain the same security properties with previous schemes, but also provide users with privacy protection and have fewer transmissions and lower computational cost.

Highlights of the Russian health studies program and updated research findings

International Nuclear Information System (INIS)

Fountos, Barrett N.

2017-01-01

Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction

California Men's Health Study (CMHS: a multiethnic cohort in a managed care setting

Directory of Open Access Journals (Sweden)

Sadler Marianne C

2006-06-01

Full Text Available Abstract Background We established a male, multiethnic cohort primarily to study prostate cancer etiology and secondarily to study the etiologies of other cancer and non-cancer conditions. Methods/Design Eligible participants were 45-to-69 year old males who were members of a large, prepaid health plan in California. Participants completed two surveys on-line or on paper in 2002 – 2003. Survey content included demographics; family, medical, and cancer screening history; sexuality and sexual development; lifestyle (diet, physical activity, and smoking; prescription and non-prescription drugs; and herbal supplements. We linked study data with clinical data, including laboratory, hospitalization, and cancer data, from electronic health plan files. We recruited 84,170 participants, approximately 40% from minority populations and over 5,000 who identified themselves as other than heterosexual. We observed a wide range of education (53% completed less than college and income. PSA testing rates (75% overall were highest among black participants. Body mass index (BMI (median 27.2 was highest for blacks and Latinos and lowest for Asians, and showed 80.6% agreement with BMI from clinical data sources. The sensitivity and specificity can be assessed by comparing self-reported data, such as PSA testing, diabetes, and history of cancer, to health plan data. We anticipate that nearly 1,500 prostate cancer diagnoses will occur within five years of cohort inception. Discussion A wide variety of epidemiologic, health services, and outcomes research utilizing a rich array of electronic, biological, and clinical resources is possible within this multiethnic cohort. The California Men's Health Study and other cohorts nested within comprehensive health delivery systems can make important contributions in the area of men's health.

Agreements on emission of greenhouse gases

International Nuclear Information System (INIS)

Aulstad, Johan Greger

2001-01-01

Agreements on emission of greenhouse gases is one of the instruments used by Norwegian authorities to meet their obligations with respect to the Climate Convention and the Kyoto Protocol. This book discusses the legal issues raised by these agreements. A main topic is how the industrial emissions conform to the Pollution Act. Does the Pollution Act apply to these emissions? What is the impact of the sanction rules in this act on the emissions? The book also deals with the following general questions that arise in connection with the application of public authority: (1) Can the administration grant concessions and permits in the form of agreements? (2) What commitments can be imposed on a private party by the administration by agreement? (3) Should the procedures set down in the Pollution Act and in the Public Administration Act be followed fully when the pollution authorities make agreements? Is the opportunity of the administration to reverse more restricted when they make agreements than when they make one-sided decisions? Although this discussion primarily deals with the emission of greenhouse gases, the reasoning and conclusions are relevant in many other types of agreements in which the public administration is one of the parties. The agreement that regulates the emissions of greenhouse gases from the Norwegian aluminium industry is described in a special section. The book also gives a brief account of how agreements are used in the Danish climate policy

Cooperative monitoring of regional security agreements

Energy Technology Data Exchange (ETDEWEB)

Pregenzer, A.L.; Vannoni, M.; Biringer, K.L. [Sandia National Labs., Albuquerque, NM (United States). Nonproliferation and Arms Control Analysis Dept.

1996-11-01

This paper argues that cooperative monitoring plays a critical role in the implementation of regional security agreements and confidence building measures. A framework for developing cooperative monitoring options is proposed and several possibilities for relating bilateral and regional monitoring systems to international monitoring systems are discussed. Three bilateral or regional agreements are analyzed briefly to illustrate different possibilities. These examples illustrate that the relationship of regional or bilateral arms control or security agreements to international agreements depends on a number of factors: the overlap of provisions between regional and international agreements; the degree of interest in a regional agreement among the international community; efficiency in implementing the agreement; and numerous political considerations. Given the importance of regional security to the international community, regions should be encouraged to develop their own infrastructure for implementing regional arms control and other security agreements. A regional infrastructure need not preclude participation in an international regime. On the contrary, establishing regional institutions for arms control and nonproliferation could result in more proactive participation of regional parties in developing solutions for regional and international problems, thereby strengthening existing and future international regimes. Possible first steps for strengthening regional infrastructures are identified and potential technical requirements are discussed.

TRIPs Agreement, Important Multilateral WTO Treaty

Directory of Open Access Journals (Sweden)

Oana-Maria Florescu

2006-08-01

Full Text Available This article aims at presenting the content and the frame of the TRIPs. Agreement. It starts by introducing the reader to the terms that defined the world economical climate by the time of the Agreement negociation. Also, it explains the need of having an Agreement on intellectual property rights with impact on the business world. Moreover, the article reviews the main provisions of the Agreement and the most important intellectual property rights.

Attraction Effects in Honorific Agreement in Korean.

Science.gov (United States)

Kwon, Nayoung; Sturt, Patrick

2016-01-01

Previous studies have suggested that sentence processing is mediated by content-addressable direct retrieval processes (McElree, 2000; McElree et al., 2003). However, the memory retrieval processes may differ as a function of the type of dependency. For example, while many studies have reported facilitatory intrusion effects associated with a structurally illicit antecedent during the processing of subject-verb number or person agreement and negative polarity items (Pearlmutter et al., 1999; Xiang et al., 2009; Dillon et al., 2013), studies investigating reflexives have not found consistent evidence of intrusion effects (Parker et al., 2015; Sturt and Kwon, 2015; cf. Nicol and Swinney, 1989; Sturt, 2003). Similarly, the memory retrieval processes could be also sensitive to cross-linguistic differences (cf. Lago et al., 2015). We report one self-paced reading experiment and one eye-tracking experiment that examine the processing of subject-verb honorific agreement, a dependency that is different from those that have been studied to date, in Korean, a typologically different language from those previously studied. The overall results suggest that the retrieval processes underlying the processing of subject-verb honorific agreement in Korean are susceptible to facilitatory intrusion effects from a structurally illicit but feature-matching subject, with a pattern that is similar to subject-verb agreement in English. In addition, the attraction effect was not limited to the ungrammatical sentences but was also found in grammatical sentences. The clear attraction effect in the grammatical sentences suggest that the attraction effect does not solely arise as the result of an error-driven process (cf. Wagers et al., 2009), but is likely also to result from general mechanisms of retrieval processes of activating of potential items in memory (Vasishth et al., 2008).

Lock-In Agreements in Venture Capital Backed UK IPOs

NARCIS (Netherlands)

Espenlaub, S.; Goergen, M.; Khurshed, A.; Renneboog, L.D.R.

2002-01-01

This paper examines the impact of venture-capital backing of UK companies issuing shares at flotation on the characteristics of the lock-in agreements entered into by the existing shareholders, and on the abnormal returns realised around the expiry of the directors' lock-in agreements.The study

Collaboration between general practitioners and mental health care professionals: a qualitative study.

Science.gov (United States)

Fredheim, Terje; Danbolt, Lars J; Haavet, Ole R; Kjønsberg, Kari; Lien, Lars

2011-05-23

Collaboration between general practice and mental health care has been recognised as necessary to provide good quality healthcare services to people with mental health problems. Several studies indicate that collaboration often is poor, with the result that patient' needs for coordinated services are not sufficiently met, and that resources are inefficiently used. An increasing number of mental health care workers should improve mental health services, but may complicate collaboration and coordination between mental health workers and other professionals in the treatment chain. The aim of this qualitative study is to investigate strengths and weaknesses in today's collaboration, and to suggest improvements in the interaction between General Practitioners (GPs) and specialised mental health service. This paper presents a qualitative focus group study with data drawn from six groups and eight group sessions with 28 health professionals (10 GPs, 12 nurses, and 6 physicians doing post-doctoral training in psychiatry), all working in the same region and assumed to make professional contact with each other. GPs and mental health professionals shared each others expressions of strengths, weaknesses and suggestions for improvement in today's collaboration. Strengths in today's collaboration were related to common consultations between GPs and mental health professionals, and when GPs were able to receive advice about diagnostic treatment dilemmas. Weaknesses were related to the GPs' possibility to meet mental health professionals, and lack of mutual knowledge in mental health services. The results describe experiences and importance of interpersonal knowledge, mutual accessibility and familiarity with existing systems and resources. There is an agreement between GPs and mental health professionals that services will improve with shared knowledge about patients through systematic collaborative services, direct cell-phone lines to mental health professionals and allocated

Collaboration between general practitioners and mental health care professionals: a qualitative study

Directory of Open Access Journals (Sweden)

Haavet Ole R

2011-05-01

Full Text Available Abstract Background Collaboration between general practice and mental health care has been recognised as necessary to provide good quality healthcare services to people with mental health problems. Several studies indicate that collaboration often is poor, with the result that patient' needs for coordinated services are not sufficiently met, and that resources are inefficiently used. An increasing number of mental health care workers should improve mental health services, but may complicate collaboration and coordination between mental health workers and other professionals in the treatment chain. The aim of this qualitative study is to investigate strengths and weaknesses in today's collaboration, and to suggest improvements in the interaction between General Practitioners (GPs and specialised mental health service. Methods This paper presents a qualitative focus group study with data drawn from six groups and eight group sessions with 28 health professionals (10 GPs, 12 nurses, and 6 physicians doing post-doctoral training in psychiatry, all working in the same region and assumed to make professional contact with each other. Results GPs and mental health professionals shared each others expressions of strengths, weaknesses and suggestions for improvement in today's collaboration. Strengths in today's collaboration were related to common consultations between GPs and mental health professionals, and when GPs were able to receive advice about diagnostic treatment dilemmas. Weaknesses were related to the GPs' possibility to meet mental health professionals, and lack of mutual knowledge in mental health services. The results describe experiences and importance of interpersonal knowledge, mutual accessibility and familiarity with existing systems and resources. There is an agreement between GPs and mental health professionals that services will improve with shared knowledge about patients through systematic collaborative services, direct cell

76 FR 67440 - Market Access Agreement

Science.gov (United States)

2011-11-01

... FARM CREDIT ADMINISTRATION Market Access Agreement AGENCY: Farm Credit Administration. ACTION: Notice of Draft Second Amended and Restated Market Access Agreement; request for comments. SUMMARY: The... Market Access Agreement (the ``Restated MAA'') is entered into among AgFirst Farm Credit Bank, AgriBank...

50 CFR 81.3 - Cooperative Agreement.

Science.gov (United States)

2010-10-01

...) FINANCIAL ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM CONSERVATION OF ENDANGERED AND THREATENED SPECIES OF FISH, WILDLIFE, AND PLANTS-COOPERATION WITH THE STATES § 81.3 Cooperative Agreement. Upon... Project Agreement can be approved for endangered or threatened species projects. A cooperative agreement...

Diffusion tensor imaging of the median nerve: intra-, inter-reader agreement, and agreement between two software packages

International Nuclear Information System (INIS)

Guggenberger, Roman; Nanz, Daniel; Puippe, Gilbert; Andreisek, Gustav; Rufibach, Kaspar; White, Lawrence M.; Sussman, Marshall S.

2012-01-01

To assess intra-, inter-reader agreement, and the agreement between two software packages for magnetic resonance diffusion tensor imaging (DTI) measurements of the median nerve. Fifteen healthy volunteers (seven men, eight women; mean age, 31.2 years) underwent DTI of both wrists at 1.5 T. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the median nerve were measured by three readers using two commonly used software packages. Measurements were repeated by two readers after 6 weeks. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used for statistical analysis. ICCs for intra-reader agreement ranged from 0.87 to 0.99, for inter-reader agreement from 0.62 to 0.83, and between the two software packages from 0.63 to 0.82. Bland-Altman analysis showed no differences for intra- and inter-reader agreement and agreement between software packages. The intra-, inter-reader, and agreement between software packages for DTI measurements of the median nerve were moderate to substantial suggesting that user- and software-dependent factors contribute little to variance in DTI measurements. (orig.)

VHA Data Sharing Agreement Repository

Data.gov (United States)

Department of Veterans Affairs — The VHA Data Sharing Agreement Repository serves as a centralized location to collect and report on agreements that share VHA data with entities outside of VA. It...

We are all experts! Does stakeholder engagement in health impact scoping lead to consensus? A Dutch case study

NARCIS (Netherlands)

Broeder, den Lea; Yin Chung, Kai; Geelen, Loes; Schuit, Albertina Jantine; Wagemakers, A.

2016-01-01

Stakeholder engagement in Environmental Impact Assessment (EIA) and Health Impact Assessment (HIA) provides opportunities for inclusive environmental decision-making contributing to the attainment of agreement about the potential environmental and health impacts of a plan. A case evaluation of

40 CFR 35.3010 - Delegation agreement.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Delegation agreement. 35.3010 Section... STATE AND LOCAL ASSISTANCE Construction Grants Program Delegation to States § 35.3010 Delegation agreement. (a) Before execution of the delegation agreement, the Regional Administrator must determine that...

7 CFR 900.109 - Mediation agreement.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Mediation agreement. 900.109 Section 900.109 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Mediation agreement. An agreement arrived at by mediation shall not become effective until approved by the...

Flexible climate agreements after 2012

International Nuclear Information System (INIS)

Vevatne, Jonas

2004-01-01

The Kyoto agreement is only a small step towards much stronger and broader commitments and new creativity is needed to further develop a really global climate policy. A flexible approach is necessary to obtain broad participation and substantial reduction of the emissions of greenhouse gases. Flexibility is also important to ease negotiations, to ensure cost-effectiveness and implement a global climate agreement. The US withdrawal from the Kyoto Protocol has rendered the agreement much less effective than the original goal of five per cent reduction of the emission from the industrialized countries. In addition the emissions are increasing much faster in countries that have not committed themselves to the agreement. The agreement runs out in 2012 and should be followed by a new agreement, the negotiations about which are to start up no later than 2005. Attempts by the European Union to begin a discussion about future commitments were very quickly wrecked by the G77 group with strong support from the U.S.A. To formulate a practical climate policy the general goal in the Climate Convention must be interpreted and specified. It may seem impossible to agree upon a long-term goal. But the clarity it provides will be very useful. It will be a guide for short-term goals and a reference for evaluation of success

Implications of the Central America-Dominican Republic-Free Trade Agreement for the nutrition transition in Central America.

Science.gov (United States)

Hawkes, Corinna; Thow, Anne Marie

2008-11-01

To identify potential impacts of the Central America-Dominican Republic-Free Trade Agreement (CAFTA-DR) on food consumption patterns associated with the nutrition transition, obesity, and diet-related chronic diseases. Examination of CAFTA-DR agreement to identify measures that have the potential to affect food availability and retail prices. CAFTA-DR includes agreements on tariffs, tariff-rate quotas (TRQs), and sanitary and phytosanitary regulations with direct implications for the availability and prices of various foods. Agreements on investment, services, and intellectual property rights (IPR) are also relevant because they create a business climate more conducive to long-term investment by the transnational food industry. Trade liberalization under CAFTA-DR is likely to increase availability and lower relative prices of two food groups associated with the nutrition transition: meat and processed foods. These outcomes are expected to occur as the direct result of increased imports from the United States and increased production by U.S. companies based in Central America, and the indirect result of increased domestic meat production (due to increased availability of cheaper animal feed) and increased production of processed foods by domestic companies (due to a more competitive market environment). CAFTA-DR is likely to further the nutrition transition in Central America by increasing the consumption of meat; highly processed foods; and new, non-traditional foods. The public health community should be more aware of the implications of trade agreements for dietary health. Governments and related stakeholders should assess the coherence between changes fostered by specific trade agreements with national policies on diet and nutrition.

Benefits and costs of programmatic agreements

Science.gov (United States)

2015-02-01

The performing organization, on behalf of the FHWA Office of Planning, Environment, and Realty, conducted a benefit-cost assessment of programmatic agreements and approaches. The assessment consisted of a case study approach that evaluated three agre...

Validity and reliability of the South African health promoting schools monitoring questionnaire.

Science.gov (United States)

Struthers, Patricia; Wegner, Lisa; de Koker, Petra; Lerebo, Wondwossen; Blignaut, Renette J

2017-04-01

Health promoting schools, as conceptualised by the World Health Organisation, have been developed in many countries to facilitate the health-education link. In 1994, the concept of health promoting schools was introduced in South Africa. In the process of becoming a health promoting school, it is important for schools to monitor and evaluate changes and developments taking place. The Health Promoting Schools (HPS) Monitoring Questionnaire was developed to obtain opinions of students about their school as a health promoting school. It comprises 138 questions in seven sections: socio-demographic information; General health promotion programmes; health related Skills and knowledge; Policies; Environment; Community-school links; and support Services. This paper reports on the reliability and face validity of the HPS Monitoring Questionnaire. Seven experts reviewed the questionnaire and agreed that it has satisfactory face validity. A test-retest reliability study was conducted with 83 students in three high schools in Cape Town, South Africa. The kappa-coefficients demonstrate mostly fair (κ-scores between 0.21 and 0.4) to moderate (κ-scores between 0.41 and 0.6) agreement between test-retest General and Environment items; poor (κ-scores up to 0.2) agreement between Skills and Community test-retest items, fair agreement between Policies items, and for most of the questions focussing on Services a fair agreement was found. The study is a first effort at providing a tool that may be used to monitor and evaluate students' opinions about changes in health promoting schools. Although the HPS Monitoring Questionnaire has face validity, the results of the reliability testing were inconclusive. Further research is warranted. © The Author 2016. Published by Oxford University Press.

25 CFR 502.5 - Collateral agreement.

Science.gov (United States)

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Collateral agreement. 502.5 Section 502.5 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GENERAL PROVISIONS DEFINITIONS OF THIS CHAPTER § 502.5 Collateral agreement. Collateral agreement means any contract, whether or not in writing...

75 FR 76729 - Market Access Agreement

Science.gov (United States)

2010-12-09

... FARM CREDIT ADMINISTRATION Market Access Agreement AGENCY: Farm Credit Administration. ACTION: Notice of approval of the draft amendment to the amended and restated market access agreement. SUMMARY... Credit Bank of Wichita and the Western Farm Credit Bank under Section 7.12 of the Market Access Agreement...

43 CFR 24.5 - International agreements.

Science.gov (United States)

2010-10-01

... WILDLIFE POLICY: STATE-FEDERAL RELATIONSHIPS § 24.5 International agreements. (a) International conventions... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false International agreements. 24.5 Section 24... shall be to recommend that the United States negotiate and accede to only those international agreements...

Global health competencies according to nursing faculty from Brazilian higher education institutions

Directory of Open Access Journals (Sweden)

Carla Aparecida Arena Ventura

2014-04-01

Full Text Available OBJECTIVES: to identify the agreement of faculty affiliated with Brazilian higher education institutions about the global health competencies needed for undergraduate nursing students' education and whether these competencies were covered in the curriculum offered at the institution where they were teaching.METHOD: exploratory-descriptive study, involving 222 faculty members who answered the Brazilian version of the "Questionnaire on Core Competencies in Global Health", made available electronically on the website Survey Monkey.RESULTS: participants predominantly held a Ph.D. (75.8%, were women (91.9% and were between 40 and 59 years of age (69.3%. The mean and standard deviation of all competencies questioned ranged between 3.04 (0.61 and 3.88 (0.32, with scores for each competency ranging from 1 "strongly disagree" to 4 "strongly agree". The results demonstrated the respondents' satisfactory level of agreement with the global health competencies.CONCLUSIONS: the study demonstrated a high mean agreement level of the nursing faculty from Brazilian HEI with the global health competencies in the questionnaire. The curricula of the HEI where they teach partially address some of these. The competencies in the domain "Globalization of health and health care" are the least addressed.

Health professionals' beliefs about domestic abuse and the issue of disclosure: a critical incident technique study.

Science.gov (United States)

Taylor, Julie; Bradbury-Jones, Caroline; Kroll, Thilo; Duncan, Fiona

2013-09-01

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals' beliefs about domestic abuse disclosure. In addition, the intersection between health professionals' beliefs and abused women's views remains uninvestigated. We report on a two-phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals' beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self-Regulation of Health and Illness (CSM). This model is typically used in disease-orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi-structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty-nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals' beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals' beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of

76 FR 63618 - Notice of Agreements Filed

Science.gov (United States)

2011-10-13

...; Washington, DC 20036. Synopsis: The amendment removes Korea from the geographic scope of them agreement and... geographic scope of the Agreement to include Taiwan. The parties requested expedited review. Agreement No... and Korea, China, Taiwan, Thailand, Vietnam, and Singapore. Agreement No.: 012138. Title: CSAV/CCNI...

22 CFR 120.23 - Distribution agreement.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Distribution agreement. 120.23 Section 120.23... § 120.23 Distribution agreement. An agreement (e.g., a contract) to establish a warehouse or distribution point abroad for defense articles exported from the United States for subsequent distribution to...

Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials.

Directory of Open Access Journals (Sweden)

Benjamin Kasenda

2016-06-01

Full Text Available Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i the existence and types of publication agreements in trial protocols, (ii the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii the frequency of co-authorship by industry employees.We used a retrospective cohort of randomized clinical trials (RCTs based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5% mentioned an agreement regarding publication of results. Of these 456, 393 (86.2% documented an industry partner's right to disapprove or at least review proposed manuscripts; 39 (8.6% agreements were without constraints of publication. The remaining 24 (5.3% protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0% trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]. Of 71 agreements reported in publications, 52 (73.2% were concordant with those documented in the protocol. In 14 of 37 (37.8% publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements.Publication agreements constraining academic authors' independence are common. Journal articles seldom report on publication agreements, and, if they do

Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials

Science.gov (United States)

Kasenda, Benjamin; von Elm, Erik; You, John J.; Tomonaga, Yuki; Saccilotto, Ramon; Amstutz, Alain; Bengough, Theresa; Meerpohl, Joerg J.; Stegert, Mihaela; Olu, Kelechi K.; Tikkinen, Kari A. O.; Neumann, Ignacio; Carrasco-Labra, Alonso; Faulhaber, Markus; Mulla, Sohail M.; Mertz, Dominik; Akl, Elie A.; Bassler, Dirk; Busse, Jason W.; Nordmann, Alain; Gloy, Viktoria; Ebrahim, Shanil; Schandelmaier, Stefan; Sun, Xin; Vandvik, Per O.; Johnston, Bradley C.; Walter, Martin A.; Burnand, Bernard; Hemkens, Lars G.; Bucher, Heiner C.; Guyatt, Gordon H.; Briel, Matthias

2016-01-01

Background Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i) the existence and types of publication agreements in trial protocols, (ii) the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii) the frequency of co-authorship by industry employees. Methods and Findings We used a retrospective cohort of randomized clinical trials (RCTs) based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5%) mentioned an agreement regarding publication of results. Of these 456, 393 (86.2%) documented an industry partner’s right to disapprove or at least review proposed manuscripts; 39 (8.6%) agreements were without constraints of publication. The remaining 24 (5.3%) protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0%) trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]). Of 71 agreements reported in publications, 52 (73.2%) were concordant with those documented in the protocol. In 14 of 37 (37.8%) publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements. Conclusions Publication agreements constraining academic authors’ independence are common. Journal articles seldom report on

Evaluation of Agreement Between Video and Written Questionnaires for Asthma Symptoms Among Children of Tehran: ISAAC Study

Directory of Open Access Journals (Sweden)

MR Masjedi

2008-07-01

Full Text Available Introduction: International study on asthma was conducted to study the prevalence of Asthma symptoms among 13-14 year old children using written and video questionnaires during the early 90's. The aim of the present study (ISAAC was to evaluate the agreement between the two questionnaires which were self-completed by the children. Methods: This study, which was a part of the third phase of International Study of Asthma and Allergy in Childhood (ISAAC and performed exactly similar to phase1, was performed by National Research Institute of Tuberculosis and Lung Diseases (NRITLD in two cities of Iran; Rasht and Tehran. All stages of the study were performed in accordance with ISAAC protocol. The present study discusses data related to children of Tehran. A total of 3100 school children aged 13-14 years were questioned about asthma symptoms using written and video questionnaires of ISAAC study. For statistical analysis, initially a descriptive study of the available data was performed. Thereafter, chance corrected agreement between the two questionnaires was evaluated using Cohen’s Kappa co-efficiency. Results: Of the total of 3100 children, 52.4% were male and 47.6% female, with a mean age of 13.6 years. Although the questions discussed in the two questionnaires were not exactly similar, the results of the video questionnaires showed a statistically significant lower positive response to asthma symptoms as compared to the written version. Kappa co-efficiency ranged between 0.06- 0.21 (mean=0.12, which is considered poor for all variables. Conclusion: Positive responses to having asthma symptoms were significantly higher using the written questionnaire compared to the video questionnaire. Similar to previous studies, agreement between the two was considered poor for all variables. Although factors such as language, culture, dwelling area, e.t.c. have special effects on results of these questionnaires, results indicate that the two questionnaires

Strategic planning of an integrated program for state oversight agreements

International Nuclear Information System (INIS)

Walzer, A.E.; Cothron, T.K.

1991-01-01

Among the barrage of agreements faced by federal facilities are the State Oversight Agreements (known as Agreements in Principle in many states). These agreements between the Department of Energy (DOE) and the states fund the states to conduct independent environmental monitoring and oversight which requires plans, studies, inventories, models, and reports from DOE and its management and operating contractors. Many states have signed such agreements, including Tennessee, Kentucky, Washington, Idaho, Colorado, California, and Florida. This type of oversight agreement originated in Colorado as a result of environmental concerns at the Rocky Flats Plant. The 5-year State Oversight Agreements for Tennessee and Kentucky became effective on May 13, 1991, and fund these states nearly $21 million and $7 million, respectively. Implementation of these open-quotes comprehensive and integratedclose quotes agreements is particularly complex in Tennessee where the DOE Oak Ridge Reservation houses three installations with distinctly different missions. The program development and strategic planning required for coordinating and integrating a program of this magnitude is discussed. Included are the organizational structure and interfaces required to define and coordinate program elements across plants and to also effectively negotiate scope and schedules with the state. The planned Program Management Plan, which will contain implementation and procedural guidelines, and the management control system for detailed tracking of activities and costs are outlined. Additionally, issues inherent in the nature of the agreements and implementation of a program of this magnitude are discussed. Finally, a comparison of the agreements for Tennessee, Kentucky, Colorado, and Idaho is made to gain a better understanding of the similarities and differences in State Oversight Agreements to aid in implementation of these agreements

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

Science.gov (United States)

Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso

2013-06-01

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

Vienna Agreement law 15.986 it approve Vienna Agreement for Protection ozone layer and annex

International Nuclear Information System (INIS)

1988-01-01

The Agreement of Vienna is approved with respect to the protection of the Layer of Ozono, definitions,general duties, research and observations systematics, co-operation in the Spheres Scientific Juridical, and information, Technological Conference, transmission from the protocols, amends, secretariat, adoption to the agreement or the protocols, adoption and amendment of controversy, signing, ratify, approve annexes, solution or vote, relation approving, adhesion, rights between the present agreement and its protocols, entrance in vigor, reserves, retirement, deposition, exchange of information [es

76 FR 553 - Notice of Agreements Filed

Science.gov (United States)

2011-01-05

... obsolete language on the duration of Agreement, and changes the name and restates the Agreement. By Order... agreement's governing board and would update the corporate addresses of American President Lines, Ltd.; APL.... as a party to the agreement and updates the corporate addresses of American President Lines, Ltd...

Prevalence of Metabolic Syndrome in Elderly and Agreement among Four Diagnostic Criteria

International Nuclear Information System (INIS)

Saad, Maria Auxiliadora Nogueira; Cardoso, Gilberto Perez; Martins, Wolney de Andrade; Velarde, Luis Guillermo Coca; Cruz, Rubens Antunes Filho da

2014-01-01

Metabolic syndrome (MS) is an aggregation of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). Population aging is accompanied by higher prevalence of MS, which varies depending on the population studied and the diagnostic criteria used. To determine prevalence of MS in the elderly using four diagnostic criteria and agreement between them. Cross-sectional study on 243 patients older than 60 years (180 women) in Niterói, RJ. They were evaluated by clinical examination, fasting glucose, fasting insulin, lipid profile and anthropometric measurements - weight, height, waist circumference and waist/hip ratio. Prevalence of MS was estimated by World Health Organization (WHO) modified, National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Prevalence was high with the four criteria WHO (51.9%), NCEP-ATPIII (45.2%), IDF (64.1%) and JIS (69.1%), and agreement between criteria by kappa was moderate in almost all comparisons WHO vs. IDF (k = 0.47;95% confidence interval (CI), 0.35 to 0.58); WHO vs. NCEP-ATPIII (k = 0.51; 95% CI, 0.40 to 0.61); WHO vs. JIS (k = 0.45; 95% CI, 0.33 to 0.56); IDF vs. NCEP-ATPIII (k = 0.55; 95% CI, 0.45 to 0.65) and NCEP-ATPIII vs. JIS (k = 0.53; 95% CI, 0.43-0.64), except between IDF vs. JIS (K = 0.89;95% CI, 0.83 to 0.95), which was considered good. Prevalence of MS was high with the four diagnostic criteria, mainly by JIS. There was good agreement between JIS and IDF criteria and moderate among the others

Prevalence of Metabolic Syndrome in Elderly and Agreement among Four Diagnostic Criteria

Energy Technology Data Exchange (ETDEWEB)

Saad, Maria Auxiliadora Nogueira, E-mail: auxiliadorasaad@yahoo.com.br [Fundação Municipal de Saúde de Niterói, Niterói, RJ (Brazil); Cardoso, Gilberto Perez; Martins, Wolney de Andrade; Velarde, Luis Guillermo Coca; Cruz, Rubens Antunes Filho da [Universidade Federal Fluminense, Niterói, RJ (Brazil)

2014-03-15

Metabolic syndrome (MS) is an aggregation of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). Population aging is accompanied by higher prevalence of MS, which varies depending on the population studied and the diagnostic criteria used. To determine prevalence of MS in the elderly using four diagnostic criteria and agreement between them. Cross-sectional study on 243 patients older than 60 years (180 women) in Niterói, RJ. They were evaluated by clinical examination, fasting glucose, fasting insulin, lipid profile and anthropometric measurements - weight, height, waist circumference and waist/hip ratio. Prevalence of MS was estimated by World Health Organization (WHO) modified, National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Prevalence was high with the four criteria WHO (51.9%), NCEP-ATPIII (45.2%), IDF (64.1%) and JIS (69.1%), and agreement between criteria by kappa was moderate in almost all comparisons WHO vs. IDF (k = 0.47;95% confidence interval (CI), 0.35 to 0.58); WHO vs. NCEP-ATPIII (k = 0.51; 95% CI, 0.40 to 0.61); WHO vs. JIS (k = 0.45; 95% CI, 0.33 to 0.56); IDF vs. NCEP-ATPIII (k = 0.55; 95% CI, 0.45 to 0.65) and NCEP-ATPIII vs. JIS (k = 0.53; 95% CI, 0.43-0.64), except between IDF vs. JIS (K = 0.89;95% CI, 0.83 to 0.95), which was considered good. Prevalence of MS was high with the four diagnostic criteria, mainly by JIS. There was good agreement between JIS and IDF criteria and moderate among the others.

Challenges on preparing unitization agreements in Brazil

Energy Technology Data Exchange (ETDEWEB)

Ribeiro, Marilda Rosado de Sa [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Faculdade de Direito; Appi, Valeria Tiriba [PETROBRAS, Rio de Janeiro, RJ (Brazil)

2004-07-01

As a further stage of the new oil and gas industry in Brazil, various challenges are now faced as an outcome from the O and G projects progress, under the legal framework in force in Brazil. Among all are the first unitization processes, which require a set of steps to be performed in order to achieve a unitization agreement. The paper aims at analyzing the legal, technical and drafting issues to be dealt with in such agreements. After a brief introduction to the general issues at stake in the unitization agreements the study shall encompass a follow up of the sequence of events to be complied with. One could mention the settlement of the criteria onto calculations to serve as guidelines for the negotiations will be based on. That, is usually based on concepts as oil in place, possible O and G in the reservoir, or reserve, which must be agreed by all involved parties. Another possible step to be considered is the creation of a common database, in order to permit fast decisions and optimise E and P operations in the unitized area. Other concerns should be addressed, depending on the amount of O and G to be produced from the unitized area, as: the avoidance of multiple redeterminations aiming to decrease unnecessary expenditures, which could jeopardize the arising project profitability; and the recalculations of Government take, royalties and other incumbencies, to be shared by all involved parties. The paper shall also mention the experience of other countries trying to adopt, where applicable and compatible with the best practices of the oil industry, solutions adopted where tradition in oil and gas is more mature. It should be considered that, in each bidding round the Brazilian Concession Agreement has undergone changes, therefore during an unitization process with two different versions of the Concession Agreement differences between corresponding clauses will have to be faced. Comments should also be made about satellite agreements, encompassing O and G buying

77 FR 42310 - Notice of Agreements Filed

Science.gov (United States)

2012-07-18

...; Washington, DC 20006-4007. Synopsis: The agreement would provide for delivery of data to the Port of Oakland... delivery. Agreement No.: 201217. Title: Port of Long Beach Data Services Agreement. Parties: Port of Long... 1100; Washington, DC 20006-4007. Synopsis: The agreement would provide for delivery of data to the Port...

42 CFR 137.275 - May Self-Governance Tribes include IHS construction programs in a construction project agreement...

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May Self-Governance Tribes include IHS construction... OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Purpose and Scope § 137.275 May Self-Governance Tribes include IHS construction programs in a construction project agreement or in a funding...

A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population.

Directory of Open Access Journals (Sweden)

Benedetta Pongiglione

Full Text Available To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy.A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase, and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively.Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions.Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.

Trade, Labour Markets and Health.

Science.gov (United States)

McNamara, Courtney; Labonté, Ronald

2017-04-01

Previous analyses indicate that there are a number of potentially serious health risks associated with the Trans-Pacific Partnership (TPP). The objective of this work is to provide further insight into the potential health impacts of the TPP by investigating labour market pathways. The impact of the TPP on employment and working conditions is a major point of contention in broader public debates. In public health literature, these factors are considered fundamental determinants of health, yet they are rarely addressed in analyses of trade and investment agreements. We therefore undertake a prospective policy analysis of the TPP through a content analysis of the agreement's Labour Chapter. Provisions of the Chapter are analyzed with reference to the health policy triangle and four main areas through which labour markets influence health: power relations, social policies, employment conditions and working conditions. Findings indicate that implementation of the TPP can have important impacts on health through labour market pathways. While the Labour Chapter is being presented by proponents of the agreement as a vehicle for improvement in labour standards, we find little evidence to support this view. Instead, we find several ways the TPP may weaken employment relations to the detriment of health.

23 CFR 140.606 - Project agreements.

Science.gov (United States)

2010-04-01

... Reimbursement for Bond Issue Projects § 140.606 Project agreements. Project Agreements, Form PR-2, shall be... 23 Highways 1 2010-04-01 2010-04-01 false Project agreements. 140.606 Section 140.606 Highways... projects. 1 The text of FHWA Form PR-2 is found in 23 CFR part 630, subpart C, appendix A. ...

14 CFR 1274.909 - Term of agreement.

Science.gov (United States)

2010-01-01

... Agreement, which, by their express terms or by necessary implication, apply for periods of time other than... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Term of agreement. 1274.909 Section 1274... COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.909 Term of agreement. Term of Agreement July...

77 FR 59402 - Announcement of Supplemental Funding for Cooperative Agreements to the New Mexico Department of...

Science.gov (United States)

2012-09-27

...), in collaboration with the U.S. Department of Health and Human Services, works toward creating... cooperative agreements, OGA/ HHS will support and/or stimulate awardees activities by working with them in a...

Safeguards agreements - Their legal and conceptual basis

International Nuclear Information System (INIS)

Sanders, B.; Rainer, R.H.

1977-01-01

The application of Agency safeguards requires treaty arrangements (Safeguards Agreements) between the State or States concerned and the Agency. The authority for the Agency to conclude such agreements and to implement them is provided for in the Agency's Statute. On the basis of the statutory provisions safeguards principles and procedures have been elaborated. These have been laid down in: The Agency's Safeguards System 1965, extended in 1966 and 1968; and the basis for negotiating safeguards agreements with NNWS pursuant to NPT. The verification of the undertaking by the State concerned not to use items subject to safeguards for purposes contrary to the terms of the agreement is ensured through the application of various safeguards measures. Containment and surveillance measures are expected to play an increasingly important role. One of the specific features of NPT Safeguards Agreements is the establishment of national systems of accounting and control of nuclear material. The majority of the agreements concluded under the non-NPT safeguards agreements implement obligations undertaken under co-operation agreements between States for peaceful uses of nuclear energy. These agreements naturally reflect approaches adopted by the parties, in particular regarding the circumstances under which safeguards should be applied. Thus, the concepts used in the non-NPT safeguards agreements and the Safeguards System document, which is incorporated in these agreements by reference, are in continuous evolution. The Agency's Safeguards System document (INFCIRC/66/Rev.2) continues to be supplemented in practical application and through explicit decision by the Board. The non-NPT safeguards agreements contain, besides technical safeguards provisions from this document, and further provision for notification, inventories and financial matters, legal and political provisions such as sanctions in the case of non-compliance, and privileges and immunities. The paper discusses the

The Impact of the Canada-Korea Free Trade Agreement as Negotiated

Directory of Open Access Journals (Sweden)

Dan Ciuriak

2014-12-01

Full Text Available This paper analyzes the impact of the Canada-Korea Free Trade Agreement on the basis of the published text and agreed schedule of commitments. We find that the Agreement reinforces existing patterns of comparative advantage between Canada (agriculture and resource-based sectors and Korea (autos and other industries. The sensitive sectors that held up the deal for years - autos into Canada and beef into Korea - witness major trade gains, but are not unduly disrupted. In both economies, the major output gains otherwise come in non-traded services sectors, driven by income effects. We find that trade diversion effects are quite significant; this lends support for the domino theory of major free trade agreements - since the Korea-EU agreement broke the ice, the pressure has intensified on third parties to re-level playing fields by striking their own deals. The study breaks new ground in modelling services trade by developing policy impacts based on the extent to which the text of the Agreement modifies Korea's and Canada's scores on the OECD's Services Trade Restrictiveness Index and by providing estimates of Mode 3 Services trade impacts. The analysis of the Agreement as negotiated, the present study, in our view, is a step forward in understanding the impact of modern free trade agreements.

The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.

Science.gov (United States)

Mokkink, Lidwine B; Terwee, Caroline B; Patrick, Donald L; Alonso, Jordi; Stratford, Paul W; Knol, Dirk L; Bouter, Lex M; de Vet, Henrica C W

2010-05-01

Aim of the COSMIN study (COnsensus-based Standards for the selection of health status Measurement INstruments) was to develop a consensus-based checklist to evaluate the methodological quality of studies on measurement properties. We present the COSMIN checklist and the agreement of the panel on the items of the checklist. A four-round Delphi study was performed with international experts (psychologists, epidemiologists, statisticians and clinicians). Of the 91 invited experts, 57 agreed to participate (63%). Panel members were asked to rate their (dis)agreement with each proposal on a five-point scale. Consensus was considered to be reached when at least 67% of the panel members indicated 'agree' or 'strongly agree'. Consensus was reached on the inclusion of the following measurement properties: internal consistency, reliability, measurement error, content validity (including face validity), construct validity (including structural validity, hypotheses testing and cross-cultural validity), criterion validity, responsiveness, and interpretability. The latter was not considered a measurement property. The panel also reached consensus on how these properties should be assessed. The resulting COSMIN checklist could be useful when selecting a measurement instrument, peer-reviewing a manuscript, designing or reporting a study on measurement properties, or for educational purposes.

The Text of the Fifth Agreement to Extend the 1987 Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology (RCA). Extension of Agreement. Latest Status

International Nuclear Information System (INIS)

2012-01-01

The Text of the Fifth Agreement to Extend the 1987 Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology (RCA). Extension of Agreement. Latest Status [es

Switching Between Noun and Verb Agreement Rules Comes at a Cost: Cross-Sectional and Interventional Studies in a Developmental Sample

Directory of Open Access Journals (Sweden)

Van Reybroeck Marie

2014-11-01

Full Text Available This study clarifies the impact of switching context between noun and verb number agreement rules in written language production. In Experiment 1, children from grade 3 to 6 were asked to fill in sentences with nouns and verbs in either a switching condition (noun followed by verb or a repeating condition (noun followed by noun. The results showed that third- and fourth-grade children produced more erroneous agreements in the switching condition than in the repeating condition, showing that switching between rules comes at a cost, whereas fifth- and sixth-grade participants’ performance was not affected by the switching context. Based on these findings, Experiment 2 aimed to assess whether a switching treatment offers a greater opportunity to improve the acquisition of grammatical agreement production, as compared to a simple treatment. Teachers from grade 3 gave either a switching treatment (mixed noun and verb exercises or a simple treatment (noun exercises followed by verb exercises. The results show that children learned better from the switching treatment than from the simple treatment. These findings highlight the cost of switching between noun and verb agreement rules during the acquisition of grammatical number agreement and also how grammatical spelling acquisition can be improved at school.

Self-Other Agreement Between Employees on their Need for Achievement, Power, and Affiliation: A Social Relations Study

NARCIS (Netherlands)

S.B. Doeze Jager-van Vliet (Sandra); M.Ph. Born (Marise); H.T. van der Molen (Henk)

2017-01-01

textabstractThe present study focused on self-other agreement between employees on their Need for Achievement, Need for Power and Need for Affiliation, which needs are relevant for performance and wellbeing at work. The Social Relations Model was used to examine consensus between other-raters,

Distributed control design for nonlinear output agreement in convergent systems

NARCIS (Netherlands)

Weitenberg, Erik; De Persis, Claudio

2015-01-01

This work studies the problem of output agreement in homogeneous networks of nonlinear dynamical systems under time-varying disturbances using controllers placed at the nodes of the networks. For the class of contractive systems, necessary and sufficient conditions for output agreement are derived,

Reliability and Agreement in Student Ratings of the Class Environment

Science.gov (United States)

Nelson, Peter M.; Christ, Theodore J.

2016-01-01

The current study estimated the reliability and agreement of student ratings of the classroom environment obtained using the Responsive Environmental Assessment for Classroom Teaching (REACT; Christ, Nelson, & Demers, 2012; Nelson, Demers, & Christ, 2014). Coefficient alpha, class-level reliability, and class agreement indices were…

A comparison of doctors', parents' and children's reports of health states and health-related quality of life in children with chronic conditions.

Science.gov (United States)

Morrow, A M; Hayen, A; Quine, S; Scheinberg, A; Craig, J C

2012-03-01

Health-related quality of life is an important outcome. Self-report is the gold standard, but in the paediatric setting we often rely on proxy reporting. Our understanding of the differences between self- and proxy reports and the factors that influence them is limited. These differences can impact on treatment choices and the patient-doctor relationship. To evaluate differences between children's, parents' and doctors' perceptions of health states and health-related quality of life in children with chronic illness and explore factors which explain these differences. Consecutive families attending eligible clinics at a tertiary paediatric centre were invited to complete the Health Utilities Index (HUI) 23 questionnaire. Percentage agreement and kappas were calculated as a measure of the agreement between pairs. Chi-squared tests or Fisher's exact test, if appropriate, were performed to determine if there was an association between level of agreement and participant variables. Data were collected for 130 parent-doctor pairs, 59 child-parent pairs and 59 child-doctor pairs. Overall health-related quality of life scores did not differ between responders, but there was poorer agreement for subjective domains. Doctor-child agreement was lower than parent-child agreement. Children with a diagnosis of cerebral palsy or chronic neurological condition were more likely to have lower inter-rater agreement for both subjective and objective domains. On the HUI2, agreement was lower for parent-child pairs when the father was the respondent. For child-doctor pairs, an increased frequency of patient-doctor visits and doctors' seniority were predictors of poorer agreement on the HUI3 and HUI2 respectively. We identified factors associated with level of agreement for self- and proxy reporting on the HUI23. Parent-child agreement was higher than doctor-child agreement. Patients with significant pain or emotional distress and patients with a diagnosis of severe cerebral palsy or

76 FR 28226 - Southwest Health Alliances, Inc., Doing Business as BSA Provider Network; Analysis of Agreement...

Science.gov (United States)

2011-05-16

... I.B, because it is intended to reach agreements between and among independent competitors... Commission to facilitate monitoring its compliance with the Consent Order. Pursuant to Paragraph X, the...

Evaluation of interobserver agreement in Albertoni's classification for mallet finger

Directory of Open Access Journals (Sweden)

Vinícius Alexandre de Souza Almeida

Full Text Available ABSTRACT Objective: To measure the reliability of Albertoni's classification for mallet finger. Methods: Agreement study. Forty-three radiographs of patients with mallet finger were assessed by 19 responders (12 hand surgeons and seven residents. Injuries were classified by Albertoni's classification. For agreement comparison, lesions were grouped as: (A tendon avulsion; (B avulsion fracture; (C fracture of the dorsal lip; and (D physis injury-and subgroups (each group divided into two subgroups. Agreement was assessed by Fleiss's modification for kappa statistics. Results: Agreement was excellent for Group A (k = 0.95 (0.93-0.97 and remained good when separated into A1 and A2. Group B was moderate (k = 0.42 (0.39-0.44 and poor when separated into B1 and B2. In the Group C, agreement was good (k = 0.72 (0.70-0.74, but when separated into C1 and C2, it became moderate. Group D was always poor (k = 0.16 (0.14-0.19. The general agreement was moderate, with (k = 0.57 (0.56-0.58. Conclusion: Albertoni's classification evaluated for interobserver agreement is considered a reproducible classification by the method used in the research.

23 CFR 630.110 - Modification of original agreement.

Science.gov (United States)

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Modification of original agreement. 630.110 Section 630... OPERATIONS PRECONSTRUCTION PROCEDURES Project Authorization and Agreements § 630.110 Modification of original agreement. (a) When changes are needed to the original project agreement, a modification of agreement shall...

Environmental health studies

International Nuclear Information System (INIS)

Easterly, C.E.; Shank, K.E.

1978-01-01

The two major thrusts of the environmental health studies have been in the areas of health physics aspects of fusion power and methodology for assessing health effects related to nuclear facilities. Researchers were unable to discern a dose-response relationship or to find adverse health effects in the local population around nuclear facilities which might be related to radiation exposure. A second study analyzed the trends in incidence of cancer, congenital malformation, and fetal and infant mortality for Oak Ridge, Anderson County, and Roane County relative to Tennessee. Finally, a more in-depth study on congenital malformations and fetal mortality trends for nine East Tennessee counties surrounding Oak Ridge was completed. The objective of the Health Physics Aspects of Fusion Power Program is to provide, on a timely basis, scientific information and technical evaluations on the potential impacts of fusion power to occupational workers and to members of the public. The primary areas of study in this program during the past year have been (1) factors affecting calculations of dose resulting from a release of tritium, (2) an assessment of the potential for reducing occupational risk from exposures to tritium, and (3) experimental studies of tritium conversion from molecular hydrogen to tritiated water

78 FR 35270 - Notice of Agreements Filed

Science.gov (United States)

2013-06-12

... Russia from the geographic scope of the agreement. Agreement No.: 012210. Title: Siem Car Carrier Pacific AS/Eukor Car Carriers Inc. Space Charter Agreement. Parties: Siem Car Carrier Pacific AS and Eukor...

76 FR 16420 - Notice of Agreements Filed

Science.gov (United States)

2011-03-23

.... Title: Hanjin and WHS Transpacific Vessel Sharing and Slot Allocation Agreement. Parties: Hanjin... amendment would add COSCON as a party to the Agreement and revise the name of the Agreement to Hanjin/WHS...

Study of obligations defined in agreements between parties involved in clinical trials of medicinal products in Bulgaria.

Science.gov (United States)

N Getov, Ilko; Gocheva-Hristova, Tanya; Lebanova, Hristina V; Grigorov, Evgeni E

2012-08-01

To analyse and assess the legislative and contractual obligations of the parties involved in the conduct of clinical trials, with identification of the needs for comprehensive contractual regulation of their rights and responsibilities. This survey has been carried out by means of review, analysis of comprehensiveness, comparative legislative analysis and assessment of compliance with the legislation of sample of investigator and site agreements governing the process of conducting clinical trials. The survey comprises analyses of contractual relations between the sponsor of the study and the investigator, and between the sponsor of the study and the trial site, respectively, relevant to clinical trials which are actually conducted in Bulgaria at the time of and following the survey. Comparative method based on pre-defined structured indices was employed to outline the major variances in the volume of responsibilities and obligations of the said parties to the clinical trial, as regulated by the investigator and site agreements. The analysis of comprehensiveness showed evident omissions in the regulation of relations and interactions between the parties to the agreements. The detailed contractual regulation providing for the statutory obligations and responsibilities of the parties involved in the conduct of clinical trials is a good guarantee for proper understanding of the obligations of each party and for compliance with their relevant responsibilities in view of protecting the rights of the participants in the clinical trials - patients or healthy volunteers.

Final task force report on the Agreement State Program

International Nuclear Information System (INIS)

1977-12-01

Section 274 of the Atomic Energy Act provides a statutory means by which the U.S. Nuclear Regulatory Commission may relinquish to the States a part of its regulatory authority over the use of source material, by-product material, and small quantities of special nuclear material. The Commission is required to retain regulatory authority over the licensing of nuclear facilities, exports and imports of nuclear materials and facilities, larger quantities of special nuclear material, and activities conducted by other Federal agencies which are not exempted by the Act. This study analyzes the NRC Agreement State Program to determine: whether the NRC should aggressively promote Agreement State status; whether the NRC should relinquish additional responsibility to the States and if so, which responsibilities and under what circumstances, and conversely if NRC should reassert authority in any areas; to what extent the NRC should continue to oversee State performance; and whether changes in the statute or regulations are desirable or required. At present, there are 25 states that have not opted for agreement status. Appendix A contains a discussion of the legislative history of Section 274, a report on the current status of the program, Agreement State review procedures, the full text of Section 274, a list of Agreement States, dates of agreements, number of licenses, a list of non-Agreement States, and numbers of NRC licenses in these States. Appendix B analyzes states' comments

The Text of a Safeguards Agreement relating to the Bilateral Agreement between Japan and Australia

Energy Technology Data Exchange (ETDEWEB)

NONE

1973-01-26

The text of a Safeguards Agreement between the Agency, Japan and Australia relating to the agreement of 21 February 1972 between the two Governments for co-operation in the peaceful uses of atomic energy is reproduced in this document for the information of all Members.

A Corporate Veto on Health Policy? Global Constitutionalism and Investor-State Dispute Settlement.

Science.gov (United States)

Hawkins, Benjamin; Holden, Chris

2016-10-01

The importance of trade and investment agreements for health is now widely acknowledged in the literature, with much attention now focused on the impact of investor-state dispute settlement (ISDS) mechanisms. However, much of the analysis of such agreements in the health field remains largely descriptive. We theorize the implications of ISDS mechanisms for health policy by integrating the concept of global constitutionalism with veto point theory. It is argued that attempts to constitutionalize investment law, through a proliferation of International Investment Agreements (IIAs), has created a series of new veto points at which corporations may seek to block new policies aimed at protecting or enhancing public health. The multiplicity of new veto points in this global "spaghetti bowl" of IIAs creates opportunities for corporations to venue shop; that is, to exploit the agreements, and associated veto points, through which they are most likely to succeed in blocking or deterring new regulation. These concepts are illustrated with reference to two case studies of investor-state disputes involving a transnational tobacco company, but the implications of the analysis are of equal relevance for a range of other industries and health issues. Copyright © 2016 by Duke University Press.

Protecting the autonomy of states to enact tobacco control measures under trade and investment agreements.

Science.gov (United States)

Mitchell, Andrew; Sheargold, Elizabeth

2015-06-01

Since the adoption of the WHO's WHO Framework Convention on Tobacco Control, governments have been pursuing progressively stronger and more wide-reaching tobacco control measures. In response, tobacco companies are frequently using international trade and investment agreements as tools to challenge domestic tobacco control measures. Several significant new trade and investment agreements that some fear may provide new legal avenues to the tobacco industry to challenge health measures are currently under negotiation, including the Trans-Pacific Partnership (a 12 party agreement of Asia-Pacific regional countries) and the Transatlantic Trade and Investment Partnership (an agreement between the USA and the European Union). This commentary examines different options for treaty provisions that the parties could employ in these agreements to minimise legal risks relating to tobacco control measures. It recommends that parties take a comprehensive approach, combining provisions that minimise the potential costs of litigation with provisions that increase the likelihood of a state successfully defending tobacco control measures in such litigation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Study on a model for future occupational health: proposal for an occupational health service model in Japan.

Science.gov (United States)

Higashi, Toshiaki

2006-10-01

The Study Model for Future Occupational Health (funded by a research grant from the Ministry of Health, Welfare and Labor) is a joint research project involving various organizations and agencies undertaken from 2002 to 2004. Society has undergone a dramatic transformation due to technological developments and internationalization. At the same time a low birth rate and an aging population have resulted in an increase in both the percentage of workers experiencing strong anxiety and stress in relation to their jobs and the working environment and the number of suicides. As a natural consequence, occupational health services are now expected to provide EAP, consulting and other functions that were formerly considered outside the realm of occupational health. In consideration of this background, the present study propose the following issues to provide a model for future occupational health services that meet the conditions presently confronted by each worker. 1. How to provide occupational health services and occupational physicians' services: 1) a basic time of 20 minutes of occupational health services per year should be allotted to each worker and to all workers; 2) the obligatory regulations should be revised to expand the obligation from businesses each with 50 or more employees under the present laws to businesses each with 30 or more employees. 2. Providers of occupational health services and occupational physicians' services: (1) reinforcement of outside occupational health agencies; (2) fostering occupational health consultant firms; (3) development of an institute of occupational safety and health; (4) support of activities by authorized occupational physicians in the field; (5) expanding of joint selection of occupational physicians including subsidy increase and the extension of a period of subsidy to five hears; (6) licensing of new entry into occupational health undertaking. 3. Introduction of new report system: (1) establishment of the obligation to

Safeguards agreements - their legal and conceptual basis

International Nuclear Information System (INIS)

Sanders, B.; Rainer, R.

1977-01-01

The application of Agency safeguards requires treaty arrangements (''Safeguards Agreements'') between the State or States concerned and the Agency. The authority for the Agency to conclude such agreements and to implement them is provided for in the Agency's Statute (Articles II, III A.5 and XII). On the basis of the statutory provisions safeguards principles and procedures have been elaborated. These have been laid down in: (a) The Agency's Safeguards System 1965, extended in 1966 and 1968 (INFCIRC/66/Rev.2); and (b) The basis for negotiating safeguards agreements with NNWS pursuant to NPT (INFCIRC/153). The verification of the undertaking by the State concerned not to use items subject to safeguards for purposes contrary to the terms of the agreement is verified through the application of various safeguards measures (design review, records, reports and inspection). Containment and surveillance measures are expected to play an increasingly important role. NPT Safeguards Agreements foresee as one of their specific features the establishment of national systems of accounting and control of nuclear material. The majority of the agreements concluded under document INFCIRC/66/Rev.2 - i.e. the non-NPT safeguards agreements - implement obligations undertaken under co-operation agreements between States for peaceful uses of nuclear energy. These agreements naturally reflect approaches adopted by the parties, in particular as to the circumstances under which safeguards should be applied. Thus, the concepts used in the non-NPT safeguards agreements and the safeguards system of document INFCIRC/66/Rev.2 which is incorporated in these agreements by reference are in continuous evolution. Document INFCIRC/66/Rev.2 continues to be supplemented in practical application and through explicit decision by the Board. The non-NPT safeguards agreements contain, besides technical safeguards provisions from document INFCIRC/66/Rev.2, and further provision for notification, inventories

Agreement and reproducibility in identification of endometriosis using magnetic resonance imaging

International Nuclear Information System (INIS)

Saba, Luca; Sulcis, Rosa; Mallarini, Giorgio; Guerriero, Stefano; Ajossa, Silvia; Melis, Gianbenedetto

2010-01-01

Background: Magnetic resonance imaging (MRI) is a promising technique in the study of endometriosis, allowing a complete mapping of lesions before surgery. However, the value of MRI in the diagnosis of endometriosis in the bladder, in superficial peritoneal lesions, and in ovarian foci and uterosacral ligaments is still under debate. Purpose: To assess inter- and intra-observer agreement in the evaluation of endometriosis in different anatomical locations using MRI. Material and Methods: From June 2006 to February 2008, 83 female patients (mean age 39, range 19-49 years) who had undergone MRI examination for suspected endometriosis were evaluated by two radiologists. MRI at 1.5 Tesla was performed with SE and TSE sequences, T1- and T2-weighted with and without fat suppression. Each examination was completed with gadolinium administration. Each dataset was independently evaluated by the radiologists for the presence or absence of endometriosis. The location (ovaries, uterosacral ligaments (USLs), pouch of Douglas, vagina, rectosigmoid, rectovaginal septum, and bladder) of suspected lesions was recorded. Cohen kappa statistical analysis was performed to calculate agreement between measurements. After 2 months the data were analyzed again by the two observers to assess intra-observer agreement. Results: Of the 83 MRI examinations performed, 12 patients demonstrated no evidence of endometriosis. In the remaining 71 studies, 157 endometriotic lesions ranging in size from 0.4 to 6.2 cm were detected. Of the 157 lesions, 53 (33.75% incidence) were smaller than 1 cm. In the ovaries, the inter-observer agreement was 92.77% and the kappa value was 0.802 (95% CI, 0.695-0.91). In the bladder the inter-observer agreement was 96.39% and the kappa value was 0.553 (95% CI 0.056-1). In the USLs the inter-observer agreement was 90.96% and the kappa value 0.583 (95% CI, 0.381-0.784). In the rectovaginal septum the inter-observer agreement was 94.58% and the kappa value 0.739 (95% CI

Agreement and reproducibility in identification of endometriosis using magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Saba, Luca; Sulcis, Rosa; Mallarini, Giorgio (Dept. of Science of the Images, Azienda Ospedaliero Universitaria di Cagliari, Cagliari (Italy)), e-mail: lucasaba@tiscali.it; Guerriero, Stefano; Ajossa, Silvia; Melis, Gianbenedetto (Dept. of Gynaecology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari (Italy))

2010-06-15

Background: Magnetic resonance imaging (MRI) is a promising technique in the study of endometriosis, allowing a complete mapping of lesions before surgery. However, the value of MRI in the diagnosis of endometriosis in the bladder, in superficial peritoneal lesions, and in ovarian foci and uterosacral ligaments is still under debate. Purpose: To assess inter- and intra-observer agreement in the evaluation of endometriosis in different anatomical locations using MRI. Material and Methods: From June 2006 to February 2008, 83 female patients (mean age 39, range 19-49 years) who had undergone MRI examination for suspected endometriosis were evaluated by two radiologists. MRI at 1.5 Tesla was performed with SE and TSE sequences, T1- and T2-weighted with and without fat suppression. Each examination was completed with gadolinium administration. Each dataset was independently evaluated by the radiologists for the presence or absence of endometriosis. The location (ovaries, uterosacral ligaments (USLs), pouch of Douglas, vagina, rectosigmoid, rectovaginal septum, and bladder) of suspected lesions was recorded. Cohen kappa statistical analysis was performed to calculate agreement between measurements. After 2 months the data were analyzed again by the two observers to assess intra-observer agreement. Results: Of the 83 MRI examinations performed, 12 patients demonstrated no evidence of endometriosis. In the remaining 71 studies, 157 endometriotic lesions ranging in size from 0.4 to 6.2 cm were detected. Of the 157 lesions, 53 (33.75% incidence) were smaller than 1 cm. In the ovaries, the inter-observer agreement was 92.77% and the kappa value was 0.802 (95% CI, 0.695-0.91). In the bladder the inter-observer agreement was 96.39% and the kappa value was 0.553 (95% CI 0.056-1). In the USLs the inter-observer agreement was 90.96% and the kappa value 0.583 (95% CI, 0.381-0.784). In the rectovaginal septum the inter-observer agreement was 94.58% and the kappa value 0.739 (95% CI

Vaginal vault suspension during hysterectomy for benign indications: a prospective register study of agreement on terminology and surgical procedure.

Science.gov (United States)

Bonde, Lisbeth; Noer, Mette Calundann; Møller, Lars Alling; Ottesen, Bent; Gimbel, Helga

2017-07-01

Several suspension methods are used to try to prevent pelvic organ prolapse (POP) after hysterectomy. We aimed to evaluate agreement on terminology and surgical procedure of these methods. We randomly chose 532 medical records of women with a history of hysterectomy from the Danish Hysterectomy and Hysteroscopy Database (DHHD). Additionally, we video-recorded 36 randomly chosen hysterectomies. The hysterectomies were registered in the DHHD. The material was categorized according to predefined suspension methods. Agreement compared suspension codes in DHHD (gynecologists' registrations) with medical records (gynecologists' descriptions) and with videos (reviewers' categorizations) respectively. Whether the vaginal vault was suspended (pooled suspension) or not (no suspension method + not described) was analyzed, in addition to each suspension method. Regarding medical records, agreement on terminology was good among patients undergoing pooled suspension in cases of hysterectomy via the abdominal and vaginal route (agreement 78.7, 92.3%). Regarding videos, agreement on surgical procedure was good among pooled suspension patients in cases of hysterectomy via the abdominal, laparoscopic, and vaginal routes (agreement 88.9, 97.8, 100%). Agreement on individual suspension methods differed regarding both medical records (agreement 0-90.1%) and videos (agreement 0-100%). Agreement on terminology and surgical procedure regarding suspension method was good in respect of pooled suspension. However, disagreement was observed when individual suspension methods and operative details were scrutinized. Better consensus of terminology and surgical procedure is warranted to enable further research aimed at preventing POP among women undergoing hysterectomy.

WTO new round agreement and nuclear

International Nuclear Information System (INIS)

Lee, M. K.; Moon, L. H.; Kim, S. S.

2002-01-01

The start of new round of WTO could be recognized as a turning point shifting from bilateral or regional trade system to multilateral trade system worldwide. The changes in international trade system are expected to have some impact on the Korean nuclear industry. The purpose of this study is to understand the impact on prepare opening the market for the plant design and engineering. This market has been protected by Agreement on Government Procurement(AGP). However, this market will be eventually influenced by GATS(General Agreement on Trade in Services) with KEPCO's on going privatization being completed. There have been no impacts on R and D fund provided by the government as yet. However, in case of Government supported R and D for commercial purpose, there are much concerns to be discussed further within new WTO agreement. It is necessary to develop a strategy for maximizing national interests and promoting R and D in the negotiation for design and construction services related with nuclear industry, and energy services. Furthermore, to effectively explore new nuclear markets in developing countries including China, market analyses for their countries are required

Level of Agreement and Factors Associated With Discrepancies Between Nationwide Medical History Questionnaires and Hospital Claims Data

Directory of Open Access Journals (Sweden)

Yeon-Yong Kim

2017-09-01

Full Text Available Objectives The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Methods Data from self-reported questionnaires that assessed an individual’s history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Results Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of self-reported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Conclusions Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

Level of Agreement and Factors Associated With Discrepancies Between Nationwide Medical History Questionnaires and Hospital Claims Data.

Science.gov (United States)

Kim, Yeon-Yong; Park, Jong Heon; Kang, Hee-Jin; Lee, Eun Joo; Ha, Seongjun; Shin, Soon-Ae

2017-09-01

The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of self-reported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

Federal Facility Agreement progress report

Energy Technology Data Exchange (ETDEWEB)

1993-10-01

The (SRS) Federal Facility Agreement (FFA) was made effective by the US. Environmental Protection Agency Region IV (EPA) on August 16, 1993. To meet the reporting requirements in Section XXV of the Agreement, the FFA Progress Report was developed. The FFA Progress Report is the first of a series of quarterly progress reports to be prepared by the SRS. As such this report describes the information and action taken to September 30, 1993 on the SRS units identified for investigation and remediation in the Agreement. This includes; rubble pits, runoff basins, retention basin, seepage basin, burning pits, H-Area Tank 16, and spill areas.

Federal Facility Agreement progress report

International Nuclear Information System (INIS)

1993-10-01

The (SRS) Federal Facility Agreement (FFA) was made effective by the US. Environmental Protection Agency Region IV (EPA) on August 16, 1993. To meet the reporting requirements in Section XXV of the Agreement, the FFA Progress Report was developed. The FFA Progress Report is the first of a series of quarterly progress reports to be prepared by the SRS. As such this report describes the information and action taken to September 30, 1993 on the SRS units identified for investigation and remediation in the Agreement. This includes; rubble pits, runoff basins, retention basin, seepage basin, burning pits, H-Area Tank 16, and spill areas

US-India agreement for peaceful nuclear cooperation

International Nuclear Information System (INIS)

2008-01-01

The United States and India acheived a historic agreement for strategic partnership after the completion of negotiations on the bilateral agreement for peaceful nuclear cooperation, also known as the agreement of 123. This agreement regulates the civilian nuclear trade between the two countries and opens the door wide to U.S. and Indian companies for a partnership in every other country in the civil nuclear industry. This agreement has opened the door to complete the remaining steps for the the widest American Indian cooperation in the field of civil uses of atomic energy. Critics to the agreement within the United States say that the agreement reflected serious consequences on the ability of the United States to force other countries to comply with the prevention of nuclear proliferation. The global criticism focused on that the agreement strikes at the heart of the Treaty on the Non-Proliferation of Nuclear Weapons, and is considered a dangerous precedent to break the laws of the International Tribunal, and especially the laws and rules of the International Group of Suppliers, which includes 45 countries. The International Atomic Energy Agency (IAEA) says that the agreement is an important step towards meeting India's growing energy needs, especially nuclear technology which is the engine of development. Immediately after the completion of the United States and India for their bilateral agreement for nuclear cooperation, Israel announced that it was seeking U.S. help in the establishment of a power reactor while pressing the direction of tightening control over Iran's nuclear program while some Arab countries announced their desire to have nuclear reactors for electricity generation purposes.

Does adding clinical data to administrative data improve agreement among hospital quality measures?

Science.gov (United States)

Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann

2017-09-01

Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.

Climate Justice and the Paris Agreement

International Nuclear Information System (INIS)

Michelot, Agnes

2016-01-01

The concept of climate justice has been, for the first time, used in an international agreement - namely, the Paris Agreement. But this recognition of the notion of climate justice is extremely restricted by the very way it is formulated. Preamble of the Paris Agreement 'notes' that climate justice is recognized by 'certain cultures'. Does it mean that particular and concrete stakes of climate justice of the pre-COP21 agenda have been recognized or, on the contrary, that the notion so introduced is actually an empty shell without any genuine legal perspective? Considering this uncertainty, it appears relevant to analyze the Paris Agreement through the claims of various groups and coalitions, which influenced the COP21 negotiations

75 FR 62407 - Office of Administration; Single-Source Cooperative Agreement Award; Announcing the Award a...

Science.gov (United States)

2010-10-08

... the development of a conceptual information technology architecture with ACF/Office of Information... Agreement to the Johns Hopkins University, Applied Physics Lab (APL) and School of Public Health, To Support the Development of a Human Services National Interoperable Architecture AGENCY: Office of Information...

International nuclear agreements

International Nuclear Information System (INIS)

Miatello, A.; Severino, R.

1988-01-01

This multilingual glossary, in the laborious compilation of which the authors have been greatly assisted by a group of professional translators and experts, presents for the first time a substantial number of entries in four languages (English, French, German and Italian), whose terminology and phraseology, all bearing the appropriate normative reference, has been drawn from the official text of the most relevant international agreements on nuclear policy. It is complemented by a thorough critical study on the status of nonproliferation by Lawrence Scheinman and Josef Pilat. Librarians, translators and interpreters as well as scholars and researchers in international law will find this volume a reference tool of specific interest

European Union's public fishing access agreements in developing countries.

Science.gov (United States)

Le Manach, Frédéric; Chaboud, Christian; Copeland, Duncan; Cury, Philippe; Gascuel, Didier; Kleisner, Kristin M; Standing, André; Sumaila, U Rashid; Zeller, Dirk; Pauly, Daniel

2013-01-01

The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU) and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreements at an average of 75% of their cost (financial contribution agreed upon in the agreements), while private European business interests paid the equivalent of 1.5% of the value of the fish that was eventually landed. This raises questions of fisheries benefit-sharing and resource-use equity that the EU has the potential to address during the nearly completed reform of its Common Fisheries Policy.

European Union's public fishing access agreements in developing countries.

Directory of Open Access Journals (Sweden)

Frédéric Le Manach

Full Text Available The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreements at an average of 75% of their cost (financial contribution agreed upon in the agreements, while private European business interests paid the equivalent of 1.5% of the value of the fish that was eventually landed. This raises questions of fisheries benefit-sharing and resource-use equity that the EU has the potential to address during the nearly completed reform of its Common Fisheries Policy.

Semantic annotation of consumer health questions.

Science.gov (United States)

Kilicoglu, Halil; Ben Abacha, Asma; Mrabet, Yassine; Shooshan, Sonya E; Rodriguez, Laritza; Masterton, Kate; Demner-Fushman, Dina

2018-02-06

Consumers increasingly use online resources for their health information needs. While current search engines can address these needs to some extent, they generally do not take into account that most health information needs are complex and can only fully be expressed in natural language. Consumer health question answering (QA) systems aim to fill this gap. A major challenge in developing consumer health QA systems is extracting relevant semantic content from the natural language questions (question understanding). To develop effective question understanding tools, question corpora semantically annotated for relevant question elements are needed. In this paper, we present a two-part consumer health question corpus annotated with several semantic categories: named entities, question triggers/types, question frames, and question topic. The first part (CHQA-email) consists of relatively long email requests received by the U.S. National Library of Medicine (NLM) customer service, while the second part (CHQA-web) consists of shorter questions posed to MedlinePlus search engine as queries. Each question has been annotated by two annotators. The annotation methodology is largely the same between the two parts of the corpus; however, we also explain and justify the differences between them. Additionally, we provide information about corpus characteristics, inter-annotator agreement, and our attempts to measure annotation confidence in the absence of adjudication of annotations. The resulting corpus consists of 2614 questions (CHQA-email: 1740, CHQA-web: 874). Problems are the most frequent named entities, while treatment and general information questions are the most common question types. Inter-annotator agreement was generally modest: question types and topics yielded highest agreement, while the agreement for more complex frame annotations was lower. Agreement in CHQA-web was consistently higher than that in CHQA-email. Pairwise inter-annotator agreement proved most

Degree of agreement among sepsis diagnosis criteria in adult emergency room patients with infection

Science.gov (United States)

Sinto, R.; Chandra, A. T.; Lie, K. C.; Suwarto, S.

2018-03-01

The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March and April 2017. We recorded diagnosis, gender, age, comorbidities, infection source, and origin. Every subject was classified into sepsis and non-sepsis based on 1991, 2001 and sepsis-3 criteria. Raw % and Kappa agreement coefficients (κ) were calculated according to previously established formula to measure the degree of agreement among three diagnostic criteria. As many as 278 subjects were included in this study. The raw % agreement and κ between 1991 and 2001 criteria is 69.07% and 0.34 respectively. The raw % agreement and κ between 2001 and sepsis-3 criteria is 56.12% and 0.15 respectively. The raw % agreement and κ between 1991 and sepsis-3 criteria is 48.19% and -0.02. In conclusions, there is afair agreement between 1991 and 2001 criteria, poor agreement between 2001 and sepsis-3 criteria, and poor disagreement between 1991 and sepsis-3 criteria. This necessitates further Indonesian study of the best diagnosis criteria to diagnose an infected patient with sepsis.

48 CFR 1542.1203 - Processing agreements.

Science.gov (United States)

2010-10-01

... MANAGEMENT CONTRACT ADMINISTRATION Novation and Change of Name Agreements 1542.1203 Processing agreements. (a... required documentary evidence. (2) Verify the accuracy of the list of contracts through the Contract...

Improving regulatory capacity to manage risks associated with trade agreements.

Science.gov (United States)

Walls, Helen L; Smith, Richard D; Drahos, Peter

2015-03-21

Modern trade negotiations have delivered a plethora of bilateral and regional preferential trade agreements (PTAs), which involve considerable risk to public health, thus placing demands on governments to strengthen administrative regulatory capacities in regard to the negotiation, implementation and on-going management of PTAs. In terms of risk management, the administrative regulatory capacity requisite for appropriate negotiation of PTAs is different to that for the implementation or on-going management of PTAs, but at all stages the capacity needed is expensive, skill-intensive and requires considerable infrastructure, which smaller and poorer states especially struggle to find. It is also a task generally underestimated. If states do not find ways to increase their capacities then PTAs are likely to become much greater drivers of health inequities. Developing countries especially struggle to find this capacity. In this article we set out the importance of administrative regulatory capacity and coordination to manage the risks to public health associated with PTAs, and suggest ways countries can improve their capacity.

Trade Agreements PTI

Data.gov (United States)

Department of Homeland Security — The objective of the Trade Agreements PTI is to advance CBP’s mission by working with internal and external stakeholders to facilitate legitimate trade and address...

African Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology. Third extension of agreement

International Nuclear Information System (INIS)

2005-01-01

Pursuant to Article XIV.2, the Agreement 'shall continue in force for a period of five years from the date of its entry into force and may be extended for further periods of five years if the Government Parties so agree'. The third extension of the Agreement entered into force on 4 April 2005, upon expiration of the second extension of the Agreement and will remain in force for an additional period of five years, i.e. through 3 April 2010. As of 10 May 2005, 20 States have notified the Agency of their acceptance of the extension of the Agreement. The status list of the Agreement is reproduced in this document for the information of all Members. Members will be notified of further acceptances of the extension of the Agreement by addenda to this information circular

Agreement on trade-related aspects of intellectual property rights and access to medication: does Egypt have sufficient safeguards against potential public health implications of the agreement / Heba Wanis

Index Scriptorium Estoniae

Wanis, Heba

2010-01-01

Intellektuaalomandi Õiguste Kaubandusaspektide Lepingust (TRIPS Agreement) ja selle mõjust ravimitele juurdepääsule Egiptuses. Ülevaade ravimitööstusest, ravimitele juurdepääsu põhiteguritest ning ravimite ja tervishoiu olukorrast

27 CFR 70.485 - Closing agreements.

Science.gov (United States)

2010-04-01

... Relating to Alcohol, Tobacco, Firearms, and Explosives Administrative Remedies § 70.485 Closing agreements... disadvantage through consummation of such an agreement. (b) Scope of closing agreement—(1) In general. A...

23 CFR 635.115 - Agreement estimate.

Science.gov (United States)

2010-04-01

... CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.115 Agreement estimate. (a) Following the award of contract, an agreement estimate based on the contract unit prices and estimated quantities shall be...

Stress, health and quality of life of female migrant domestic workers in Singapore: a cross-sectional study.

Science.gov (United States)

Anjara, S G; Nellums, L B; Bonetto, C; Van Bortel, T

2017-10-10

There is a global increase in migrant workers. In Singapore, there are over 230,000 migrant domestic workers (MDWs). Female MDWs may experience high levels of stress and social isolation, which may negatively impact on their health and quality of life. There have also been documented cases of abuse and exploitation. However, there is a lack of empirical research with this population. This study aimed to investigate factors impacting on the health and quality of life of female MDWs in Singapore, including socio-demographic and job related characteristics, stress, social isolation, and working management style. A cross-sectional survey was carried out with 182 female MDWs in Singapore. The survey examined health and quality of life (WHOQoL-Bréf), social connectedness (the Friendship Scale), and preferred and experienced working management style (the Theory X and Theory Y Questionnaire). Descriptive analyses were carried out in addition to ANOVA, t-tests, and chi-square tests, followed by a multivariate analysis using linear regression. Participants were found to have good overall quality of life and satisfaction with health. Age and working experience were found to be significantly (p health). Agreement between experienced and preferred working management style was also found to be associated with higher quality of life scores (with the exception of the social relationships domain). Though women reported relatively good overall quality of life, more than half of participants reported feeling stressed. In addition, nearly 20% of participants reported being isolated or very isolated. Stress was identified to be associated with isolation. In the multivariate analysis, stress was found to contribute to worse quality of life in all domains except social relationships, after adjusting for confounders. Social connectedness was positively associated with all domains of quality of life, and agreement of working management style was positively associated with physical health

Tri-Party Agreement Milestone M-45-07A; complete evaluation of subsurface barrier feasibility: Summary report

Energy Technology Data Exchange (ETDEWEB)

Cox, G.E.; Peters, B.B.; Treat, R.L. [Enserch Environmental Corp., Richland, WA (United States); Bazinet, G.D.; Cruse, J.M.; Hampsten, K.L. [Westinghouse Hanford Co., Richland, WA (United States)

1994-09-01

The US Department of Energy (DOE) has established the Tank Waste Remediation System (TWRS) program to safely manage and dispose the low-level and high-level radioactive and hazardous wastes currently held in 177 tanks and approximately 1,900 sealed capsules located on the Hanford Site. The remediation of the entire Hanford Site is being conducted under the Hanford Federal Facility Agreement and Consent Order, otherwise known as the Tri-Party Agreement. The three parties that concluded the agreement are the DOE, the US Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology). The purpose of the Tri-Party Agreement is to ensure that Hanford Site activities are performed in a manner that protects the public health, welfare, and the environment. The agreement provides a framework and structure for the many different agencies and regulations under which work is performed on the Site, listing responsibilities and attaching scheduled dates of completion for minimum performances (known as milestones). The Tri-Party Agreement Milestone M-45-07A requires that an assessment of the feasibility of subsurface barriers to support retrieval of tank waste be performed. The activities to meet this milestone have been completed, and are documented herein.

Tri-Party Agreement Milestone M-45-07A; complete evaluation of subsurface barrier feasibility: Summary report

International Nuclear Information System (INIS)

Cox, G.E.; Peters, B.B.; Treat, R.L.; Bazinet, G.D.; Cruse, J.M.; Hampsten, K.L.

1994-09-01

The US Department of Energy (DOE) has established the Tank Waste Remediation System (TWRS) program to safely manage and dispose the low-level and high-level radioactive and hazardous wastes currently held in 177 tanks and approximately 1,900 sealed capsules located on the Hanford Site. The remediation of the entire Hanford Site is being conducted under the Hanford Federal Facility Agreement and Consent Order, otherwise known as the Tri-Party Agreement. The three parties that concluded the agreement are the DOE, the US Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology). The purpose of the Tri-Party Agreement is to ensure that Hanford Site activities are performed in a manner that protects the public health, welfare, and the environment. The agreement provides a framework and structure for the many different agencies and regulations under which work is performed on the Site, listing responsibilities and attaching scheduled dates of completion for minimum performances (known as milestones). The Tri-Party Agreement Milestone M-45-07A requires that an assessment of the feasibility of subsurface barriers to support retrieval of tank waste be performed. The activities to meet this milestone have been completed, and are documented herein

[The significance of a large number of health insurance funds and fusions for health services research with statutory health insurance data in Germany - experiences of the lidA study].

Science.gov (United States)

March, S; Powietzka, J; Stallmann, C; Swart, E

2015-02-01

Since 1970 the health insurance system in Germany has shrunk by more than 90% to 132 statutory health insurance funds (SHI) at present. For studies using data from different SHI, this development means a reduction of contacts and a higher workload when requesting data. The latter is due to the fact that fusions bind resources in the health insurance funds. In order to avoid selection in studies among the insured, all SHI must be contacted. Additionally, 15 controlling institutions on the state and national level have to agree as determined in § 75 of the German Social Code number 10. The lidA study - a German cohort study on work, age and health intends to link primary and secondary data from all SHI of those insured who have given their agreement for participation. Since the beginning of the study in 2009 the number of SHI has been reduced by 70. Of the 6 585 interviews in 2011 approximately half of the interviewees agreed in written form that their individual health insurance data can be linked. This portion of the insured is dispersed among 95 SHI. At this point, 11 contracts with SHI are realised (approximately 50% of the insured) and 8 data controlling authorities have been contacted. The problems involved in the fusion of SHI and its meaning for research are explained in this article. The fusion of SHI makes sense for the long term. It will lead to a reduction of contacts and contracts that researchers have to establish in order to analyse the data. Therefore, this article also discusses the alternative of creating a meta-data set of all the data from the different SHI combined. © Georg Thieme Verlag KG Stuttgart · New York.

[Palliative home care in Westfalia-Lippe--baseline study 12 and 36 months after coming into effect of the "agreement to the implementation of ambulant home palliative careforterminally ill patients"].

Science.gov (United States)

Lux, E A; Althaus, A; Classen, B; Hilscher, H; Hofmeister, U; Holtappels, P; Mansfeld-Nies, R; Weller, H U

2013-07-25

On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. 12 and 36 months after coming into effect of the agreement a questionnaire was sent to the regional palliative care networks to collect data about supply structure, number of patients and their place of death. In the year 2011 85,410 people died in Westfalia-Lippe, 9.0% of them were included in palliative care structures. 69.5% of the included patients died at home, 9.9% in hospital (in 2010: 68.7% at home, 14.7% in hospital). A correlation between the population density or the number of included patients per palliative networkcould not be detected. Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.

India’s Participation In The Regional Trade Agreements

Directory of Open Access Journals (Sweden)

V. I. Baronov

2017-01-01

Full Text Available The main objective of the proposed study is to identify the specifics of India’s participation in the regional trade agreements (RTAs, a comparative analysis of the main provisions of the RTAs and the impact of membership in the integration agreements on the country’s foreign trade relations. In the world economic literature there is no unity of opinions on the economic effect of the participation of states in RTAs. The author’s thesis is that the final effect of membership in the RTAs depends on the amount of customs duties on the date of signing the agreement (the higher they are, the greater the effect of trade creation, and also on the place of the partner country in the trade of another participating state (the greater is mutual turnover, the greater effect of trade creation. Of course, other factors affect, such as geographical proximity, transportation and other transaction costs. India’s participation in the regional trade agreements (RTA was one of the tasks of implementing the policy “Look East”, which was approved in 1991. The countries of Southeast Asia have been identified as a regional priority, which was caused by the geo-strategic and economic reasons. Later, regional coverage has been extended to the countries of Northeast and South Asia because of increasing the role of China in the world economy and politics, which has become a strategic challenge and economic opportunities for the Indian economy. India is a participant of 13 RTAs, the majority of which are bilateral. In India’s integration practice, one of four types of RTAs is applied: (1 agreement on comprehensive economic partnership, which differ in the widest scope of mutual economic relations; (2 agreement on comprehensive economic cooperation; (3 free trade agreement; (4 preferential trade agreement. Most often, there is used classical integration model (of preferential or free trade area.Initially, the Indian policy of RTA dominated the political factor

Explaining parent-child (dis)agreement in generic and short stature-specific health-related quality of life reports: do family and social relationships matter?

Science.gov (United States)

Quitmann, Julia; Rohenkohl, Anja; Sommer, Rachel; Bullinger, Monika; Silva, Neuza

2016-10-21

In the context of health-related quality of life (HrQoL) assessment in pediatric short stature, the present study aimed to examine the levels of agreement/disagreement between parents' and children's reports of generic and condition-specific HrQoL, and to identify socio-demographic, clinical and psychosocial variables associated with the extent and direction of parent-child discrepancies. This study was part of the retest phase of the QoLISSY project, which was a multicenter study conducted simultaneously in France, Germany, Spain, Sweden and UK. The sample comprised 137 dyads of children/adolescents between 8 and 18 years of age, diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), and one of their parents. The participants completed child- and parent-reported questionnaires on generic (KIDSCREEN-10 Index) and condition-specific HrQoL (QoLISSY Core Module). Children/adolescents also reported on social support (Oslo 3-items Social Support Scale) and parents assessed the parent-child relationships (Parental Role subscale of the Social Adjustment Scale) and burden of short stature on parents (QoLISSY- additional module). The parent-child agreement on reported HrQoL was strong (intraclass correlation coefficients between .59 and .80). The rates of parent-child discrepancies were 61.5 % for generic and 35.2 % for condition-specific HrQoL, with the parents being more prone to report lower generic (42.3 %) and condition-specific HrQoL (23.7 %) than their children. The extent of discrepancies was better explained by family and social relationships than by clinical and socio-demographic variables: poorer parent-child relationships and better children's social support were associated with larger discrepancies in generic HrQoL, while more parental burden was associated with larger discrepancies in condition-specific HrQoL reports. Regarding the direction of discrepancies, higher parental burden was significantly associated with parents

Inter-rater Agreement of Clinicians' Treatment Recommendations Based on Modified Barium Swallow Study Reports.

Science.gov (United States)

Slovarp, Laurie; Danielson, Jennifer; Liss, Julie

2018-06-07

The modified barium swallow study (MBSS) is a commonly used radiographic procedure for diagnosis and treatment of swallowing disorders. Despite attempts by dysphagia specialists to standardize the MBSS, most institutions have not adopted such standardized procedures. High variability of assessment patterns arguably contribute to variability of treatment recommendations made from diagnostic information derived from the MBSS report. An online survey was distributed to speech-language pathologists (SLPs) participating in American Speech Language Hearing Association (ASHA) listservs. Sixty-three SLPs who treat swallowing disorders participated. Participating SLPs reviewed two MBSS reports and chose physiologic treatment targets (e.g., tongue base retraction) based on each report. One report primarily contained symptomatology (e.g., aspiration, pharyngeal residue) with minimal information on impaired physiology (e.g., laryngeal incompetence, reduced hyolaryngeal elevation/excursion). In contrast, the second report contained a clear description of impaired physiology to explain the dysphagia symptoms. Fleiss kappa coefficients were used to analyze inter-rater agreement across the high and low physiology report types. Results revealed significantly higher inter-rater agreement across clinicians when reviewing reports with clear explanation(s) of physiologic impairment relative to reports that primarily focused on symptomatology. Clinicians also reported significantly greater satisfaction and treatment confidence following review of reports with clear description(s) of impaired physiology.

Possibilities for Negotiated Agreements on Energy Efficiency in CEE Countries

International Nuclear Information System (INIS)

Stanic, Z.

1997-01-01

This article summarises the results of the four month study of the possibilities for using Negotiated Agreements on Energy Efficiency between Government and Industry as a tool for improving energy efficiency in the CEE industrial sector. Negotiated Agreements are becoming increasingly popular in many countries as a potential means of addressing environmental problems (SO 2 , NO x and CO 2 ) and resource depletion (the use of fossil fuels), without adversely affecting economic development. In the report the use of these instrument in a number of countries is considered and described in view of developing a framework for assessing the possibilities for such agreements in CEE countries. The framework was applied through a case-study of Poland and a quick 'scan' of Belarus, Croatia and Latvia. (author)

Chernobyl Studies Project - working group 7.0 environmental transport and health effects. Progress report, October 1993--January 1994

Energy Technology Data Exchange (ETDEWEB)

Hendrickson, S.M. [ed.

1994-03-01

The DOE-funded Chernobyl Studies Project was begun as part of a cooperative agreement between the US and the former USSR, (quote) To develop jointly methods to project rapidly the health effects of any future reactor accident (quote). Most of the initial tasks for this project are completed or near completion. The focus has now turned primarily to the issue of health effects from the Chernobyl accident. Currently, we are extensively engaged in case-control and cohort studies of thyroid diseases among Belarussian children and in the Ukraine. A major part of the effort is providing methods and applications of dose reconstruction and providing support and equipment for the medical teams. This document contains reports on progress in the following task areas: Management; External Dose; Hydrological Transport; Chromosome Painting Dosimetry; Stochastic Effects; Thyroid Studies; and Leukemia Studies.

An Experimental Study on Internal and External Negotiation for Trade Agreements

Directory of Open Access Journals (Sweden)

Hankyoung Sung

2017-06-01

Full Text Available This paper experimentally studies the performance of negotiation considering individual and party, like a country, share of benefit over the best ones. It experiments two-stage bargaining games, internal and external negotiations. From the experimental results, this paper shows strong tendency to select fair allocation in the internal negotiations, but the tendency would be weaker with attractive outside option. In addition, the outside option may claim difference in individual benefit. From the regressions on individual performance in the negotiations, being a proposing party would matter to enhance the performance. However, relative individual performance within party fairness matters. Still attractive no-agreement options happen to break the tendency. As policy implication for trade negotiation, this paper warns that possible loss in individual benefit from not active participation to the external negotiations, no active role of proposer in case that players stick to internal allocations, and deviation of advantageous sector due to attractive outside options.

Unfolding the phenomenon of inter-rater agreement

DEFF Research Database (Denmark)

Slaug, Bjørn; Schilling, Oliver; Helle, Tina

2011-01-01

Objective: The overall objective was to unfold the phenomenon of inter-rater agreement: to identify potential sources of variation in agreement data and to explore how they can be statistically accounted for. The ultimate aim was to propose recommendations for in-depth examination of agreement, i...

75 FR 78245 - Notice of Agreements Filed

Science.gov (United States)

2010-12-15

... Mexico, Panama, Jamaica, Colombia, and the Far East, including China, Hong Kong, and Korea. Agreement No.../CSAV Slot Swap Agreement. Parties: China Shipping Container Lines Co. Ltd., China Shipping Container... trade between United States ports and ports in China and Vietnam. Agreement No.: 201208-001. Title...

75 FR 14159 - Notice of Agreements Filed

Science.gov (United States)

2010-03-24

... parties to exchange slots in the trade between U.S. East Coast ports and ports in Turkey. Agreement No.: 201048-005. Title: Lease and Operating Agreement between Philadelphia Regional Port Authority and... FEDERAL MARITIME COMMISSION Notice of Agreements Filed The Commission hereby gives notice of the...

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians.

Science.gov (United States)

Berry, Marc P; Martí, Joan-Daniel; Ntoumenopoulos, George

2016-10-01

Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full

Agency Agreements Process Champion Support Intern

Science.gov (United States)

Miksa, Ember

2018-01-01

This document will provide information on the 2018 Spring semester NIFS Intern who represented the Office of Chief Financial Officer (OCFO) as a Reimbursable Accountant at Kennedy Space Center (KSC). This intern supported the Agency Agreements Process Champions and Team Lead, Susan Kroskey, Sandy Massey and Mecca Murphy, with major initiatives to advance the KSC OCFO's vision of creating and innovating healthy financial management practices that maximize the value of resources entrusted to NASA. These initiatives include, but are not limited to: updating the Agency Guidance and NASA Procedural Guidance 9090.1 Agreements, implementing a new budget structure to be utilized across all centers, submitting a Call Request (CRQ) to enhance non-federal customer reporting, initiating a discussion to incorporate a 3-year funding program for NASA agreements, and undertaking the Office of Inspector General (OIG) Audit. In support of these initiatives, this intern identified technical methods to enhance and reduce the workload of financial processes for reimbursable and non-reimbursable agreements, prepared reports in support of accounting functions, and performed administrative work and miscellaneous technical tasks in support of the OCFO as requested. In conclusion of the internship, the intern will become knowledgeable on reimbursable accounting, reimbursable policy, types of reimbursable agreements, the agreements process, estimated pricing reports, and the roles and responsibilities of the Financial Accounting and Financial Services offices.

12 CFR 533.6 - Disclosure of covered agreements.

Science.gov (United States)

2010-01-01

... REPORTING OF CRA-RELATED AGREEMENTS § 533.6 Disclosure of covered agreements. (a) Applicability date. This... mailing the agreement. (7) Use of CRA public file by insured depository institution or affiliate. An... institution's CRA public file if the institution makes the agreement available in accordance with the...

African Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology. Fourth Extension of Agreement

International Nuclear Information System (INIS)

2010-01-01

Pursuant to Article XIV.2, the Agreement 'shall continue in force for a period of five years from the date of its entry into force and may be extended for further periods of five years if the Government Parties so agree'. The fourth extension of the Agreement entered into force on 4 April 2010, upon expiration of the third extension of the Agreement and will remain in force for an additional period of five years, i.e. through 3 April 2015. As of 30 April 2010, 8 States have notified the Agency of their acceptance of the extension of the Agreement. The status list of the Agreement is reproduced in this document for the information of all Members [es

Fifth Supply Agreement. Agreement for the Transfer of Low Enriched Uranium for a Research Reactor in Romania

International Nuclear Information System (INIS)

2008-01-01

The text of the Fifth Supply Agreement among the Government of Romania, the Government of the United States of America and the International Atomic Energy Agency for the Transfer of Low Enriched Uranium for a Research Reactor in Romania is reproduced in this document for the information of all Members of the Agency. The Agency's Board of Governors approved the text of the Agreement on 20 November 2003, which was signed by the authorized representatives of Romania and the United States, and by the Director General of the IAEA, on 24 November 2003. Pursuant to Article V of the Agreement, the Agreement entered into force on 24 November 2003, upon signature by the representatives of Romania, the United States and the Director General of the IAEA

45 CFR 162.915 - Trading partner agreements.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Trading partner agreements. 162.915 Section 162... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS General Provisions for Transactions § 162.915 Trading partner agreements. A covered entity must not enter into a trading partner agreement that would do any of the...

10 CFR 603.1340 - Technology investment agreement.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Technology investment agreement. 603.1340 Section 603.1340 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Definitions of Terms Used in this Part § 603.1340 Technology investment agreement. A TIA is a special type of...

24 CFR 266.15 - Risk-Sharing Agreement.

Science.gov (United States)

2010-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS General Provisions § 266.15 Risk-Sharing Agreement. Execution of a Risk-Sharing Agreement is a prerequisite to... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Risk-Sharing Agreement. 266.15...

7 CFR 3550.205 - Delinquency workout agreements.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Delinquency workout agreements. 3550.205 Section 3550... Delinquency workout agreements. Borrowers with past due accounts may be offered the opportunity to avoid liquidation by entering into a delinquency workout agreement that specifies a plan for bringing the account...

22 CFR 120.21 - Manufacturing license agreement.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Manufacturing license agreement. 120.21 Section... DEFINITIONS § 120.21 Manufacturing license agreement. An agreement (e.g., contract) whereby a U.S. person grants a foreign person an authorization to manufacture defense articles abroad and which involves or...

22 CFR 120.22 - Technical assistance agreement.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Technical assistance agreement. 120.22 Section... DEFINITIONS § 120.22 Technical assistance agreement. An agreement (e.g., contract) for the performance of a... license to manufacture defense articles. Assembly of defense articles is included under this section...

25 CFR 225.33 - Assignment of minerals agreements.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Assignment of minerals agreements. 225.33 Section 225.33 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS OIL AND GAS, GEOTHERMAL, AND SOLID MINERALS AGREEMENTS Minerals Agreements § 225.33 Assignment of minerals agreements. An...

12 CFR 346.6 - Disclosure of covered agreements.

Science.gov (United States)

2010-01-01

... POLICY DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS § 346.6 Disclosure of covered agreements. (a... exceed the cost of copying and mailing the agreement. (7) Use of CRA public file by insured depository... the insured depository institution's CRA public file if the institution makes the agreement available...

The Text of the Safeguards Agreement relating to the Bilateral Agreement between India and the United States of America

International Nuclear Information System (INIS)

1971-01-01

The text of the Safeguards Agreement between the Agency, the Government of India and the Government of the United States of America providing for the Agency to apply safeguards in relation to the agreement between those Governments concerning co-operation in the civil uses of atomic energy, is reproduced in part I of this document for the information of all Members. The text of the co-operation agreement is reproduced in part II. The Safeguards Agreement entered into force on 27 January 1971

The Text of the Safeguards Agreement relating to the Bilateral Agreement between India and the United States of America

Energy Technology Data Exchange (ETDEWEB)

NONE

1971-09-03

The text of the Safeguards Agreement between the Agency, the Government of India and the Government of the United States of America providing for the Agency to apply safeguards in relation to the agreement between those Governments concerning co-operation in the civil uses of atomic energy, is reproduced in part I of this document for the information of all Members. The text of the co-operation agreement is reproduced in part II. The Safeguards Agreement entered into force on 27 January 1971.

5 CFR 575.210 - Service agreement requirements.

Science.gov (United States)

2010-01-01

... agreement must specify that if an employee does not successfully complete the training before the service... employee. (c) The service agreement must specify the total amount of the incentive, the method of paying... incentive, an agency must require the employee to sign a written service agreement to complete a specified...

Cues, quantification, and agreement in language comprehension.

Science.gov (United States)

Tanner, Darren; Bulkes, Nyssa Z

2015-12-01

We investigated factors that affect the comprehension of subject-verb agreement in English, using quantification as a window into the relationship between morphosyntactic processes in language production and comprehension. Event-related brain potentials (ERPs) were recorded while participants read sentences with grammatical and ungrammatical verbs, in which the plurality of the subject noun phrase was either doubly marked (via overt plural quantification and morphological marking on the noun) or singly marked (via only plural morphology on the noun). Both acceptability judgments and the ERP data showed heightened sensitivity to agreement violations when quantification provided an additional cue to the grammatical number of the subject noun phrase, over and above plural morphology. This is consistent with models of grammatical comprehension that emphasize feature prediction in tandem with cue-based memory retrieval. Our results additionally contrast with those of prior studies that showed no effects of plural quantification on agreement in language production. These findings therefore highlight some nontrivial divergences in the cues and mechanisms supporting morphosyntactic processing in language production and comprehension.

Intersibling agreement for Goldberg's big five adjective markers.

Science.gov (United States)

Lanthier, R P

2000-04-01

In a sample of 240 college students intersibling agreement was examined for Goldberg's 100 unipolar Big Five adjective markers. Participants showed self-enhancement by rating themselves more favorably on three of the five traits (Agreeableness, Conscientiousness, and Culture/Intellect); however, self-ratings on Neuroticism were higher than siblings' ratings. Correlations among raters were moderate (mean r = .41) and comparable to values obtained in studies using peer ratings. The type of the sibling relationship, based on ratings of relationship quality, moderated the rank-order measures but not the mean agreement.

Evidence for the credibility of health economic models for health policy decision-making

DEFF Research Database (Denmark)

Søgaard, Rikke; Lindholt, Jes S.

2012-01-01

OBJECTIVE: To investigate whether the credibility of health economic models of screening for abdominal aortic aneurysms for health policy decision-making has improved since 2005 when a systematic review by Campbell et al. concluded that reporting standards were poor and there was divergence between...... benefited from general advances in health economic modelling and some improvements in reporting were noted. However, the low level of agreement between studies in model structures and assumptions, and difficulty in justifying these (convergent validity), remain a threat to the credibility of health economic...... models. Decision-makers should not accept the results of a modelling study if the methods are not fully transparent and justified. Modellers should, whenever relevant, supplement a primary report of results with a technical report detailing and discussing the methodological choices made....

Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects: a reliability and agreement study.

Science.gov (United States)

Krogh, T P; Fredberg, U; Christensen, R; Stengaard-Pedersen, K; Ellingsen, T

2013-10-01

Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice. This study was designed as an intra- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement. In the intraobserver study, the ICC with regard to tendon thickness ranged from 0.76 to 0.81, depending on the measurement techniques used. The agreement ranged from 0.06 to 0.13 mm. In the interobserver study, the tendon thickness ICC ranged from 0.45 to 0.65 and the agreement ranged from -0.17 to 0.13 mm. The ICC for color Doppler activity was 0.93, with agreement in 14/18 (78 %) of the cases. A perfect reliability was demonstrated for bony spurs, with an ICC of 1 and exact agreement in 18/18 (100 %) of the cases. Good to excellent reliability was obtained for all measurements. The ultrasonographic techniques evaluated in this trial can be recommended for use in both research and clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

29 CFR 215.6 - The Model Agreement.

Science.gov (United States)

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false The Model Agreement. 215.6 Section 215.6 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR GUIDELINES, SECTION 5333(b), FEDERAL TRANSIT LAW § 215.6 The Model Agreement. The Model (or National) Agreement mentioned in paragraphs...

Intramodality and intermodality agreement in radiography and computed tomography of equine distal limb fractures.

Science.gov (United States)

Crijns, C P; Martens, A; Bergman, H-J; van der Veen, H; Duchateau, L; van Bree, H J J; Gielen, I M V L

2014-01-01

Computed tomography (CT) is increasingly accessible in equine referral hospitals. To document the level of agreement within and between radiography and CT in characterising equine distal limb fractures. Retrospective descriptive study. Images from horses that underwent radiographic and CT evaluation for suspected distal limb fractures were reviewed, including 27 horses and 3 negative controls. Using Cohen's kappa and weighted kappa analysis, the level of agreement among 4 observers for a predefined set of diagnostic characteristics for radiography and CT separately and for the level of agreement between the 2 imaging modalities were documented. Both CT and radiography had very good intramodality agreement in identifying fractures, but intermodality agreement was lower. There was good intermodality and intramodality agreement for anatomical localisation and the identification of fracture displacement. Agreement for articular involvement, fracture comminution and fracture fragment number was towards the lower limit of good agreement. There was poor to fair intermodality agreement regarding fracture orientation, fracture width and coalescing cracks; intramodality agreement was higher for CT than for radiography for these features. Further studies, including comparisons with surgical and/or post mortem findings, are required to determine the sensitivity and specificity of CT and radiography in the diagnosis and characterisation of equine distal limb fractures. © 2013 EVJ Ltd.

Form 6 - gas balancing agreement

International Nuclear Information System (INIS)

Anon.

1990-01-01

In 1988, a special Committee of the Rocky Mountain Mineral Law Foundation undertook a project to draft a model from gas balancing agreement. This project was initiated at the request of a number of Foundation members who felt that a model form gas balancing agreement would facilitate the negotiation of operating agreement, since gas balancing issues had become sticking points in the process. The Committee was composed of attorneys representing a wide cross-section of the oil and gas industry including both major and independent oil companies, production companies with interstate pipeline affiliates, and private practitioners. The Committee attempted to address the more controversial issues in gas balancing with optional provisions in the Form. To facilitate the negotiation process, the number of optional provisions was minimized. This form may be used as an Appendix to the new A.A.P.L. Form 610-1989 Model Form Operating Agreement. This book includes provision of this Form which are: Ownership of gas production; Balancing of production accounts; Cash balancing upon depletion; Deliverability tests; Nominations; Statements; Payment of taxes; Operating expenses; Overproducing allowable; Payment of leasehold burdens; Operator's liability; Successors and assigns; Audits; Arbitration; and Operator's fees

Intra- and interobserver agreement of computed tomography in assessment of the mandibular condyle

Energy Technology Data Exchange (ETDEWEB)

Cho, Bong Hae; Jung, Yun Hoa [Pusan National Univ. College of Dentistry, Pusan (Korea, Republic of)

2007-12-15

To study the intra- and interobserver agreement of multidetector row computed tomography (MDCT) in interpretation of degenerative changes of the mandibular condyle. Five observers independently evaluated one hundred temporomandibular joint MDCT images for signs of osteophytes, erosion, sclerosis and flattening. The intra- and interobserve agreements were calculated by using Kappa statistics. The intraobserver agreement was substantial for erosion (k=0.75), flattening (k=0.74) and sclerosis (k=0.72) and almost perfect for osteophytes (k=0.84). The interobserver agreement was fair for flattening (k=0.39), moderate for erosion (k=0.58) and sclerosis (k=0.48) and substantial for osteophytes (k=0.75). This study shows that we can expert good agreement for the presence of osteophytes, but not for flattening in the interpretation of MDCT images of the condyle.

The Text of the Safeguards Transfer Agreement relating to the Bilateral Agreement between Pakistan and Canada

Energy Technology Data Exchange (ETDEWEB)

NONE

1969-11-13

The text of the Safeguard Transfer Agreement between Pakistan, Canada and the Agency relating to the agreement of 14 May 1959 between the two Governments for co-operation in the peaceful uses of atomic energy is reproduced in this document for the information of all Members.

The Text of a Safeguards Transfer Agreement relating to the Bilateral Agreement between France and Japan

International Nuclear Information System (INIS)

1973-01-01

The text of a Safeguards Transfer Agreement between the Agency, France and Japan relating to the agreement of 26 February 1972 between the two Governments for co-operation in the peaceful uses of nuclear energy is reproduced in this document for the information or all Members

The Text of the Safeguards Transfer Agreement relating to the Bilateral Agreement between Pakistan and Canada

International Nuclear Information System (INIS)

1969-01-01

The text of the Safeguard Transfer Agreement between Pakistan, Canada and the Agency relating to the agreement of 14 May 1959 between the two Governments for co-operation in the peaceful uses of atomic energy is reproduced in this document for the information of all Members

The Text of the Safeguards Transfer Agreement relating to the Bilateral Agreement between Canada and Japan

International Nuclear Information System (INIS)

1966-01-01

The text of the Safeguards Transfer Agreement between the Agency, Canada and Japan relating to the agreement between those Governments concerning co-operation in the promotion and development of the peaceful uses of atomic energy is reproduced in this document for the information of all Members

The Text of a Safeguards Transfer Agreement relating to the Bilateral Agreement between France and Japan

Energy Technology Data Exchange (ETDEWEB)

NONE

1973-01-31

The text of a Safeguards Transfer Agreement between the Agency, France and Japan relating to the agreement of 26 February 1972 between the two Governments for co-operation in the peaceful uses of nuclear energy is reproduced in this document for the information or all Members.

47 CFR 73.1650 - International agreements.

Science.gov (United States)

2010-10-01

... Agreements for the Broadcasting Service in Region 2: (i) MF Broadcasting 535-1605 kHz, Rio de Janeiro, 1981. (ii) MF Broadcasting 1605-1705 kHz, Rio de Janeiro, 1988. (3) Bi-lateral Agreements between the United...

Mitotic Figure Recognition: Agreement among Pathologists and Computerized Detector

Directory of Open Access Journals (Sweden)

Christopher Malon

2012-01-01

Full Text Available Despite the prognostic importance of mitotic count as one of the components of the Bloom – Richardson grade [3], several studies ([2, 9, 10] have found that pathologists’ agreement on the mitotic grade is fairly modest. Collecting a set of more than 4,200 candidate mitotic figures, we evaluate pathologists' agreement on individual figures, and train a computerized system for mitosis detection, comparing its performance to the classifications of three pathologists. The system’s and the pathologists’ classifications are based on evaluation of digital micrographs of hematoxylin and eosin stained breast tissue. On figures where the majority of pathologists agree on a classification, we compare the performance of the trained system to that of the individual pathologists. We find that the level of agreement of the pathologists ranges from slight to moderate, with strong biases, and that the system performs competitively in rating the ground truth set. This study is a step towards automatic mitosis count to accelerate a pathologist's work and improve reproducibility.

Effects of parallel planning on agreement production.

Science.gov (United States)

Veenstra, Alma; Meyer, Antje S; Acheson, Daniel J

2015-11-01

An important issue in current psycholinguistics is how the time course of utterance planning affects the generation of grammatical structures. The current study investigated the influence of parallel activation of the components of complex noun phrases on the generation of subject-verb agreement. Specifically, the lexical interference account (Gillespie & Pearlmutter, 2011b; Solomon & Pearlmutter, 2004) predicts more agreement errors (i.e., attraction) for subject phrases in which the head and local noun mismatch in number (e.g., the apple next to the pears) when nouns are planned in parallel than when they are planned in sequence. We used a speeded picture description task that yielded sentences such as the apple next to the pears is red. The objects mentioned in the noun phrase were either semantically related or unrelated. To induce agreement errors, pictures sometimes mismatched in number. In order to manipulate the likelihood of parallel processing of the objects and to test the hypothesized relationship between parallel processing and the rate of agreement errors, the pictures were either placed close together or far apart. Analyses of the participants' eye movements and speech onset latencies indicated slower processing of the first object and stronger interference from the related (compared to the unrelated) second object in the close than in the far condition. Analyses of the agreement errors yielded an attraction effect, with more errors in mismatching than in matching conditions. However, the magnitude of the attraction effect did not differ across the close and far conditions. Thus, spatial proximity encouraged parallel processing of the pictures, which led to interference of the associated conceptual and/or lexical representation, but, contrary to the prediction, it did not lead to more attraction errors. Copyright © 2015 Elsevier B.V. All rights reserved.

The text of the third agreement to extend the 1987 Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology (RCA). Extension of agreement

International Nuclear Information System (INIS)

2002-01-01

The text of the Third Agreement to Extend the 1987 Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology, 'the 1987 RCA', is reproduced herein for the information of all Members. Pursuant to Article 1 of the Third Agreement to Extend the 1987 Regional Co-operative Agreement, the 1987 RCA shall continue in force for a further period of five years with effect from 12 June 2002, i.e., through 11 June 2007. As of 15 May 2002, notifications of acceptance had been received by the Director General from the Governments of Bangladesh, China, India, Indonesia, Republic of Korea, Malaysia, Pakistan, Sri Lanka and Viet Nam. The latest status list is attached

Maturation of the middle phalanx of the third finger and cervical vertebrae: a comparative and diagnostic agreement study.

Science.gov (United States)

Perinetti, G; Perillo, L; Franchi, L; Di Lenarda, R; Contardo, L

2014-11-01

Diagnostic agreement on individual basis between the third middle phalanx maturation (MPM) method and the cervical vertebral maturation (CVM) method has conjecturally been based mainly on overall correlation analyses. Herein, the true agreement between methods according to stage and sex has been evaluated through a comprehensive diagnostic performance analysis. Four hundred and fifty-one Caucasian subjects were included in the study, 231 females and 220 males (mean age, 12.2 ± 2.5 years; range, 7.0-17.9 years). The X-rays of the middle phalanx of the third finger and the lateral cephalograms were examined for staging by blinded operators, blinded for MPM stages and subjects' age. The MPM and CVM methods based on six stages, two pre-pubertal (1 and 2), two pubertal (3 and 4), and two post-pubertal (5 and 6), were considered. Specifically, for each MPM stage, the diagnostic performance in the identification of the corresponding CVM stage was described by Bayesian statistics. For both sexes, overall agreement was 77.6%. Most of the disagreement was due to 1 stage apart. Slight disagreement was seen for the stages 5 and 6, where the third middle phalanx shows an earlier maturation. The two maturational methods show an overall satisfactorily diagnostic agreement. However, at post-pubertal stages, the middle phalanx of the third finger appears to mature earlier than the cervical vertebrae. Post-pubertal growth phase should thus be based on the presence of stage 6 in MPM. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Disagreements in meta-analyses using outcomes measured on continuous or rating scales: observer agreement study

DEFF Research Database (Denmark)

Tendal, Britta; Higgins, Julian P T; Jüni, Peter

2009-01-01

difference (SMD), the protocols for the reviews and the trial reports (n=45) were retrieved. DATA EXTRACTION: Five experienced methodologists and five PhD students independently extracted data from the trial reports for calculation of the first SMD result in each review. The observers did not have access...... to the reviews but to the protocols, where the relevant outcome was highlighted. The agreement was analysed at both trial and meta-analysis level, pairing the observers in all possible ways (45 pairs, yielding 2025 pairs of trials and 450 pairs of meta-analyses). Agreement was defined as SMDs that differed less...... than 0.1 in their point estimates or confidence intervals. RESULTS: The agreement was 53% at trial level and 31% at meta-analysis level. Including all pairs, the median disagreement was SMD=0.22 (interquartile range 0.07-0.61). The experts agreed somewhat more than the PhD students at trial level (61...

Power sales contract/energy supply agreements

International Nuclear Information System (INIS)

Wallace, R.B.

1999-01-01

The factors involved in negotiating power purchase/sales arrangements in Ontario's newly deregulated electricity market are described, and the ways in which they will evolve in the future are predicted. Indications are that the trends that will govern the changes in the electric power industry will be the same as those that existed in the natural gas industry. For this reason, a comparative evaluation of purchase and sale agreements in the two industries was provided. Traditional power purchase arrangements, including requests for proposals, the seller's response, the memorandum of understanding, and the principal terms of a traditional bilateral power purchase agreement were examined. The author predicted that over time, and probably fairly fast in power pool jurisdictions, the traditional power purchase agreement will give way to the concept of energy as a pure commodity and to a standard form of agreement. 1 appendix

14 CFR 372.24 - Surety bond, depository agreement, escrow agreement.

Science.gov (United States)

2010-01-01

... (2) which is listed in Best's Insurance Reports (fire and casualty) with a general policyholders... surety to any charter participant shall not exceed the charter operator's applicable tariff fare. Such... not exceed the charter operator's applicable tariff fare; and (ii) Enter into an agreement with a bank...

12 CFR 207.5 - Related agreements considered a single agreement.

Science.gov (United States)

2010-01-01

... RESERVE SYSTEM DISCLOSURE AND REPORTING OF CRA-RELATED AGREEMENTS (REGULATION G) § 207.5 Related... of the CRA. (b) Substantively related contracts. All written contracts to which an insured depository... each such contract is in fulfillment of the CRA, if the contracts were negotiated in a coordinated...

Identifying research priorities for patient safety in mental health: an international expert Delphi study

Science.gov (United States)

Murray, Kevin; Thibaut, Bethan; Ramtale, Sonny Christian; Adam, Sheila; Darzi, Ara; Archer, Stephanie

2018-01-01

Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health. Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements. Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included. Main outcome measures Agreement in research priorities on a five-point scale. Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important. Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this. PMID:29502096

7 CFR 3021.620 - Cooperative agreement.

Science.gov (United States)

2010-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Definitions § 3021.620 Cooperative agreement. Cooperative agreement means an award of financial assistance...

OPEC's response to international climate agreements

International Nuclear Information System (INIS)

Braaten, J.; Golombek, R.

1998-01-01

This paper studies a game between a group of countries that have agreed to participate in an international climate agreement (the signatories) and OPEC. The purpose of the signatories is to design carbon taxes that maximize their total net income, given a goal on global carbon emissions. As a response to the climate agreement, OPEC imposes an oil tax on its member states that maximizes OPEC's profits. Within a numerical model we find the subgame-perfect equilibrium of a game in which each player chooses when to fix his decision variables. It is shown that in equilibrium the group of signatories chooses to be the leader and OPEC chooses to be the follower. It is demonstrated, however, that for both agents the order of move is of minor (numerical) importance. Hence, the players have limited incentives for strategic behaviour. 17 refs

Production sharing agreements

International Nuclear Information System (INIS)

1994-01-01

This paper, which was presented at the Production Sharing Agreement seminar, discusses economic rent, negotiations, trends in fiscal system development, and concessionary systems. Production sharing contracts, risk service contracts, joint ventures and the global market are examined. (UK)

The Text of the Safeguards Transfer Agreement relating to the Bilateral Agreement between Denmark and the United Kingdom

International Nuclear Information System (INIS)

1965-01-01

The text of the Safeguards Transfer Agreement between the Agency, Denmark and the United Kingdom of Great Britain and Northern Ireland relating to the agreement between those Governments concerning co-operation in the promotion and development of the peaceful uses of atomic energy is reproduced in this document for the information of all Members. This Safeguards Transfer Agreement was signed and entered into force on 23 June 1965

The Text of the Safeguards Transfer Agreement relating to the Bilateral Agreement between Denmark and the United Kingdom

Energy Technology Data Exchange (ETDEWEB)

NONE

1965-07-23

The text of the Safeguards Transfer Agreement between the Agency, Denmark and the United Kingdom of Great Britain and Northern Ireland relating to the agreement between those Governments concerning co-operation in the promotion and development of the peaceful uses of atomic energy is reproduced in this document for the information of all Members. This Safeguards Transfer Agreement was signed and entered into force on 23 June 1965.

Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

Science.gov (United States)

Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

2014-11-08

Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring

48 CFR 18.118 - Trade agreements.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Trade agreements. 18.118 Section 18.118 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES EMERGENCY ACQUISITIONS Available Acquisition Flexibilities 18.118 Trade agreements...

75 FR 37438 - Minnesota Rural Health Cooperative; Analysis of the Agreement Containing Consent Order to Aid...

Science.gov (United States)

2010-06-29

... benefit consumers; and (2) the price agreements are reasonably necessary to realize those efficiencies... behavior, none of the programs creates enforceable obligations for physicians to improve their clinical... engage in them on its own without any involvement from the other clinics. Finally, the challenged conduct...

42 CFR 137.78 - May a Self-Governance Tribe negotiate a funding agreement for a term longer or shorter than one...

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May a Self-Governance Tribe negotiate a funding agreement for a term longer or shorter than one year? 137.78 Section 137.78 Public Health PUBLIC HEALTH... SERVICES TRIBAL SELF-GOVERNANCE Funding General § 137.78 May a Self-Governance Tribe negotiate a funding...

A framework for nuclear agreement and verification

International Nuclear Information System (INIS)

Ali, A.

1991-01-01

This chapter assesses the prospects for a nuclear agreement between India and Pakistan. The chapter opens with a review of past and present political environments of the two countries. The discussion proceeds to describe the linkage of global arms control agreements, prospects for verification of a Comprehensive Test Ban Treaty, the role of nuclear power in any agreements, the intrusiveness of verification, and possible post-proliferation agreements. Various monitoring and verification technologies are described (mainly satellite oriented). The chapter concludes with an analysis of the likelihood of persuading India and Pakistan to agree to a nonproliferation arrangement

European Union's public fishing access agreements in developing countries

OpenAIRE

Le Manach, F.; Chaboud, Christian; Copeland, D.; Cury, Philippe; Gascuel, D.; Kleisner, K.M.; Standing, A.; Sumaila, U.R.; Zeller, D.; Pauly, D.

2013-01-01

The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU) and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreem...

FFTF Authorization Agreement

International Nuclear Information System (INIS)

DAUTEL, W.A.

2000-01-01

The purpose of the Authorization Agreement is to serve as a mechanism whereby the U.S. Department of Energy, Richland Operations Office (RL) and Fluor Hanford (FH) jointly clarify and agree to key conditions for conducting work safely and efficiently