WorldWideScience

Sample records for legislative update clinical

  1. Legislative update.

    Science.gov (United States)

    1999-07-23

    Recent State legislation on HIV-related issues is summarized. Connecticut enacted a bill imposing penalties when public servants and health care workers are deliberately exposed to body fluids. Louisiana passed a bill mandating HIV testing for each incoming State prison inmate. New York has several bills under consideration related to guardianship, confidentiality of crime victims who are potentially exposed to HIV, and disability benefits for firefighters and police officers who contract HIV, tuberculosis, or hepatitis in the line of duty. North Carolina has a new law aimed at serving additional clients in the State=s AIDS drug assistance program. Oregon is working on a bill authorizing HIV testing for all defendants who may have transmitted body fluids to a crime victim.

  2. Acid rain legislation update

    International Nuclear Information System (INIS)

    Storey, H.L.

    1990-01-01

    This paper presents the author's view that the coal industry should develop a strategy to respond to the global warming issue. A few weeks ago a speaker stated that the global warming issue placed coal at the crossroads. He stated that global warming legislation, could reduce the consumption of coal by approximately twenty-five percent, without global warming legislation coal would continue to grow at a approximately three percent per year. It is believed there is a path to be traveled between the two options, legislation or no legislation, that can result in coal obtaining the position as the primary fuel source for electrical generating throughout the world. This is a path the coal industry can define and should follow

  3. Regulatory, legislative, and policy updates with anticoagulant use.

    Science.gov (United States)

    Fanikos, John; Buckley, Leo F; Aldemerdash, Ahmed; Terry, Kimberly J; Piazza, Gregory; Connors, Jean M; Goldhaber, Samuel Z

    2015-04-01

    Thromboembolism afflicts millions of patients annually in the United States and is associated with a significant cost burden. Recent advances in oral anticoagulation have provided clinicians with more options for management of these diseases. Accordingly, regulatory, legislative, and policy-making organizations have intervened with the aim of improving patient outcomes, ensuring patient safety, and reducing costs. There have been a number of recent developments in surveillance, litigation, and regulatory oversight that clinicians should recognize. In this review article we summarize key updates related to the management of anticoagulant therapy as it relates to thrombosis prevention and treatment.

  4. Scabies: A clinical update.

    Science.gov (United States)

    Hardy, Myra; Engelman, Daniel; Steer, Andrew

    2017-01-01

    Scabies is a common, yet neglected, skin disease. Scabies occurs across Australia, but most frequently in socioeconomically disadvantaged populations in tropical regions, including in remote Aboriginal and Torres Strait Islander communities. In temperate settings, the disease clusters in institutional care facilities. The objective of this article is to provide updates on the clinical diagnosis and treatment approaches for scabies in Australia. Clinical examination remains the mainstay of diagnosis, although dermatoscopy is a useful adjunct. Scabies presents with severe itch and a papular rash, with a predilection for the hands, feet and genitalia. The distribution may be more widespread in infants and older people. Secondary bacterial infection is also common in patients with scabies. Crusted scabies is a rare but highly infectious variant. Topical permethrin is highly effective for individual treatment, but less practical for treatment of asymptomatic contacts and control of outbreaks. Oral ivermectin is a safe and effective alternative, and is now listed on the Pharmaceutical Benefits Scheme as a third-line treatment.

  5. A 1992 update on legislation and regulations affecting power generation

    International Nuclear Information System (INIS)

    Schorr, M.M.

    1992-01-01

    This paper discusses the major energy and related environmental legislation and regulations affecting power generation and recent developments in these areas, including: The growth of non-utility electricity generation under the Public Utility Regulatory Policies Act (PURPA); The Clean Air Act and the Amendments of 1990 (CAAA); Proposed legislation to implement the National Energy Strategy (NES); The EPA WEPCO decision, the Court of Appeals ruling on the EPA decision and attempts at a 'WEPCO Fix' in both legislation (NES) and new EPA regulations. 16 refs

  6. VIIP 2017 Clinical Update

    Science.gov (United States)

    Tarver, William

    2017-01-01

    INTRODUCTION: NASA's Space Medicine community knowledge regarding the "Vision Impairment Intracranial Pressure", or VIIP.has been evolving over time.. Various measures of occupational health related to this condition had to be determined and then plans/processes put into place. The most robust of these processes were inititated in 2010. This presentation will provide a clinic update of the astronaut occupational health data related to VIIP. METHODS: NASA and its international partners require its astronauts to undergo routine health measures deemed important to monitoring VIIP. The concern is that the spaceflight environment aboard ISS could cause some astronauts to have physiologic changes detrimental to either ongoing mission operations or long-term health related to the ocular system and possibly the CNS. Specific medical tests include but are not limited to brain/orbit MRI (NASA unique protocol), OCT, fundoscopy and ocular ultrasound. Measures are taken prior to spaceflight, in-flight and post-flight. Measures to be reported include incidence of disc edema, globe flattening, choroidal folds, ONSD and change in refractive error. RESULTS: 73 ISS astronauts have been evaluated at least partially for VIIP related measures. Of these individuals, approximately 1 in 7 have experienced disc edema. The prevalence of the other findings is more complicated as the medical testing has changed over time. Overall, 26 separate individuals have experienced at least one of the findings NASA has associated with VIIP Another confounding factor is most of the astronauts have prior spaceflight experience at the time of the "pre-flight" testing. DISCUSSION: In 2010 NASA and its US operating segment (USOS) partners (CSA, ESA and JAXA) began routine occupational monitoring and data collection for most VIIP related changes. Interpretation of that data is extremely challenging for several reasons. For example, the determination of disc edema is the most complete finding as we have had

  7. Hypokalemia: a clinical update

    Directory of Open Access Journals (Sweden)

    Efstratios Kardalas

    2018-04-01

    Full Text Available Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalemia requires urgent medical attention. The aim of this review is to present updated information regarding: (1 the definition and prevalence of hypokalemia, (2 the physiology of potassium homeostasis, (3 the various causes leading to hypokalemia, (4 the diagnostic steps for the assessment of hypokalemia and (5 the appropriate treatment of hypokalemia depending on the cause. Practical algorithms for the optimal diagnostic, treatment and follow-up strategy are presented, while an individualized approach is emphasized.

  8. [Disability leave and sick leave in Spain. 2016 legislative update].

    Science.gov (United States)

    Vicente-Herrero, María Teófila; Terradillos-García, María Jesús; Capdevila-García, Luisa M; Ramírez-Íñiguez de la Torre, María Victoria; Aguilar-Jiménez, Encarna; Aguado-Benedí, María José; López-González, Angel Arturo; Torres-Alberich, José Ignacio

    2018-01-01

    In Spanish, the concepts of discapacidad (disability leave) and incapacidad (sick leave) jointly refer to the impairment of a person due to injuries, diseases or deficiencies that limit their activity in a social, personal or occupational field. However, this common link does not imply that both concepts are the same. Statistical data from INE (Instituto Nacional de Estadística: Statistic National Institute) show that Spain had in 2015 3.85 million persons with a disability (59.8% were women). Statistical data from 2015 from INSS (Instituto Nacional de Seguridad Social: Social Security National Institute) show high levels in the number of processes and in workers affected by temporary sick leave, with social costs to the social security system. Both concepts have been updated: about disability leave, Law 39/2006 adjusted terminology by avoiding the use of concepts with discriminating or pejorative connotation. Regarding sick leave, the Ley General de Seguridad Social (General Social Security Law)has been amended and came into effect in January, 2016. It is necessary to know and distinguish these aspects for a better administrative management, and a more oriented information to the affected patient.

  9. How to be Cautious but Open to Learning: Time to Update Biotechnology and GMO Legislation.

    Science.gov (United States)

    Hansson, Sven Ove

    2016-08-01

    Precautionary measures to protect human health and the environment should be science based. This implies that they should be directed at a potential danger for which there is credible scientific evidence (although that evidence need not be conclusive). Furthermore, protective measures should be updated as relevant science advances. This means that decisionmakers should be prepared to strengthen the precautionary measures if the danger turns out to be greater than initially suspected, and to reduce or lift them, should the danger prove to be smaller. Most current legislation on agricultural biotechnology has not been scientifically updated. Therefore, it reflects outdated criteria for identifying products that can cause problems. Modern knowledge in genetics, plant biology, and ecology has provided us with much better criteria that risk analysts can use to identify the potentially problematic breeding projects at which precautionary measures should be directed. Legislation on agricultural biotechnology should be scientifically updated. Furthermore, legislators should learn from this example that regulations based on the current state of science need to have inbuilt mechanisms for revisions and adjustments in response to future developments in science. © 2016 Society for Risk Analysis.

  10. Legislation

    International Nuclear Information System (INIS)

    2002-01-01

    This bulletin contains information about activities of the Nuclear Regulatory Authority of the Slovak Republic (UJD). In this leaflet the legislation activities of the UJD are presented. The Nuclear Regulatory Authority (UJD) of the Slovak Republic, as the central body, performs legislative activities within its competence and defines binding criteria in the area of nuclear safety. In the area of nuclear safety the Act No.130/1998 Coll. 'on peaceful use of nuclear energy' (Atomic Act) is the principal document which came into force on July 1, 1998. Based on the Atomic Act UJD issued decrees on special materials and installations, limits for maximum quantities of nuclear materials at which nuclear damage is not presumed. Furthermore, the regulations are issued which deal with provision of physical protection of nuclear material and radioactive waste, professional ability of employees at nuclear installations, registration and control of nuclear materials, emergency planning for the case of an incident or an events on nuclear installations at their decommissioning, transportation of nuclear materials and radioactive waste. Simultaneously, other 6 regulations are just before the before the completion and they are in various stages of the of the legislative process. In addition, UJD performs remarkable activities in legislative area by preparation of comments to drafts of other relating generally binding legal provisions of the Slovak Republic. UJD also acts as the participant of the review procedure in the area of technical standards and publication. UJD also issues documents which have character of the recommendations, so called safety guides. These guides contain methods and approach how to meet safety requirements presented in binding documents, as acts and decrees. In accordance with the Atomic act it is possible to use nuclear energy or make business in the area of nuclear energy only the basis of the authorisation issued by UJD. Authorisations are following

  11. Vasectomy reversal: a clinical update

    Directory of Open Access Journals (Sweden)

    Abhishek P Patel

    2016-01-01

    Full Text Available Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

  12. Stuttering: Clinical and research update.

    Science.gov (United States)

    Perez, Hector R; Stoeckle, James H

    2016-06-01

    To provide an update on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. The MEDLINE and Cochrane databases were searched for past and recent studies on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. Most recommendations are based on small studies, limited-quality evidence, or consensus. Stuttering is a speech disorder, common in persons of all ages, that affects normal fluency and time patterning of speech. Stuttering has been associated with differences in brain anatomy, functioning, and dopamine regulation thought to be due to genetic causes. Attention to making a correct diagnosis or referral in children is important because there is growing consensus that early intervention with speech therapy for children who stutter is critical. For adults, stuttering can be associated with substantial psychosocial morbidity including social anxiety and low quality of life. Pharmacologic treatment has received attention in recent years, but clinical evidence is limited. The mainstay of treatment for children and adults remains speech therapy. A growing body of research has attempted to uncover the pathophysiology of stuttering. Referral for speech therapy remains the best option for children and adults. Copyright© the College of Family Physicians of Canada.

  13. Clinical update on contact allergy

    DEFF Research Database (Denmark)

    Uter, Wolfgang; Johansen, Jeanne Duus; Orton, David I

    2005-01-01

    PURPOSE OF REVIEW: The aim of this article is to review recent findings in contact allergy, regarding clinical research. RECENT FINDINGS: The biocide methyldibromo glutaronitrile was identified to be an important sensitizer. Subsequently, it was banned from leave-on cosmetics in the European Union...... studies have demonstrated broad individual variation of elicitation thresholds, dependent on the allergen concentration during induction, and other factors. Some unsuspected routes of exposure to allergens include oral, inhalational, connubial or airborne contact. Experimental studies provide...

  14. Clinical applications of immunoglobulin: update

    Directory of Open Access Journals (Sweden)

    Marcia Cristina Zago Novaretti

    2011-06-01

    Full Text Available Human immunoglobulin is the most used blood product in the clinical practice. Immunoglobulin applications have increased quickly since the elucidation of its immunomodulatory and antiinflammatory properties which turned this blood product into a precious tool in the treatment of numerous diseases that present with humoral immune deficiency or that cause immune system dysfunction. Currently, the approved indications for Ig are: primary immunodeficiencies, secondary immunodeficiencies (multiple myeloma or chronic lymphoid leukemia, Kawasaki syndrome, immune thrombocytopenic purpura, Guillain Barré syndrome, graft-versus-host disease following bone marrow transplantation and repeat infections in HIV children. On the other hand, there are numerous "off-label" indications of immunoglobulin, which represent 20-60% of all clinical applications of this drug. It is important to study all these indications and, above all, the scientific evidence for its use, in order to provide patients with a new therapeutic option without burdening the health system. This review results from a wide selection of papers identified in the Pubmed and Lilacs scientific electronic databases. A group of descriptors were used from human immunoglobulin to the names of each disease that immunoglobulin is clinically applied. Our main objective is to list the numerous indications of immunoglobulin, both authorized and "off-label" and to analyze these indications in the light of the most recent scientific evidence.

  15. Clinical update on contact allergy

    DEFF Research Database (Denmark)

    Uter, Wolfgang; Johansen, Jeanne Duus; Orton, David I

    2005-01-01

    PURPOSE OF REVIEW: The aim of this article is to review recent findings in contact allergy, regarding clinical research. RECENT FINDINGS: The biocide methyldibromo glutaronitrile was identified to be an important sensitizer. Subsequently, it was banned from leave-on cosmetics in the European Union......, and cutting fluid components. SUMMARY: Constant awareness for new allergens, confirmed by critical evaluation, standardization of patch test materials, and the identification of temporal patterns and subgroups at risk will improve both the diagnosis and prevention of allergic contact dermatitis....

  16. Gestational diabetes: A clinical update

    DEFF Research Database (Denmark)

    Kampmann, Ulla; Madsen, Lene Ring; Skajaa, Gitte Oeskov

    2015-01-01

    Gestational diabetes mellitus (GDM) is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance...... an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring....... of clarity and consensus. If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes. This review provides...

  17. Marfan Syndrome: A Clinical Update.

    Science.gov (United States)

    Bitterman, Adam D; Sponseller, Paul D

    2017-09-01

    Marfan syndrome is a connective tissue disorder that can affect many organ systems. Affected patients present with orthopaedic manifestations of the syndrome during all phases of life. Pain caused by musculoskeletal abnormalities often requires definitive orthopaedic treatment. Orthopaedic surgeons must understand the phenotypes of Marfan syndrome so they can recognize when screening is warranted and can appropriately address the skeletal manifestations. Through medical advancements, patients with Marfan syndrome are living longer and more active lives. Knowledge of the latest diagnostic criteria for the disorder, as well as of advances in understanding the skeletal phenotype, clinical trials of medication therapy, and lifestyle considerations is important for orthopaedic surgeons who treat these patients because these clinicians often are the first to suspect Marfan syndrome and recommend screening.

  18. Clinical update on scorpion envenoming

    Directory of Open Access Journals (Sweden)

    Palmira Cupo

    2015-12-01

    Full Text Available Abstract: Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.

  19. Clinical update on metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Juan Diego Hernández-Camacho

    2017-12-01

    Full Text Available Metabolic syndrome has been defined as a global issue since it affects a lot of people. Numerous factors are involved in metabolic syndrome development. It has been described that metabolic syndrome has negative consequences on health. Consequently, a lot of treatments have been proposed to palliate it such as drugs, surgery or life style changes where nutritional habits have shown to be an important point in its management. The current study reviews the literature existing about the actual epidemiology of metabolic syndrome, the components involucrate in its appearance and progression, the clinical consequences of metabolic syndrome and the nutritional strategies reported in its remission. A bibliographic search in PubMed and Medline was performed to identify eligible studies. Authors obtained that metabolic syndrome is present in population from developed and undeveloped areas in a huge scale. Environmental and genetic elements are involucrate in metabolic syndrome development. Metabolic syndrome exponentially increased risk of cardiovascular disease, some types of cancers, diabetes mellitus type 2, sleep disturbances, etc. Nutritional treatments play a crucial role in metabolic syndrome prevention, treatment and recovery.

  20. UPDATING RUSSIAN FRANCHISING LEGISLATIVE CONTROL IN SERVICE SECTORS WITH DUE ACCOUNT OF FOREIGN EXPERIENCE

    OpenAIRE

    M. I. Kolinchenko

    2012-01-01

    Insufficient use of franchising is one of the major factors hampering the development of services in Russia. Main problems of franchising in Russia concentrate currently in the legislative and legal spheres. There is no specific law on franchising in the domestic legislation system. Russia is substantially behind the U.S. and Europe, so far as laws and operating practices related to franchising are concerned. Urgent adjustments are needed for current legislation in Russia, first of all to bri...

  1. Update in clinical allergy and immunology.

    Science.gov (United States)

    von Gunten, S; Marsland, B J; von Garnier, C; Simon, D

    2012-12-01

    In the recent years, a tremendous body of studies has addressed a broad variety of distinct topics in clinical allergy and immunology. In this update, we discuss selected recent data that provide clinically and pathogenetically relevant insights or identify potential novel targets and strategies for therapy. The role of the microbiome in shaping allergic immune responses and molecular, as well as cellular mechanisms of disease, is discussed separately and in the context of atopic dermatitis, as an allergic model disease. Besides summarizing novel evidence, this update highlights current areas of uncertainties and debates that, as we hope, shall stimulate scientific discussions and research activities in the field. © 2012 John Wiley & Sons A/S.

  2. UPDATING RUSSIAN FRANCHISING LEGISLATIVE CONTROL IN SERVICE SECTORS WITH DUE ACCOUNT OF FOREIGN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    M. I. Kolinchenko

    2012-01-01

    Full Text Available Insufficient use of franchising is one of the major factors hampering the development of services in Russia. Main problems of franchising in Russia concentrate currently in the legislative and legal spheres. There is no specific law on franchising in the domestic legislation system. Russia is substantially behind the U.S. and Europe, so far as laws and operating practices related to franchising are concerned. Urgent adjustments are needed for current legislation in Russia, first of all to bring it in line with accepted standards of franchising in the West, particularly relating to theprotection of franchisers and franchisee.

  3. A descriptive analysis of state legislation and policy addressing clinical trials participation.

    Science.gov (United States)

    Baquet, Claudia R; Mishra, Shiraz I; Weinberg, Armin D

    2009-05-01

    This report describes state policy and legislation related to clinical trials participation and Maryland's model to enhance clinical trial availability and participation. Descriptive review of state policy and legislation related to coverage for clinical trials costs based on data from the National Cancer Institute (NCI) State Cancer Legislative Database, the American Cancer Society, and NCI; additionally, discussion of Maryland's comprehensive multilevel clinical trial model comprising policy initiatives, community engagement, research, education, and infrastructure support. Twenty-four states have mandated clinical trial coverage through specific legislation or agreements since 1994. Covered benefits varied among the states. Besides cost and insurance barriers, there is a need to address important patient, physician and researcher, and structural barriers to clinical trial participation. Maryland provides a comprehensive model to address the multi-faceted clinical trial participation determinants as it tracks state and federal policy, documents trial barriers, and conducts community education.

  4. Firearm-assisted suicide: legislative, policing and clinical concerns.

    Science.gov (United States)

    Sarma, Kiran; Griffin, Diarmuid; Kola, Susanna

    2010-01-01

    Until recent years the Republic of Ireland had one of the most restrictive regimes on firearms access with the Irish police (An Garda Siochana) consistently refusing to grant certificates for a wide range of guns including handguns, high calibre rifles and shotguns capable of holding more than three cartridges. In 2004 the High Court ruled that this policy was without legislative backing and since then the police began to issue certificates for firearms where the applicant is not disentitled under law from possessing a gun. Set against this backdrop, this paper explores the consequences of liberal gun regimes in the context of access to firearms by those suffering from mental illness and who pose a threat of parasuicide or suicide. Consideration is given to experiences in other jurisdictions and international research on firearm suicide prevention. Finally some recommendations for changes in legislation, policy and protocol in the Irish context are presented. 2009 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  5. Update on the Vienna Protocol and CSC: issues of implementation and application in national legislation

    International Nuclear Information System (INIS)

    Horbach, N. l. J. T.

    2000-01-01

    This paper aims to reflect the recent developments in respect of the 1997 Vienna Protocol (VP) and the 1997 Convention on Supplementary Compensation (CSC), i.e. the changes in signatories and ratificiations of both instruments, and the impacts these will have upon the geographical scope of nuclear liability laws of those countries covered or linked to each other within the international nuclear liability regime. To the extent that certain countries have ratified either the VP or the CSC, it is important to analyse their existing nuclear liability legislation and the manner in which it already implements or aims to implement certain crucial new elements introduced by both instruments, such as, the liability limitation in time and amount, the extension of the geographical scope to damage wherever suffered as well as in the EEZ, the extension of the definition of nuclear damage and preventive measures, and finally, the deletion of some of the exoneration of the operatos's liability. In this context, especially the concept of nuclear environmental damage and the extent to which it is currently covered by existing nuclear liability legislation or, possibly, environmental law, will be given some special attention. Finally, the paper will focus on various aspects of the implementation and application of these new elements of both 1997 instruments within some CEEC's nuclear liability regimes as an example to identify those issues that will produce special problems (e.g., administrative, legal, insurance, or political) or necessitate additional legislative efforts in respect of their implementation in national laws. (author)

  6. The Voices for Healthy Kids and State Legislation to Prevent Childhood Obesity: An Update.

    Science.gov (United States)

    Bleich, Sara N; Jones-Smith, Jesse C; Walters, Hannah J; Rutkow, Lainie

    2018-04-09

    The purpose of this study is to examine general time trends in childhood obesity legislative activity in all 50 states (overall and by health equity focus) and whether the Voices for Healthy Kids Campaign (Voices) was associated with increased legislative activity. LexisNexis State Capital was used to identify bills related to childhood obesity from 2012 to 2016. Linear and linear probability models were used to assess general time trends and regression-based difference-in-difference models to assess whether time trends differed for states that received a Voices grant. The data were analyzed in 2017. A total of 989 bills were introduced (Year 1=304, Year 2=364; Year 3=321), and a total of 93 bills were enacted (Year 1=34, Year 2=24, Year 3=35) after baseline. The mean number of bills introduced (baseline=4.3, Year 1=6.6, Year 2=7.3, Year 3=7.0, p=0.007), and the average state enactment rate (baseline=11%, Year 1=16%, Year 2=8%, Year 3=27%, p-trend=0.02) increased significantly. States with Voices grantees introduced 2.1 more bills than non-grantee states (p=0.04). The estimated difference over time in bill enactment and health equity focus did not differ by Voices grantee status. Childhood obesity bill introduction and enactment increased between 2013 and 2016. The evidence-based advocacy supported by Voices appears to be significantly associated with greater increases in state-level bill introduction, but not enactment of legislation to address childhood obesity. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  7. The Impact of Reproductive Health Legislation on Family Planning Clinic Services in Texas

    Science.gov (United States)

    Hopkins, Kristine; Aiken, Abigail R. A.; Stevenson, Amanda; Hubert, Celia; Grossman, Daniel; Potter, Joseph E.

    2015-01-01

    We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state’s family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012–2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services. PMID:25790404

  8. A clinical update on paediatric lupus

    African Journals Online (AJOL)

    Keywords were the following: Systemic Lupus Erythematosus; SLE;. Children; Update ... Systemic lupus erythematosus in children is a life-threatening chronic disease that is being increasingly recognised. More black African children .... oral corticosteroids in conjunction with disease-modifying agents as discussed above.

  9. Legislative update: United States

    International Nuclear Information System (INIS)

    Anon.

    2007-01-01

    The US Senate consented to the ratification of the Convention on Supplementary Compensation for Nuclear Damage (CSC) on 4 August 2006. The entry into force of the Convention on Supplementary Compensation will substantially change the face of the international nuclear liability regime. The CSC is a free-standing instrument, open to all states. This means that countries can become party to a new global regime providing for liability and compensation for victims of a nuclear incident, without also having to become a contracting party to the Paris Convention or the Vienna Convention. This is certainly a major step forward given that at the present time, over half of the world's reactors in operation or under construction are not covered by any of the international nuclear third party liability conventions. The CSC creates an instrument by which states can ensure that more money will be made available to compensate more victims for a broader range of damage than ever before. The CSC provides for two tiers of compensation. The first tier, fixed at 300 million Special Drawing Rights, is to be provided by the liable operator. This tier is to be distributed on a non-discriminatory basis to victims both inside and outside of the Installation State. If 300 million SDRs are insufficient to compensate all damage, then contracting parties will be required to contribute to the second tier (the international fund). The amount of this second tier is not fixed, but rather will depend on the number of operating nuclear power plants in contracting parties, and is designed to increase as the number of such plants increases

  10. THERAPIES FOR CROHN'S DISEASE: a clinical update

    Directory of Open Access Journals (Sweden)

    Carlos Walter SOBRADO

    Full Text Available ABSTRACT The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

  11. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.

    Science.gov (United States)

    Bhattacharyya, Neil; Gubbels, Samuel P; Schwartz, Seth R; Edlow, Jonathan A; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard; Seidman, Michael D; Prasaad Steiner, Robert W; Tsai Do, Betty; Voelker, Courtney C J; Waguespack, Richard W; Corrigan, Maureen D

    2017-03-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

  12. Mental health legislation in Lebanon: Nonconformity to international standards and clinical dilemmas in psychiatric practice.

    Science.gov (United States)

    Kerbage, Hala; El Chammay, Rabih; Richa, Sami

    2016-01-01

    Mental health legislation represents an important mean of protecting the rights of persons with mental disabilities by preventing human rights violations and discrimination and by legally reinforcing the objectives of a mental health policy. The last decade has seen significant changes in the laws relating to psychiatric practice all over the world, especially with the implementation of the Convention for the Rights of People with Disabilities (CRPD). In this paper, we review the existing legislation in Lebanon concerning the following areas in mental health: treatment and legal protection of persons with mental disabilities, criminal laws in relation to offenders with mental disorders, and laws regulating incapacity. We will discuss these texts in comparison with international recommendations and standards on the rights of persons with disabilities, showing the recurrent contradiction between them. Throughout our article, we will address the clinical dilemmas that Lebanese psychiatrists encounter in practice, in the absence of a clear legislation that can orient their decisions and protect their patients from abuse. Copyright © 2015. Published by Elsevier Ltd.

  13. Pediatric Oxygen Therapy: A Clinical Update.

    Science.gov (United States)

    Haque, Anwarul; Rizvi, Munaza; Arif, Fehmina

    2016-01-01

    Oxygen therapy is a life-saving, medical intervention in the management of hospitalized children. The goal of oxygen therapy is to prevent or treat tissue hypoxia. Oxygen should be prescribed according to the principles of drug prescription, however, use of oxygen in clinical practice is often inappropriate without knowledge of its potential risks and benefits. This article summarizes practical aspects of clinical use of oxygen in terms of indication, administration, and monitoring, weaning, discontinuation and oxygen toxicity to rationalize therapy and achieve maximum benefits.

  14. A clinical update on paediatric lupus

    African Journals Online (AJOL)

    proteins in the cell nucleus. Recent evidence is emerging to illustrate the intertwined roles of the adaptive and innate immune system in this disease, and type 1 interferon has been shown to play a prominent role in the development of SLE.[8]. What diagnostic criteria exist? SLE is diagnosed clinically and in the laboratory.

  15. SnET2: clinical update

    Science.gov (United States)

    Razum, Nicholas J.; Snyder, Albert B.; Doiron, Daniel R.

    1996-04-01

    Tin Ethyl Etiopurpurin, SnET2, is a synthetic chlorin analog presently in Phase-II/III clinical trials for the treatment of cutaneous cancers. Trials to date include the treatment of basal cell carcinomas, squamous cell carcinomas, breast adenocarcinomas metastatic to the chest wall and cutaneous Kaposi's sarcomas in AIDS patients. Results to date have shown significant clinical responses for drug doses between 1.0 mg/kg and 1.6 mg/kg, with the threshold for Kaposi's sarcoma being slightly higher than in other indications. Light doses from 100 J/cm2 to 300 J/cm2 were delivered from 24 to 72 hours post SnET2 infusion. Induced transient skin photosensitivity at the lower therapeutic doses has been mild, lasting approximately a week. Results of the Phase I and II trials are presented.

  16. Biosensors in clinical chemistry - 2011 update.

    Science.gov (United States)

    D'Orazio, Paul

    2011-09-18

    Research activity and applications of biosensors for measurement of analytes of clinical interest over the last eight years are reviewed. Nanotechnology has been applied to improve performance of biosensors using electrochemical, optical, mechanical and physical modes of transduction, and to allow arrays of biosensors to be constructed for parallel sensing. Biosensors have been proposed for measurement of cancer biomarkers, cardiac biomarkers as well as biomarkers for autoimmune disease, infectious disease and for DNA analysis. Novel applications of biosensors include measurements in alternate sample types, such as saliva. Biosensors based on immobilized whole cells have found new applications, for example to detect the presence of cancer and to monitor the response of cancer cells to chemotherapeutic agents. The number of research reports describing new biosensors for analytes of clinical interest continues to increase; however, movement of biosensors from the research laboratory to the clinical laboratory has been slow. The greatest impact of biosensors will be felt at point-of-care testing locations without laboratory support. Integration of biosensors into reliable, easy-to-use and rugged instrumentation will be required to assure success of biosensor-based systems at the point-of-care. Copyright © 2011 Elsevier B.V. All rights reserved.

  17. PRP and Articular Cartilage: A Clinical Update

    Directory of Open Access Journals (Sweden)

    Antonio Marmotti

    2015-01-01

    Full Text Available The convincing background of the recent studies, investigating the different potentials of platelet-rich plasma, offers the clinician an appealing alternative for the treatment of cartilage lesions and osteoarthritis. Recent evidences in literature have shown that PRP may be helpful both as an adjuvant for surgical treatment of cartilage defects and as a therapeutic tool by intra-articular injection in patients affected by osteoarthritis. In this review, the authors introduce the trophic and anti-inflammatory properties of PRP and the different products of the available platelet concentrates. Then, in a complex scenario made of a great number of clinical variables, they resume the current literature on the PRP applications in cartilage surgery as well as the use of intra-articular PRP injections for the conservative treatment of cartilage degenerative lesions and osteoarthritis in humans, available as both case series and comparative studies. The result of this review confirms the fascinating biological role of PRP, although many aspects yet remain to be clarified and the use of PRP in a clinical setting has to be considered still exploratory.

  18. Management of ulcerative colitis: a clinical update

    Directory of Open Access Journals (Sweden)

    Fabio Vieira Teixeira

    2015-10-01

    Full Text Available The objective of this study was to evaluate the consensus of expert societies and published guidelines on the management of ulcerative colitis, and to compare with the experience of the authors, in order to standardize procedures that would help the reasoning and decision-making process of the physician. A search was performed in scientific literature, specifically in electronic databases: Medline/Pubmed, SciELO, EMBASE and Cochrane, and the following descriptors were used: ulcerative colitis, acute colitis, clinical treatment, surgery and randomized trial. It can be concluded that the goals of therapy in ulcerative colitis are clinical and endoscopic remission, deep, sustained remission without corticosteroids, prevention of hospitalizations and surgeries, and improved quality of life. The surgical indications are reserved for selected cases, ranging from medical intractability, complications (severe refractory acute colitis, toxic megacolon, perforation and hemorrhage and malignancy. Information in this review article must be submitted to evaluation and criticism of the specialist responsible for the conduct to be followed, in the face of his/her reality and the clinical status of each patient.The degree of recommendation and strength of evidence were based using the GRADE system (The Grades of Recommendation, Assessment, Development, and Evaluation described below:1. A: Experimental or observational studies of higher consistency.2. B: Experimental or observational studies of lower consistency.3. C: Case reports (non-controlled studies.4. D: Opinion without critical evaluation, based on consensus, physiological studies or animal models. Resumo: O objetivo deste trabalho foi avaliar os consensos de sociedades de especialistas e guidelines publicados sobre o manejo da retocolite ulcerativa, e confrontar com a experiência dos autores, a fim de padronizar condutas que auxiliem o raciocínio e a tomada de decisão do médico. Foi realizada busca

  19. Validation, updating and impact of clinical prediction rules: a review.

    Science.gov (United States)

    Toll, D B; Janssen, K J M; Vergouwe, Y; Moons, K G M

    2008-11-01

    To provide an overview of the research steps that need to follow the development of diagnostic or prognostic prediction rules. These steps include validity assessment, updating (if necessary), and impact assessment of clinical prediction rules. Narrative review covering methodological and empirical prediction studies from primary and secondary care. In general, three types of validation of previously developed prediction rules can be distinguished: temporal, geographical, and domain validations. In case of poor validation, the validation data can be used to update or adjust the previously developed prediction rule to the new circumstances. These update methods differ in extensiveness, with the easiest method a change in model intercept to the outcome occurrence at hand. Prediction rules -- with or without updating -- showing good performance in (various) validation studies may subsequently be subjected to an impact study, to demonstrate whether they change physicians' decisions, improve clinically relevant process parameters, patient outcome, or reduce costs. Finally, whether a prediction rule is implemented successfully in clinical practice depends on several potential barriers to the use of the rule. The development of a diagnostic or prognostic prediction rule is just a first step. We reviewed important aspects of the subsequent steps in prediction research.

  20. Methylmalonic and Propionic Acidemias: Clinical Management Update

    Science.gov (United States)

    Fraser, Jamie L.; Venditti, Charles P.

    2017-01-01

    Purpose of review Recent clinical studies and management guidelines for the treatment of the organic acidopathies methylmalonic acidemia (MMA) and propionic acidemia (PA) address the scope of interventions to maximize health and quality of life. Unfortunately, these disorders continue to cause significant morbidity and mortality due to acute and chronic systemic and end-organ injury. Recent findings Dietary management with medical foods has been a mainstay of therapy for decades, yet well controlled patients can manifest growth, development, cardiac, ophthalmological, renal and neurological complications. Patients with organic acidopathies suffer metabolic brain injury which targets specific regions of the basal ganglia in a distinctive pattern, and these injuries may occur even with optimal management during metabolic stress. Liver transplantation has improved quality of life and metabolic stability, yet transplantation in this population does not entirely prevent brain injury or the development of optic neuropathy and cardiac disease. Summary Management guidelines should identify necessary screening for patients with MMA and PA, and improve anticipatory management of progressive end-organ disease. Liver transplantation improves overall metabolic control, but injury to non-regenerative tissues may not be mitigated. Continued use of medical foods in these patients requires prospective studies to demonstrate evidence of benefit in a controlled manner. PMID:27653704

  1. Methylmalonic and propionic acidemias: clinical management update.

    Science.gov (United States)

    Fraser, Jamie L; Venditti, Charles P

    2016-12-01

    Recent clinical studies and management guidelines for the treatment of the organic acidopathies methylmalonic acidemia (MMA) and propionic acidemia address the scope of interventions to maximize health and quality of life. Unfortunately, these disorders continue to cause significant morbidity and mortality due to acute and chronic systemic and end-organ injury. Dietary management with medical foods has been a mainstay of therapy for decades, yet well controlled patients can manifest growth, development, cardiac, ophthalmological, renal, and neurological complications. Patients with organic acidopathies suffer metabolic brain injury that targets specific regions of the basal ganglia in a distinctive pattern, and these injuries may occur even with optimal management during metabolic stress. Liver transplantation has improved quality of life and metabolic stability, yet transplantation in this population does not entirely prevent brain injury or the development of optic neuropathy and cardiac disease. Management guidelines should identify necessary screening for patients with methylmalonic acidemia and propionic acidemia, and improve anticipatory management of progressive end-organ disease. Liver transplantation improves overall metabolic control, but injury to nonregenerative tissues may not be mitigated. Continued use of medical foods in these patients requires prospective studies to demonstrate evidence of benefit in a controlled manner.

  2. Nuclear medicine in clinical neurology: an update

    International Nuclear Information System (INIS)

    Oldendorf, W.H.

    1981-01-01

    Isotope scanning using technetium 99m pertechnetate has fallen into disuse since the advent of x-ray computerized tomography. Regional brain blood flow studies have been pursued on a research basis. Increased regional blood flow during focal seizure activity has been demonstrated and is of use in localizing such foci. Cisternography as a predictive tool in normal pressure hydrocephalus is falling into disuse. Positron tomographic scanning is a potent research tool that can demonstrate both regional glycolysis and blood flow. Unfortunately, it is extremely expensive and complex to apply in a clinical setting. With support from the National Institutes of Health, seven extramural centers have been funded to develop positron tomographic capabilities, and they will greatly advance our knowledge of stroke pathophysiology, seizure disorders, brain tumors, and various degenerative diseases. Nuclear magnetic resonance imaging is a potentially valuable tool since it creates tomographic images representing the distribution of brain water. No tissue ionization is produced, and images comparable to second-generation computerized tomographic scans are already being produced in humans

  3. Partial updating of clinical practice guidelines often makes more sense than full updating: a systematic review on methods and the development of an updating procedure.

    Science.gov (United States)

    Becker, Monika; Neugebauer, Edmund A M; Eikermann, Michaela

    2014-01-01

    To conduct a systematic review of the methods used to determine when and how to update clinical practice guidelines (CPGs) and develop a procedure for updating CPGs. We searched MEDLINE, Embase, and the Cochrane Methodology Register for methodological publications on updating CPGs. Guideline development manuals were obtained from the Web sites of guideline-developing organizations. Using the information obtained from these records, a procedure for updating CPGs was developed. A total of 5,116 journal articles were screened, and seven articles met the criteria for inclusion. Forty-seven manuals were included; of these, eight included details about the methods used to update the guidelines. Most of the included publications focused on assessing whether the CPGs needed updating and not on how to update them. The developed procedure includes a systematic monitoring system and a scheduled process for updating the CPGs, which includes guidance on how to determine the type and scope of an update. Partial updating often makes more sense than updating the whole CPG because topics and recommendations differ in terms of the need for updating. Guideline developers should implement a systematic updating procedure that includes an ongoing monitoring system that is appropriate for the nature of the guideline topics and the capabilities of the developers. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update).

    Science.gov (United States)

    Rosenfeld, Richard M; Shin, Jennifer J; Schwartz, Seth R; Coggins, Robyn; Gagnon, Lisa; Hackell, Jesse M; Hoelting, David; Hunter, Lisa L; Kummer, Ann W; Payne, Spencer C; Poe, Dennis S; Veling, Maria; Vila, Peter M; Walsh, Sandra A; Corrigan, Maureen D

    2016-02-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants). An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  5. Antiemetics: American Society of Clinical Oncology Focused Guideline Update.

    Science.gov (United States)

    Hesketh, Paul J; Bohlke, Kari; Lyman, Gary H; Basch, Ethan; Chesney, Maurice; Clark-Snow, Rebecca Anne; Danso, Michael A; Jordan, Karin; Somerfield, Mark R; Kris, Mark G

    2016-02-01

    To update a key recommendation of the American Society of Clinical Oncology antiemetic guideline. This update addresses the use of the oral combination of netupitant (a neurokinin 1 [NK1] receptor antagonist) and palonosetron (a 5-hydroxytryptamine-3 [5-HT3] receptor antagonist) for the prevention of acute and delayed nausea and vomiting in patients receiving chemotherapy. An update committee conducted a targeted systematic literature review and identified two phase III clinical trials and a randomized phase II dose-ranging study. In one phase III trial, the oral combination of netupitant and palonosetron was associated with higher complete response rates (no emesis and no rescue medications) compared with palonosetron alone in patients treated with anthracycline plus cyclophosphamide chemotherapy (74% v 67% overall; P = .001). In another phase III trial, the oral combination of netupitant and palonosetron was safe and effective across multiple cycles of moderately or highly emetogenic chemotherapies. In the phase II dose-ranging study, each dose of netupitant (coadministered with palonosetron 0.50 mg) produced higher complete response rates than palonosetron alone among patients receiving cisplatin-based chemotherapy. The highest dose of netupitant (ie, 300 mg) was most effective. All patients who receive highly emetogenic chemotherapy regimens (including anthracycline plus cyclophosphamide) should be offered a three-drug combination of an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone. The oral combination of netupitant and palonosetron plus dexamethasone is an additional treatment option in this setting. The remaining recommendations from the 2011 ASCO guideline are unchanged pending a full update. Additional information is available at www.asco.org/guidelines/antiemetics and www.asco.org/guidelineswiki. © 2015 by American Society of Clinical Oncology.

  6. Clinical update: communication issues and advance care planning.

    Science.gov (United States)

    Moore, Crystal Dea; Reynolds, Ashley M

    2013-11-01

    To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. Published articles, textbooks, reports, and clinical experience. The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Liposomal Formulations in Clinical Use: An Updated Review

    Directory of Open Access Journals (Sweden)

    Upendra Bulbake

    2017-03-01

    Full Text Available Liposomes are the first nano drug delivery systems that have been successfully translated into real-time clinical applications. These closed bilayer phospholipid vesicles have witnessed many technical advances in recent years since their first development in 1965. Delivery of therapeutics by liposomes alters their biodistribution profile, which further enhances the therapeutic index of various drugs. Extensive research is being carried out using these nano drug delivery systems in diverse areas including the delivery of anti-cancer, anti-fungal, anti-inflammatory drugs and therapeutic genes. The significant contribution of liposomes as drug delivery systems in the healthcare sector is known by many clinical products, e.g., Doxil®, Ambisome®, DepoDur™, etc. This review provides a detailed update on liposomal technologies e.g., DepoFoam™ Technology, Stealth technology, etc., the formulation aspects of clinically used products and ongoing clinical trials on liposomes.

  8. Fetal neuroimaging: an update on technical advances and clinical findings.

    Science.gov (United States)

    Robinson, Ashley J; Ederies, M Ashraf

    2018-04-01

    This paper is based on a literature review from 2011 to 2016. The paper is divided into two main sections. The first section relates to technical advances in fetal imaging techniques, including fetal motion compensation, imaging at 3.0 T, 3-D T2-weighted MRI, susceptibility-weighted imaging, computed tomography, morphometric analysis, diffusion tensor imaging, spectroscopy and fetal behavioral assessment. The second section relates to clinical updates, including cerebral lamination, migrational anomalies, midline anomalies, neural tube defects, posterior fossa anomalies, sulcation/gyration and hypoxic-ischemic insults.

  9. An update survey of academic radiologists' clinical productivity.

    Science.gov (United States)

    Lu, Ying; Zhao, Shoujun; Chu, Philip W; Arenson, Ronald L

    2008-07-01

    The total number of procedures and their relative value units (RVUs) were used to measure the productivity of radiologists. Besides variations in productivity due to differences in the percentage of clinical effort, baseline productivity also varies among clinical subspecialty sections. The authors' previous research used the full-time equivalent (FTE) as the unit to adjust for differences in the percentage of clinical effort and a set of adjustment factors (or calibration constants) to modify the default work RVUs according to types of procedures. These adjustments led to comparable average productivity measurements across subspecialty sections. Since 2003, radiology practice has continued to change, including the introduction of positron emission tomography/computed tomography into clinical practice, suggesting a need to update the understanding of clinical productivity and refine the authors' adjustment procedure. In this study, the authors analyzed the most recent survey of academic departments and derived updated adjustment factors for differences in workload among subspecialty sections. The results can be used to determine faculty staffing requirements and evaluate radiologists' performance. A survey performed by the Society of Chairmen of Academic Radiology Departments collected data in 2006 for 1,134 radiologists in 24 departments, including 10 departments that also reported productivity in an earlier 2003 survey. These data included the numbers of procedures (represented by Current Procedural Terminology [CPT] codes) performed by radiologists, percentage clinical effort, subspecialty sections, and the number of clinical days. The numbers of CPT codes were converted into total work RVUs per FTE faculty member. By grouping the CPT codes into 6 prespecified examination categories, adjustment factors were created to adjust the RVUs for CPT categories to ensure that the median total adjusted work RVUs from different subspecialty sections were comparable

  10. Ipilimumab in the treatment of advanced melanoma - a clinical update.

    Science.gov (United States)

    Kim, Dae Won; Trinh, Van Anh; Hwu, Wen-Jen

    2014-11-01

    Ipilimumab has become an important treatment option for patients with advanced melanoma; however, active research perseveres to resolve many clinical practice issues and to further improve the therapeutic index of this agent. This article aims to provide an update on long-term data, current challenge and recent progress relating to the clinical application of ipilimumab in the treatment of advanced melanoma. A literature search using PubMed database was conducted using search words ipilimumab, melanoma, treatment sequencing, adjuvant therapy, combination therapy, and biomarkers. Data were also obtained from meeting abstracts and clinical trial registries. Signal of clinical activity as adjuvant therapy in patients with resected high-risk melanoma begins to emerge, but longer follow-up is required for confirmation. Many issues, such as optimal dosing schedules and therapeutic sequences, remain unraveled. At present, treatment should be individualized based on patient- and disease-specific factors. Immunotherapy like ipilimumab still represents the best treatment option for durable remission; however, targeted therapies are more appropriate for patients with BRAF V600-mutated tumor who are symptomatic or have rapidly growing disease. With novel therapeutic options in the pipeline, the role of ipilimumab continues to evolve in the rapidly changing treatment landscape of advanced melanoma. Most likely, this agent will be utilized in combinatorial or sequential approach.

  11. Updates on the Clinical Evidenced Herb-Warfarin Interactions

    Directory of Open Access Journals (Sweden)

    Beikang Ge

    2014-01-01

    Full Text Available Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John’s wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered as highly probable to interact with warfarin (level I, three were estimated as probable (level II, and ten and twenty-one were possible (level III and doubtful (level IV, respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.

  12. Updates on the clinical evidenced herb-warfarin interactions.

    Science.gov (United States)

    Ge, Beikang; Zhang, Zhen; Zuo, Zhong

    2014-01-01

    Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John's wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered as highly probable to interact with warfarin (level I), three were estimated as probable (level II), and ten and twenty-one were possible (level III) and doubtful (level IV), respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of "interacting herbs." In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.

  13. Summary of the Update Session of Clinical Studies

    Science.gov (United States)

    Pinyavat, Teeda; Warner, David O.; Flick, Randall P.; McCann, Mary Ellen; Andropoulos, Dean B.; Hu, Danquig; Sall, Jeffrey W.; Spann, Marisa N.; Ing, Caleb

    2016-01-01

    During the Fifth Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium, experts and stakeholders met to present and discuss recent advances made in the study of neurodevelopmental outcomes following exposure to anesthetic drugs in infants and children. This article summarizes the update of five ongoing clinical studies: General Anesthesia compared to Spinal Anesthesia (GAS), Toxicity of Remifentanil and Dexmedetomidine (T-Rex), Mayo Anesthesia Safety in Kids (MASK), the UCSF (University of California San Francisco) human cohort study, and Columbia University Medical Center (CUMC) Neonatal Magnetic Resonance Imaging (MRI) study. The purpose of this summary is to discuss the contributions and limitations of these studies, how they fit into the published literature, and what questions remain to be answered. PMID:27768673

  14. Update on the clinical utility and optimal use of cefditoren

    Directory of Open Access Journals (Sweden)

    Barberán J

    2012-05-01

    Full Text Available José Barberán,1 Lorenzo Aguilar,2 María-José Giménez21Infectious Diseases Department, Hospital Central de la Defensa Gomez Ulla, 2Microbiology Department, School of Medicine, Universidad Complutense de Madrid, Madrid, SpainAbstract: This article reviews and updates published data on cefditoren. The in vitro activity of cefditoren and its potential pharmacokinetic/pharmacodynamic adequacy to cover emerging resistance phenotypes in the present decade is reviewed. Cefditoren's in vitro activity against most prevalent bacterial respiratory pathogens in the community and its pharmacokinetic/pharmacodynamic profile suggests a significant role for cefditoren in the treatment of respiratory tract infections. Clinical trials (in acute exacerbations of chronic bronchitis, community-acquired pneumonia, pharyngotonsillitis, and sinusitis performed during clinical development outside Japan, mainly in adults, are reviewed, together with new clinical studies in the treatment of pharyngotonsillitis, sinusitis, and otitis media in children, mainly in Japan, for efficacy and safety assessment. The results of these studies support the adequacy of cefditoren for the treatment of community-acquired respiratory tract infections with a safety profile similar to previous oral antibiotics. From the data reviewed, it is concluded that cefditoren is an adequate option for the treatment of mild-to-moderate community-acquired respiratory infections, especially in geographical areas with a reported prevalence of phenotypes exhibiting nonsusceptibility to common oral antibiotics.Keywords: acute exacerbations of chronic bronchitis, community-acquired pneumonia, pharyngotonsillitis, sinusitis, otitis media

  15. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).

    Science.gov (United States)

    Bhattacharyya, Neil; Gubbels, Samuel P; Schwartz, Seth R; Edlow, Jonathan A; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard; Seidman, Michael D; Steiner, Robert W Prasaad; Do, Betty Tsai; Voelker, Courtney C J; Waguespack, Richard W; Corrigan, Maureen D

    2017-03-01

    Objective This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing

  16. Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

    Science.gov (United States)

    Loren, Alison W.; Mangu, Pamela B.; Beck, Lindsay Nohr; Brennan, Lawrence; Magdalinski, Anthony J.; Partridge, Ann H.; Quinn, Gwendolyn; Wallace, W. Hamish; Oktay, Kutluk

    2013-01-01

    Purpose To update guidance for health care providers about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. Results There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. Recommendations As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise. PMID:23715580

  17. Clinical Practice Guideline: Otitis Media with Effusion (Update).

    Science.gov (United States)

    Rosenfeld, Richard M; Shin, Jennifer J; Schwartz, Seth R; Coggins, Robyn; Gagnon, Lisa; Hackell, Jesse M; Hoelting, David; Hunter, Lisa L; Kummer, Ann W; Payne, Spencer C; Poe, Dennis S; Veling, Maria; Vila, Peter M; Walsh, Sandra A; Corrigan, Maureen D

    2016-02-01

    This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME. The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients 12 years old. The update group made strong recommendations that clinicians (1) should document

  18. Implications of electronic health record meaningful use legislation for nursing clinical information system development and refinement.

    Science.gov (United States)

    Scherb, Cindy A; Maas, Meridean L; Head, Barbara J; Johnson, Marion R; Kozel, Marie; Reed, David; Swanson, Elizabeth; Moorhead, Sue

    2013-06-01

     To describe what electronic health record meaningful use requirements mean for nursing clinical information system (CIS) development.  The nursing CIS in many, if not most hospitals, has a number of critical design inadequacies that constrain the meaningful use of nursing data to ensure quality outcomes for patients and data-based maturing of the nursing profession.  It is the responsibility and obligation of nurses to ensure that CISs are designed for the meaningful use of nursing clinical data. To accomplish these ends, interoperable clinical nursing data must be documented in a properly integrated operational CIS, and must be retrievable and stored in data repositories for analysis and reports. © 2013, The Authors. International Journal of Nursing Knowledge © 2013, NANDA International.

  19. 2011 Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    Science.gov (United States)

    Azzoli, Christopher G.; Temin, Sarah; Aliff, Timothy; Baker, Sherman; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pao, William; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

    2011-01-01

    Purpose An American Society of Clinical Oncology (ASCO) focused update updates a single recommendation (or subset of recommendations) in advance of a regularly scheduled guideline update. This document updates one recommendation of the ASCO Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer (NSCLC) regarding switch maintenance chemotherapy. Clinical Context Recent results from phase III clinical trials have demonstrated that in patients with stage IV NSCLC who have received four cycles of first-line chemotherapy and whose disease has not progressed, an immediate switch to alternative, single-agent chemotherapy can extend progression-free survival and, in some cases, overall survival. Because of limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable. Recent Data Seven randomized controlled trials of carboxyaminoimidazole, docetaxel, erlotinib, gefitinib, gemcitabine, and pemetrexed have evaluated outcomes in patients who received an immediate, non–cross resistant alternative therapy (switch maintenance) after first-line therapy. Recommendation In patients with stage IV NSCLC, first-line cytotoxic chemotherapy should be stopped at disease progression or after four cycles in patients whose disease is stable but not responding to treatment. Two-drug cytotoxic combinations should be administered for no more than six cycles. For those with stable disease or response after four cycles, immediate treatment with an alternative, single-agent chemotherapy such as pemetrexed in patients with nonsquamous histology, docetaxel in unselected patients, or erlotinib in unselected patients may be considered. Limitations of this data are such that a break from cytotoxic chemotherapy after a fixed course is also acceptable, with initiation of second-line chemotherapy at disease progression. PMID:21900105

  20. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version)

    DEFF Research Database (Denmark)

    Dietrich, Christoph F; Bamber, Jeffrey; Berzigotti, Annalisa

    2017-01-01

    We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information...... and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both...

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

    Science.gov (United States)

    Alonso-Coello, Pablo; Martínez García, Laura; Carrasco, José Miguel; Solà, Ivan; Qureshi, Safia; Burgers, Jako S

    2011-09-13

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

  2. Notification of suspected and unexpected serious adverse reactions according to the Clinical Trials Directive - A descriptive analysis of the legislation and the requirements in a European context

    DEFF Research Database (Denmark)

    Larsen, Ellen Moseholm; Grarup, Jesper; Gey, Daniela Christine

    2010-01-01

    The European Clinical Trials Directive (CTD) came into force on May 1st 2004. The CTD provides the legal basis for monitoring the safety of clinical trials and covers the requirements for notification of SUSAR. Implementation of the CTD into national legislation in each Member State has resulted...... is of immediate practical use to especially non-commercial sponsors when conducting clinical trials in Europe....

  3. Atomic Energy Act and Related Legislation. Environmental Guidance Program Reference Book: Revision 6

    Energy Technology Data Exchange (ETDEWEB)

    1992-09-01

    This report presents information related to the Atomic Energy Act and related legislation. Sections are presented pertaining to legislative history and statutes, implementing regulations, and updates.

  4. Increasing Rural Health Clinic Utilization with SMS Updates: Evidence from a Randomized Evaluation in Uganda

    OpenAIRE

    Chicoine, Luke E.; Guzman, Juan Carlos

    2016-01-01

    This paper examines an alternative to monitoring staff at a public health clinic in rural Uganda. The program sent SMS updates regarding confirmed attendance of clinic staff and activities to randomly selected cell phone-owning households in the local community. A difference-in-difference approach is used to evaluate the impact of the SMS program, and finds the messages led to an increase in clinic attendance, the receipt of medicine, and reduced duration of illness for young children aged si...

  5. Update on the Clinical Development of Candidate Malaria Vaccines

    National Research Council Canada - National Science Library

    Ballou, W. R; Arevalo-Herrera, Myriam; Carucci, Daniel; Richie, Thomas L; Corradin, Giampietro; Diggs, Carter; Druilhe, Pierre; Giersing, Birgitte K; Saul, Allan; Heppner, D. G

    2004-01-01

    ... powerful driver for stimulating clinical development of candidate vaccines for malaria. This new way forward promises to greatly increase the likelihood of bringing a safe and effective vaccine to licensure...

  6. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating *

    OpenAIRE

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular atten...

  7. Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics*

    Science.gov (United States)

    Orofino-Costa, Rosane; de Macedo, Priscila Marques; Rodrigues, Anderson Messias; Bernardes-Engemann, Andréa Reis

    2017-01-01

    In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy. PMID:29166494

  8. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

    DEFF Research Database (Denmark)

    Dietrich, Christoph F; Bamber, Jeffrey; Berzigotti, Annalisa

    2017-01-01

    We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography, focused on the assessment of diffuse liver disease. The first part (long version) of these Guidelines...... and Recommendations deals with the basic principles of elastography and provides an update of how the technology has changed. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided regarding optimization of scanning technique, image display, image...... Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users....

  9. Update on basic and clinical aspects of eosinophilic oesophagitis.

    Science.gov (United States)

    Straumann, Alex; Schoepfer, Alain

    2014-08-01

    The identification of a distinct syndrome, designated eosinophilic oesophagitis (EoE), with its own clinical and histopathological characteristics, was first described in the early 1990s. Meanwhile intense research has uncovered many molecular, immunological and clinical aspects of this chronic-inflammatory disorder. This article focuses exclusively on basic and clinical insights of EoE gathered during the last few years. Regarding aetiopathogenesis it has become clear that EoE is a food-triggered disease with milk and wheat as the dominant culprit food categories. However, it is still debated whether a disturbed mucosal integrity allowing allergens to cross the mucosal barrier, or changes in wheat and milk manufacturing might induce these inflammatory responses. Furthermore, basic science and clinical studies have accordingly confirmed that a chronic eosinophilic inflammation leads to a remodelling of the oesophagus with micro- and macro-morphological alterations, ending in a strictured oesophagus with impaired function. Fortunately, long-term therapeutic trials, using either topical corticosteroids or dietary allergen avoidance, have demonstrated that this sequela can be prevented or even reversed. This finding is of clinical relevance as it supports the initiation of a consistent anti-inflammatory therapy. Nevertheless, EoE is still an enigmatic disease and the long list of unanswered questions will certainly stimulate further research. 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.

  10. CANVAS an update: clinical presentation, investigation and management.

    Science.gov (United States)

    Szmulewicz, David J; McLean, Catriona A; MacDougall, Hamish G; Roberts, Leslie; Storey, Elsdon; Halmagyi, G Michael

    2014-01-01

    Cerebellar Ataxia with Neuropathy and bilateral Vestibular Areflexia Syndrome (CANVAS) is a multi-system ataxia which results in cerebellar ataxia, a bilateral vestibulopathy and a somatosensory deficit. This sensory deficit has recently been shown to be a neuronopathy, with marked dorsal root ganglia neuronal loss. The characteristic oculomotor clinical sign is an abnormal visually enhanced vestibulo-ocular reflex. To outline the expanding understanding of the pathology in this condition, as well as diagnostic and management issues encountered in clinical practice. Retrospective data on 80 CANVAS patients is reviewed. In addition to the triad of cerebellar impairment, bilateral vestibulopathy and a somatosensory deficit, CANVAS patients may also present with orthostatic hypotension, a chronic cough and neuropathic pain. Management of falls risk and dysphagia is a major clinical priority. CANVAS is an increasingly recognised cause of late-onset ataxia and disequilibrium, and is likely to be a recessive disorder.

  11. An update on probiotics, prebiotics and symbiotics in clinical nutrition.

    Science.gov (United States)

    Olveira, Gabriel; González-Molero, Inmaculada

    2016-11-01

    The concept of prebiotics, probiotics, and symbiotics and their use in different situations of daily clinical practice related to clinical nutrition is reviewed, as well as their role in the treatment/prevention of diarrhea (acute, induced by antibiotics, secondary to radiotherapy), inflammatory bowel disease (ulcerative colitis and pouchitis), in colonic health (constipation, irritable bowel), in liver disease (steatosis and minimum encephalopathy), and in intensive care, surgical, and liver transplantation. While their effectiveness for preventing antibiotic-induced diarrhea and pouchitis in ulcerative colitis appears to be shown, additional studies are needed to establish recommendations in most clinical settings. The risk of infection associated to use of probiotics is relatively low; however, there are selected groups of patients in whom they should be used with caution (as jejunum infusion). Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating*

    Science.gov (United States)

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject. PMID:24173174

  13. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating.

    Science.gov (United States)

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject.

  14. Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease

    NARCIS (Netherlands)

    I. Zerr; K. Kallenberg; D.M. Summers; C. Romero; A. Taratuto; U. Heinemann; M. Breithaupt; D. Varges; B. Meissner; A. Ladogana (Anna); M. Schuur (Maaike); S. Haik; S.J. Collins (Steven); G.H. Jansen (Gerard); G.B. Stokin; J. Pimentel; E. Hewer; D. Collie; P. Smith; H. Roberts; J.P. Brandel; P. Tikka-Kleemola (Päivi); M. Pocchiari (Maurizio); C. Begue; P. Cras (Patrick); R.G. Will; P. Sanchez-Juan (Pascual)

    2009-01-01

    textabstractSeveral molecular subtypes of sporadic Creutzfeldt-Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications

  15. Update on Clinical Features and Brain Abnormalities in Neurogenetics Syndromes

    Science.gov (United States)

    Jackowski, Andrea Parolin; Laureano, Maura Regina; Del'Aquilla, Marco Antonio; de Moura, Luciana Monteiro; Assuncao, Idaiane; Silva, Ivaldo; Schwartzman, Jose Salomao

    2011-01-01

    Neuroimaging methods represent a critical tool in efforts to join the study of the neurobiology of genes with the neurobiology of behaviour, and to understand the neurodevelopmental pathways that give rise to cognitive and behavioural impairments. This article reviews the clinical features and highlights studies with a focus on the relevant…

  16. Prostate specific antigen - brief update on its clinical use

    African Journals Online (AJOL)

    in 1979.3,4 During the 1980s it was realised that serum PSA levels correlate with the tumour burden in men with prostate ... it has become the most clinically useful of all serum tumour markers. It has a higher specificity for prostate cancer than ..... (It can be found by simply typing. “prostate cancer risk calculator” into a search ...

  17. Clinical Trials With Mesenchymal Stem Cells: An Update.

    Science.gov (United States)

    Squillaro, Tiziana; Peluso, Gianfranco; Galderisi, Umberto

    2016-01-01

    In the last year, the promising features of mesenchymal stem cells (MSCs), including their regenerative properties and ability to differentiate into diverse cell lineages, have generated great interest among researchers whose work has offered intriguing perspectives on cell-based therapies for various diseases. Currently the most commonly used adult stem cells in regenerative medicine, MSCs, can be isolated from several tissues, exhibit a strong capacity for replication in vitro, and can differentiate into osteoblasts, chondrocytes, and adipocytes. However, heterogeneous procedures for isolating and cultivating MSCs among laboratories have prompted the International Society for Cellular Therapy (ISCT) to issue criteria for identifying unique populations of these cells. Consequently, the isolation of MSCs according to ISCT criteria has produced heterogeneous, nonclonal cultures of stromal cells containing stem cells with different multipotent properties, committed progenitors, and differentiated cells. Though the nature and functions of MSCs remain unclear, nonclonal stromal cultures obtained from bone marrow and other tissues currently serve as sources of putative MSCs for therapeutic purposes, and several findings underscore their effectiveness in treating different diseases. To date, 493 MSC-based clinical trials, either complete or ongoing, appear in the database of the US National Institutes of Health. In the present article, we provide a comprehensive review of MSC-based clinical trials conducted worldwide that scrutinizes biological properties of MSCs, elucidates recent clinical findings and clinical trial phases of investigation, highlights therapeutic effects of MSCs, and identifies principal criticisms of the use of these cells. In particular, we analyze clinical trials using MSCs for representative diseases, including hematological disease, graft-versus-host disease, organ transplantation, diabetes, inflammatory diseases, and diseases in the liver, kidney

  18. Cardiovascular Risk of Stimulant Treatment in Pediatric Attention-Deficit/Hyperactivity Disorder: Update and Clinical Recommendations

    Science.gov (United States)

    Hammerness, Paul G.; Perrin, James M.; Shelley-Abrahamson, Rachel; Wilens, Timothy E.

    2011-01-01

    Objective: This review provides an update on the cardiovascular impact of therapeutic stimulant-class medication for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Method: Relevant clinical literature was ascertained using PubMed searches limited to human studies and the English language as of May 2011. Current…

  19. American Society of Clinical Oncology 2011 CNS tumors update.

    Science.gov (United States)

    Ahluwalia, Manmeet S

    2011-10-01

    A number of important studies were presented at the CNS tumors section of the 2011 American Society of Clinical Oncology Annual Meeting. There was particular interest in RTOG 0525, a Phase III study of newly diagnosed glioblastoma treated with different schedules of temozolomide. Prognostic factors for response, survival and chemotherapy-related toxicity in primary CNS lymphoma from the German randomized Phase III trial in newly diagnosed primary CNS lymphoma were also presented.

  20. Update on contemporary management of clinically localized renal cell carcinoma.

    Science.gov (United States)

    Jorns, J J; Thiel, D D; Castle, E P

    2012-12-01

    Renal cell carcinoma (RCC) continues to increase in incidence with the largest increase manifesting in small, organ-confined tumors. This review outlines the epidemiology and current data pertaining to the management of clinically-localized RCC. In this manuscript, the current data outlining the benefit of nephron sparing to the overall survival of the patient is described. The data pertaining to minimally invasive nephron sparing is also explained in detail. From laparoscopic and robotic partial nephrectomy to watchful waiting and percutaneous ablation, the urologist is continually assaulted with new data for the management of clinically-localized RCC. The data can be confusing, and much of it is conflicting. The addition of new scoring systems or nomograms may aid in predicting which therapy would be most beneficial in certain patient groups. New scoring systems may also predict the difficulty of surgical resection and predict surgical complications. The limitations of the data pertaining to the management of clinically-localized RCC are also outlined.

  1. Update on lichen planus and its clinical variants

    Directory of Open Access Journals (Sweden)

    Gillian Weston, MSIII

    2015-08-01

    Full Text Available Lichen planus (LP is an inflammatory skin condition with characteristic clinical and histopathological findings. Classic LP typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist, including oral, nail, linear, annular, atrophic, hypertrophic, inverse, eruptive, bullous, ulcerative, lichen planus pigmentosus, lichen planopilaris, vulvovaginal, actinic, lichen planus-lupus erythematosus overlap syndrome, and lichen planus pemphigoides. Clinical presentation of the rarer variant lesions may be largely dissimilar to classic LP and therefore difficult to diagnose based solely on clinical examination. However, histopathological examination of LP and LP-variant lesions reveal similar features, aiding in the proper diagnosis of the disease. Management of LP and LP variants aims to control symptoms and to decrease time from onset to resolution; it often involves topical corticosteroids, but varies depending on the severity and location of the lesion. The literature contains an array of reports on the variations in presentation and successful management of LP and its variants. A familiarity with LP and its variants is important in achieving timely recognition and management of the disease.

  2. Clinical Update on Epidemiology, Pathogenesis, and Nonpharmacological Treatment of Insomnia

    Directory of Open Access Journals (Sweden)

    Mustafa Kahriman

    2006-04-01

    Full Text Available Scientific background: Insomnia is by far the most common form of sleep disturbance. Most typically, insomnia has been defined as the symptom of difficulty initiating or maintaining sleep and more rarely as an inability to obtain restorative sleep. Insomnia disorders are most often classified as either primary or secondary to other sleep, psychiatric, or medical conditions, although it is often difficult in practice to determine true causality of insomnia or there may be more than one cause (comorbid conditions. Increasing age, female sex, and psychiatric and medical disorders are consistent risk factors for insomnia. Insomnia is associated with significant social, medical, and financial consequences including impaired social functioning and quality of life, increased risk for psychiatric disorders, and increased health care costs. The clinical assessment of insomnia is based on a careful clinical interview, often supplemented by sleep questionnaires, sleep logs, and psychological testing. Polysomnography is indicated only in selected cases when specific sleep pathologies are suspected. Assessment: A large proportion of insomnia sufferers go undiagnosed, and therefore untreated, by their doctors, and many of these patients incur considerable personal, vocational, and health-related consequences as a result. Insomnia can be triggered by a variety of precipitating events, but when it becomes a chronic problem, psychological and behavioral factors are almost always involved in perpetuating or exacerbating sleep disturbances over time. Psychological and behavioral therapies for primary insomnia include sleep restriction, stimulus control therapy, relaxation training, cognitive strategies, and a combination of those methods, referred to as cognitive behavior therapy of insomnia. Results of the controlled clinical trials indicate that 70% to 80% of patients with primary insomnia partially benefit from cognitive behavior therapy. Although only 20% to

  3. Update on the treatment of narcolepsy: clinical efficacy of pitolisant

    Directory of Open Access Journals (Sweden)

    Calik MW

    2017-04-01

    Full Text Available Michael W Calik1,2 1Department of Biobehavioral Health Science, 2Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL, United States Abstract: Narcolepsy is a neurological disease that affects 1 in 2,000 individuals and is characterized by excessive daytime sleepiness (EDS. In 60–70% of individuals with narcolepsy, it is also characterized by cataplexy or a sudden loss of muscle tone that is triggered by positive or negative emotions. Narcolepsy decreases the quality of life of the afflicted individuals. Currently used drugs treat EDS alone (modafinil/armodafinil, methylphenidate, and amphetamine, cataplexy alone (“off-label” use of antidepressants, or both EDS and cataplexy (sodium oxybate. These drugs have abuse, tolerability, and adherence issues. A greater diversity of drug options is needed to treat narcolepsy. The small molecule drug, pitolisant, acts as an inverse agonist/antagonist at the H3 receptor, thus increasing histaminergic tone in the wake promoting system of the brain. Pitolisant has been studied in animal models of narcolepsy and used in clinical trials as a treatment for narcolepsy. A comprehensive search of online databases (eg, Medline, PubMed, EMBASE, the Cochrane Library Database, Ovid MEDLINE, Europe PubMed Central, EBSCOhost CINAHL, ProQuest Research Library, Google Scholar, and ClinicalTrials.gov was performed. Nonrandomized and randomized studies were included. This review focuses on the outcomes of four clinical trials of pitolisant to treat narcolepsy. These four trials show that pitolisant is an effective drug to treat EDS and cataplexy in narcolepsy. Keywords: narcolepsy, pitolisant, histamine

  4. 2015 Clinical trials update in sickle cell anemia

    Science.gov (United States)

    Archer, Natasha; Galacteros, Frédéric; Brugnara, Carlo

    2017-01-01

    Polymerization of HbS and cell sickling are the prime pathophysiological events in sickle cell disease (SCD). Over the last 30 years, a substantial understanding at the molecular level has been acquired on how a single amino acid change in the structure of the beta chain of hemoglobin leads to the explosive growth of the HbS polymer and the associated changes in red cell morphology. O2 tension and intracellular HbS concentration are the primary molecular drivers of this process, and are obvious targets for developing new therapies. However, polymerization and sickling are driving a complex network of associated cellular changes inside and outside of the erythrocyte, which become essential components of the inflammatory vasculopathy and result in a large range of potential acute and chronic organ damages. In these areas, a multitude of new targets for therapeutic developments have emerged, with several ongoing or planned new therapeutic interventions. This review outlines the key points of SCD pathophysiology as they relate to the development of new therapies, both at the pre-clinical and clinical levels. PMID:26178236

  5. Updated clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease

    Science.gov (United States)

    Kallenberg, K.; Summers, D. M.; Romero, C.; Taratuto, A.; Heinemann, U.; Breithaupt, M.; Varges, D.; Meissner, B.; Ladogana, A.; Schuur, M.; Haik, S.; Collins, S. J.; Jansen, Gerard H.; Stokin, G. B.; Pimentel, J.; Hewer, E.; Collie, D.; Smith, P.; Roberts, H.; Brandel, J. P.; van Duijn, C.; Pocchiari, M.; Begue, C.; Cras, P.; Will, R. G.; Sanchez-Juan, P.

    2009-01-01

    Several molecular subtypes of sporadic Creutzfeldt–Jakob disease have been identified and electroencephalogram and cerebrospinal fluid biomarkers have been reported to support clinical diagnosis but with variable utility according to subtype. In recent years, a series of publications have demonstrated a potentially important role for magnetic resonance imaging in the pre-mortem diagnosis of sporadic Creutzfeldt–Jakob disease. Magnetic resonance imaging signal alterations correlate with distinct sporadic Creutzfeldt–Jakob disease molecular subtypes and thus might contribute to the earlier identification of the whole spectrum of sporadic Creutzfeldt–Jakob disease cases. This multi-centre international study aimed to provide a rationale for the amendment of the clinical diagnostic criteria for sporadic Creutzfeldt–Jakob disease. Patients with sporadic Creutzfeldt–Jakob disease and fluid attenuated inversion recovery or diffusion-weight imaging were recruited from 12 countries. Patients referred as ‘suspected sporadic Creutzfeldt–Jakob disease’ but with an alternative diagnosis after thorough follow up, were analysed as controls. All magnetic resonance imaging scans were assessed for signal changes according to a standard protocol encompassing seven cortical regions, basal ganglia, thalamus and cerebellum. Magnetic resonance imaging scans were evaluated in 436 sporadic Creutzfeldt–Jakob disease patients and 141 controls. The pattern of high signal intensity with the best sensitivity and specificity in the differential diagnosis of sporadic Creutzfeldt–Jakob disease was identified. The optimum diagnostic accuracy in the differential diagnosis of rapid progressive dementia was obtained when either at least two cortical regions (temporal, parietal or occipital) or both caudate nucleus and putamen displayed a high signal in fluid attenuated inversion recovery or diffusion-weight imaging magnetic resonance imaging. Based on our analyses, magnetic

  6. Optical coherence tomography a clinical and technical update

    CERN Document Server

    Cunha-Vaz, José

    2012-01-01

    Optical Coherence Tomography represents the ultimate noninvasive  ocular imaging technique although being in the field for over two-decades. This book encompasses both medical and technical developments and recent achievements. Here, the authors cover the field of application from the anterior to the posterior ocular segments (Part I) and present a comprehensive review on the development of OCT. Important developments towards  clinical applications are covered in Part II, ranging from the adaptive optics to the integration on a slit-lamp, and passing through new structural  and functional information extraction from OCT data. The book is intended to be informative, coherent and comprehensive for both the medical and technical communities and aims at easing the communication between the two fields and bridging the gap between the two scientific communities.

  7. Clinical presentation and management of neonatal abstinence syndrome: an update

    Directory of Open Access Journals (Sweden)

    Ordean A

    2014-04-01

    Full Text Available Alice Ordean,1 Brian C Chisamore21Department of Family Medicine, 2Department of Pediatrics, St Joseph's Health Centre, and University of Toronto, Toronto, ON, CanadaAbstract: Exposure to prescription medications and illicit drug use during pregnancy has been associated with neonatal abstinence syndrome. The clinical presentation consists of neurological respiratory, gastrointestinal, and vasomotor disturbances. All infants require observation and supportive care to ensure appropriate adaptation and growth in the newborn period. A smaller percentage may also require additional pharmacotherapy, depending on the specific gestational substance exposure. Women should be counseled antenatally about the possible neonatal effects, and mother–baby dyad care should be implemented for this particular patient population.Keywords: neonatal withdrawal, opioids, marijuana, cocaine, benzodiazepines, selective serotonin reuptake inhibitors

  8. Review of clinical trials: update on oral insulin spray formulation.

    Science.gov (United States)

    Pozzilli, Paolo; Raskin, Philip; Parkin, Christopher G

    2010-02-01

    Large clinical trials have shown that improving glycaemic control significantly reduces the risk of long-term microvascular complications in type 1 (T1DM) and type 2 (T2DM) diabetes. Achieving optimal glycaemic control often requires the use of multiple daily insulin injections. Current approaches to insulin administration are less than optimal; many T2DM patients view insulin therapy as inconvenient and uncomfortable and may delay starting insulin therapy because of this. A new oral insulin spray formulation and delivery system provides an alternative to injectable and inhaled insulin. The system allows a liquid oral spray insulin formulation to be delivered into the mouth via an aerosolized spray. The oral insulin spray is a tasteless liquid aerosol mist formulation that is administered to the buccal mucosa using a proprietary delivery system. The active pharmaceutical ingredient is recombinant human insulin; however, the formulation behaves in a fashion more similar to the synthetic fast-acting insulin analogues. In clinical studies of healthy subjects and subjects with T1DM and T2DM, investigators have shown that the oral insulin spray was absorbed in direct relation to the amount given and had a faster onset and a shorter duration of action when compared with regular insulin given subcutaneously. In all of the studies conducted, the oral insulin spray was generally well tolerated. Some healthy individuals and subjects with T1DM experienced transient (1-2 min) mild dizziness during dosing; these symptoms were mild and self-limited. No changes in vital signs, laboratory values or physical examination results were noted. The ease of use of the insulin spray formulation may increase patient acceptance and treatment compliance, thereby potentially reducing complications and improving quality of life for patients with insulin-dependent diabetes. This article provides an overview of the safety profile and proposed mechanism of action of this insulin formulation and

  9. Suanzaoren Formulae for Insomnia: Updated Clinical Evidence and Possible Mechanisms

    Directory of Open Access Journals (Sweden)

    Qi-Hui Zhou

    2018-02-01

    Full Text Available Insomnia disorder is a widespread and refractory disease. Semen Ziziphi Spinosae, Suanzaoren, a well-known Chinese herbal medicine, has been used for treating insomnia for thousands of years. Here, we aimed to assess the available evidence of Chinese herbal formulae that contains Suanzaoren (FSZR for insomnia according to high-quality randomized controlled trials (RCTs and reviewed their possible mechanisms based on animal-based studies. Electronic searches were performed in eight databases from inception to November 2016. The primary outcome measures were polysomnography index and Pittsburgh sleep quality index. The secondary outcome measures were clinical effective rate and adverse events. The methodological quality of RCTs was assessed by Cochrane's collaboration tool, and only RCTs with positive for 4 out of 7 for the Cochrane risk of bias domains were included in analyses. Thirteen eligible studies with 1,454 patients were identified. Meta-analysis of high-quality RCTs showed that FSZR monotherapy was superior to placebo (P < 0.01; FSZR plus Diazepam was superior to Diazepam alone (P < 0.05; there were mixed results comparing FSZR with Diazepam (P > 0.05 or P < 0.05. Furthermore, FSZR caused fewer side effects than that of Diazepam. Suanzaoren contains complex mixtures of phytochemicals including sanjoinine A, Jujuboside A, spinosin and other flavonoids, which has sedative and hypnotic functions primarily mediated by the GABAergic and serotonergic system. In conclusion, the findings of present study supported that FSZR could be an alternative treatment for insomnia in clinic. FSZR exerted sedative and hypnotic actions mainly through the GABAergic and serotonergic system.

  10. Worldwide clinical safety assessment of gadoteridol injection: an update

    Energy Technology Data Exchange (ETDEWEB)

    Runge, V.M. [Department of Diagnostic Radiology, University of Kentucky, Lexington, KY 40536 (United States); Parker, J.R. [Department of Medical and Scientific Affairs, Bracco Diagnostics, Inc., P. O. Box 5225, Princeton, NJ 08543 (United States)

    1997-12-31

    Gadoteridol injection is a low molecular weight chelate complex of gadolinium (III) which is useful as a contrast agent for magnetic resonance imaging. A total of 2481 adult and pediatric subjects were studied with gadoteridol at doses from 0.025 to 0.3 mmol/kg in phase I-IIIb clinical trials in Europe and the United States. The study population had a mean age of 49 years, and included 119 patients under 18 years of age and 747 patients over 60 years of age. After 2656 administered injections of gadoteridol a total of 233 adverse events were recorded in 176 exposures, an incidence rate of 6.6 % irrespective of relationship to drug administration. The most frequently reported adverse events were nausea (1.5 %), taste perversion (0.9 %), and headache (0.6 %). All other adverse events occurred with an incidence of 0.5 % or less. This report confirms the excellent safety profile of gadoteridol in healthy subjects and patients with a variety of known or suspected pathologies. (orig.) With 3 tabs., 10 refs.

  11. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Leys Didier

    2008-01-01

    Full Text Available Cerebral venous thrombosis (CVT has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested

  12. Osteoarthritis: an update with relevance for clinical practice.

    Science.gov (United States)

    Bijlsma, Johannes W J; Berenbaum, Francis; Lafeber, Floris P J G

    2011-06-18

    Osteoarthritis is thought to be the most prevalent chronic joint disease. The incidence of osteoarthritis is rising because of the ageing population and the epidemic of obesity. Pain and loss of function are the main clinical features that lead to treatment, including non-pharmacological, pharmacological, and surgical approaches. Clinicians recognise that the diagnosis of osteoarthritis is established late in the disease process, maybe too late to expect much help from disease-modifying drugs. Despite efforts over the past decades to develop markers of disease, still-imaging procedures and biochemical marker analyses need to be improved and possibly extended with more specific and sensitive methods to reliably describe disease processes, to diagnose the disease at an early stage, to classify patients according to their prognosis, and to follow the course of disease and treatment effectiveness. In the coming years, a better definition of osteoarthritis is expected by delineating different phenotypes of the disease. Treatment targeted more specifically at these phenotypes might lead to improved outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. eHealth in cardiovascular medicine: A clinical update.

    Science.gov (United States)

    Saner, Hugo; van der Velde, Enno

    2016-10-01

    Demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations are posing great challenges to our healthcare systems. Rapid progress in computer sciences and information technologies have a great impact on the way healthcare will be delivered in the near future. This article describes opportunities and challenges of eHealth and telemedicine in the framework of our health systems and, in particular, in the context of today's cardiology services. The most promising applications of eHealth and telemedicine include: (a) prevention and lifestyle interventions; (b) chronic disease management including hypertension, diabetes and heart failure; (c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillators and implantable rhythm monitoring devices; (d) telerehabilitation. Major obstacles to the integration of eHealth and telemedicine into daily clinical practice include limited large-scale evidence, in particular, for cost-effectiveness, as well as lack of interoperability, inadequate or fragmented legal frameworks and lack of reimbursement. An important challenge for those involved in these new technologies will be to keep the main focus on patient's individual needs and to carefully evaluate the evidence behind the practice. © The European Society of Cardiology 2016.

  14. Hypertensive crisis: an update on clinical approach and management.

    Science.gov (United States)

    Ipek, Emrah; Oktay, Ahmet Afşin; Krim, Selim R

    2017-07-01

    Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively. Recent retrospective studies have demonstrated that emergency department (ED) referrals from an outpatient clinic or rapid BP-lowering strategies in the ED do not lead to improved outcomes in patients with HTN-U. HTN-C can be a de-novo manifestation or a complication of essential or secondary HTN. The presence of acute EOD is a major poor prognostic indicator in HTN-C. The main objectives of the management of HTN-C are distinction of HTN-E from HTN-U and appropriate risk stratification, prevention or regression of acute EOD due to severely elevated BP, prevention of recurrence of HTN-C with an effective long-term management plan and avoidance of rapid lowering of BP except in some special circumstances. The majority of patients with asymptomatic HTN-U can be safely managed in the outpatient setting without exposing them to the risks of aggressive BP lowering. However, patients with HTN-E require hospitalization, prompt treatment and close monitoring.

  15. Female sterilization: update on clinical efficacy, side effects and contraindications.

    Science.gov (United States)

    Gizzo, Salvatore; Bertocco, Anna; Saccardi, Carlo; Di Gangi, Stefania; Litta, Pietro Salvatore; D'antona, Donato; Nardelli, Giovanni Battista

    2014-10-01

    The aim of this review is to compare studies concerning female sterilization in order to define the most suitable approach and device for each patient considering timing, safety, cost-effectiveness, failure rate, complication rate and patient satisfaction. A systematic literature search was conducted in electronic databases MEDLINE-EMBASE-Sciencedirect and Cochrane Library between 2000 and 2012. All original descriptions, case reports, retrospective and review articles on tubal sterilization methods have been considered. Outcome measures were effectiveness, tolerability, procedure complications and female satisfaction. The ideal female sterilization system should be a simple, safe, highly efficient, easily learned, inexpensive, one-time procedure without negative side-effects. Nowadays, the trans-cervical approach is associated with minimal postoperative pain, allowing short hospitalization and fast resumption of daily activities. Laparoscopic and laparotomic approaches are considered second choices, since, particularly in developing countries, the transcervical hysteroscopic methods will increasingly spread within gynaecological clinical practice. Safety issues, hospital stay, costs and surgeons' experience are important factors in decision-making of the method for female sterilization. Hysteroscopic devices should be preferred when possible. The counselling time remains a fundamental step in choice. The decision concerning method depends on the setting, the surgeon's experience, the country's economical development and the woman's preference.

  16. European recommendations for the clinical use of HIV drug resistance testing: 2011 update

    DEFF Research Database (Denmark)

    Vandamme, Anne-Mieke; Camacho, Ricardo J; Ceccherini-Silberstein, Francesca

    2011-01-01

    is needed after treatment failure. The Panel recommends genotyping in most situations, using updated and clinically evaluated interpretation systems. It is mandatory that laboratories performing HIV resistance tests take part regularly in external quality assurance programs, and that they consider storing...... samples in situations where resistance testing cannot be performed as recommended. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically......The European HIV Drug Resistance Guidelines Panel, established to make recommendations to clinicians and virologists, felt that sufficient new information has become available to warrant an update of its recommendations, explained in both pocket guidelines and this full paper. The Panel makes...

  17. [Update of clinical programs using hadrontherapy 2008-2012].

    Science.gov (United States)

    Habrand, J-L; Datchary, J; Alapetite, C; Bolle, S; Calugaru, V; Feuvret, L; Helfre, S; Stefan, D; Delacroix, S; Demarzi, L; Dendale, R

    2013-10-01

    Hadrontherapy, a type of radiation therapy dealing with heavy charged particles, has become for the past decade one of the most sophisticated and attractive approach in the management of cancer. This is related with major technological innovations that have made available, at a relatively cheap cost, compact proton accelerators equipped with rotational gantries. The implementation of pencil beam scanning should also make treatment planning and delivery much easier and faster than conventional approaches. Until now, approximately 100,000 patients have been treated with protons worldwide. Due to more complex technological and biological challenges, light ion therapy - mainly carbon ions - has developed at a lower pace, except in Japan where most of the 15,000 treated patients have been enrolled. Current indications for protons include firstly, locally aggressive tumours non or incompletely resected, that are located close to critical normal structures: ocular melanomas, skull base and spinal canal low grade sarcomas, selected ENT carcinomas (like adenoid cystic); secondly, improvement of tolerance to radiations: delayed, mainly in paediatric malignancies, due to the exquisite sensitivity of organs under development (including to carcinogenesis); immediate, on bone marrow, mucosae… mainly in concomitant radiation-chemotherapy interactions (tested in esophagus, and lung). Most promising indications for carbon ions include inoperable highly radioresistant primaries, such as mucosal melanomas, high grade bone and soft part sarcomas, and pancreatic carcinomas. Altered fractionations are also of interests that could translate in clinical and economical benefits. Controversies have risen whether more common indications, like prostate, should also be explored. Copyright © 2013. Published by Elsevier SAS.

  18. Update on clinical trials in home mechanical ventilation.

    Science.gov (United States)

    Hodgson, Luke E; Murphy, Patrick B

    2016-02-01

    Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV.

  19. Inborn errors of purine metabolism: clinical update and therapies.

    Science.gov (United States)

    Balasubramaniam, Shanti; Duley, John A; Christodoulou, John

    2014-09-01

    Inborn errors of purine metabolism exhibit broad neurological, immunological, haematological and renal manifestations. Limited awareness of the phenotypic spectrum, the recent descriptions of newer disorders and considerable genetic heterogeneity, have contributed to long diagnostic odysseys for affected individuals. These enzymes are widely but not ubiquitously distributed in human tissues and are crucial for synthesis of essential nucleotides, such as ATP, which form the basis of DNA and RNA, oxidative phosphorylation, signal transduction and a range of molecular synthetic processes. Depletion of nucleotides or accumulation of toxic intermediates contributes to the pathogenesis of these disorders. Maintenance of cellular nucleotides depends on the three aspects of metabolism of purines (and related pyrimidines): de novo synthesis, catabolism and recycling of these metabolites. At present, treatments for the clinically significant defects of the purine pathway are restricted: purine 5'-nucleotidase deficiency with uridine; familial juvenile hyperuricaemic nephropathy (FJHN), adenine phosphoribosyl transferase (APRT) deficiency, hypoxanthine phosphoribosyl transferase (HPRT) deficiency and phosphoribosyl-pyrophosphate synthetase superactivity (PRPS) with allopurinol; adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) deficiencies have been treated by bone marrow transplantation (BMT), and ADA deficiency with enzyme replacement with polyethylene glycol (PEG)-ADA, or erythrocyte-encapsulated ADA; myeloadenylate deaminase (MADA) and adenylosuccinate lyase (ADSL) deficiencies have had trials of oral ribose; PRPS, HPRT and adenosine kinase (ADK) deficiencies with S-adenosylmethionine; and molybdenum cofactor deficiency of complementation group A (MOCODA) with cyclic pyranopterin monophosphate (cPMP). In this review we describe the known inborn errors of purine metabolism, their phenotypic presentations, established diagnostic methodology and recognised

  20. MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE.

    Science.gov (United States)

    Sobrado, Carlos Walter; Sobrado, Lucas Faraco

    2016-01-01

    Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using

  1. MO-F-BRCD-01: Stereotactic Body Radiation Therapy: Updates on Clinical, Biological, and Physics/QA:SBRT (Part 1): Biological and Clinical Updates.

    Science.gov (United States)

    Read, P

    2012-06-01

    Stereotactic Body Radiation Therapy (SBRT) is an important form of cancer therapy with increasingly broad application across a spectrum of tumor types in primary and metastatic settings. In this presentation the radiation biology, clinical experience from various trials, and cautionary updates on normal tissue tolerances will be presented. The effective radiobiology of SBRT and hypofractionated courses of therapy has become more evident with the increasing reports of retrospective clinical outcomes and prospective clinical trial results. Current open multi-institutional national cooperative trials will be reviewed. Accumulating clinical experiences are yielding new insights into practical aspects of tumor and normal tissue responses to high dose per fraction treatment. Indeed, SBRT has produced profound tumoricidal and ablative effects, however there is potential for grave toxicity and this demands that clinicians be knowledgeable regarding normal tissue tolerances for various hypofractionated courses. As a final note, the technology associated with SBRT has evolved remarkably in the last decade, and procedures that originally required hours to plan, with cumbersome quality assurance methods, arduous set-up times, and long protracted deliveries can now be performed in ever shorter time periods. Given these technology improvements and recognizing the great palliative potential of hypofractionated radiation therapy to relieve cancer symptoms quickly and efficiently, a new strategy to deliver SBRT in a single session called STAT RAD is presented for discussion. © 2012 American Association of Physicists in Medicine.

  2. European recommendations for the clinical use of HIV drug resistance testing: 2011 update

    DEFF Research Database (Denmark)

    Vandamme, Anne-Mieke; Camacho, Ricardo J; Ceccherini-Silberstein, Francesca

    2011-01-01

    is needed after treatment failure. The Panel recommends genotyping in most situations, using updated and clinically evaluated interpretation systems. It is mandatory that laboratories performing HIV resistance tests take part regularly in external quality assurance programs, and that they consider storing......The European HIV Drug Resistance Guidelines Panel, established to make recommendations to clinicians and virologists, felt that sufficient new information has become available to warrant an update of its recommendations, explained in both pocket guidelines and this full paper. The Panel makes...... the following recommendations concerning the indications for resistance testing: for HIV-1 (i) test earliest sample for protease and reverse transcriptase drug resistance in drug-naive patients with acute or chronic infection; (ii) test protease and reverse transcriptase drug resistance at virologic failure...

  3. The impact of marijuana policies on youth: clinical, research, and legal update.

    Science.gov (United States)

    2015-03-01

    This policy statement is an update of the American Academy of Pediatrics policy statement "Legalization of Marijuana: Potential Impact on Youth," published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents' use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future. Copyright © 2015 by the American Academy of Pediatrics.

  4. Neurostimulation in clinical and sub-clinical eating disorders: a systematic update of the literature.

    Science.gov (United States)

    Dalton, Bethan; Bartholdy, Savani; Campbell, Iain C; Schmidt, Ulrike

    2018-01-07

    Whilst psychological therapies are the main approach to treatment of eating disorders (EDs), advances in aetiological research suggest the need for the development of more targeted, brain-focused treatments. A range of neurostimulation approaches, most prominently repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS), are rapidly emerging as potential novel interventions. We have previously reviewed these techniques as potential treatments of EDs. To provide an update of the literature examining the effects of DBS, rTMS and tDCS on eating behaviours, body weight and associated symptoms in people with EDs and relevant analogue populations. Using PRISMA guidelines, we reviewed articles in PubMed, Web of Science, and PsycINFO from 1st January 2013 until 14th August 2017, to update our earlier search. Studies assessing the effects of neurostimulation techniques on eating and weight-related outcomes in people with EDs and relevant analogue populations were included. Data from both searches were combined. We included a total of 32 studies (526 participants); of these, 18 were newly identified by our update search. Whilst findings are somewhat mixed for bulimia nervosa, neurostimulation techniques have shown potential in the treatment of other EDs, in terms of reduction of ED and associated symptoms. Studies exploring cognitive, neural, and hormonal correlates of these techniques are also beginning to appear. Neurostimulation approaches show promise as treatments for EDs. As yet, large well-conducted randomised controlled trials are lacking. More information is needed about treatment targets, stimulation parameters and mechanisms of action. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Updating to the WAIS-III and WMS-III: considerations for research and clinical practice.

    Science.gov (United States)

    Tulsky, David S; Ledbetter, Mark F

    2000-09-01

    The Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Wechsler Memory Scale-Revised (WMS-R) are the most commonly used intelligence and memory scales in both clinical and neuropsychology. In 1997, updated versions of these instruments (the WAIS-III and WMS-III) were published. Because of the extensive use of the WAIS-R and WMS-R in the field and the body of accumulated research, there is naturally some reluctance by clinicians and researchers to update to the new versions. It is sometimes difficult for clinicians who test individuals on repeated occasions to switch over to the new versions of the scales because of the difficulty of interpreting score discrepancy between the 2 versions. Researchers, especially those conducting longitudinal research, have a similar difficulty in changing measurement devices because of the possible threat of internal validity. This article reviews the substantive revisions of the scales and outlines those issues that users should take into consideration when updating to the new versions.

  6. Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy

    Directory of Open Access Journals (Sweden)

    Marc Maegele

    2017-06-01

    Full Text Available Uncontrolled hemorrhage and subsequent trauma-induced coagulopathy (TIC are still the principle causes for preventable death after trauma and early detection and aggressive management have been associated with reduced mortality. Despite increasing knowledge about trauma resuscitation, best practice to treat this newly defined entity is still under debate. A synopsis of best current knowledge with reference to the updated European trauma guideline on the management of severe trauma hemorrhage and TIC is presented. The implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome is advocated.

  7. American Society of Clinical Oncology Policy Statement Update: Genetic and Genomic Testing for Cancer Susceptibility.

    Science.gov (United States)

    Robson, Mark E; Bradbury, Angela R; Arun, Banu; Domchek, Susan M; Ford, James M; Hampel, Heather L; Lipkin, Stephen M; Syngal, Sapna; Wollins, Dana S; Lindor, Noralane M

    2015-11-01

    The American Society of Clinical Oncology (ASCO) has long affirmed that the recognition and management of individuals with an inherited susceptibility to cancer are core elements of oncology care. ASCO released its first statement on genetic testing in 1996 and updated that statement in 2003 and 2010 in response to developments in the field. In 2014, the Cancer Prevention and Ethics Committees of ASCO commissioned another update to reflect the impact of advances in this area on oncology practice. In particular, there was an interest in addressing the opportunities and challenges arising from the application of massively parallel sequencing-also known as next-generation sequencing-to cancer susceptibility testing. This technology introduces a new level of complexity into the practice of cancer risk assessment and management, requiring renewed effort on the part of ASCO to ensure that those providing care to patients with cancer receive the necessary education to use this new technology in the most effective, beneficial manner. The purpose of this statement is to explore the challenges of new and emerging technologies in cancer genetics and provide recommendations to ensure their optimal deployment in oncology practice. Specifically, the statement makes recommendations in the following areas: germline implications of somatic mutation profiling, multigene panel testing for cancer susceptibility, quality assurance in genetic testing, education of oncology professionals, and access to cancer genetic services. © 2015 by American Society of Clinical Oncology.

  8. Addressing adolescent pregnancy with legislation.

    Science.gov (United States)

    Montgomery, Tiffany M; Folken, Lori; Seitz, Melody A

    2014-01-01

    Adolescent pregnancy is a concern among many women's health practitioners. While it is practical and appropriate to work to prevent adolescent pregnancy by educating adolescents in health care clinics, schools and adolescent-friendly community-based organizations, suggesting and supporting legislative efforts to reduce adolescent pregnancy can help address the issue on an even larger scale. This article aims to help nurses better understand current legislation that addresses adolescent pregnancy, and to encourage support of future adolescent pregnancy prevention legislation. © 2014 AWHONN.

  9. Investigation of the Practices, Legislation, Supply Chain, and Regulation of Opioids for Clinical Pain Management in Southern Africa: A Multi-sectoral, Cross-National, Mixed Methods Study.

    Science.gov (United States)

    Namisango, Eve; Allsop, Matthew J; Powell, Richard A; Friedrichsdorf, Stefan J; Luyirika, Emmanuel B K; Kiyange, Fatia; Mukooza, Edward; Ntege, Chris; Garanganga, Eunice; Ginindza-Mdluli, Mavis Ntombifuthi; Mwangi-Powell, Faith; Mondlane, Lidia Justino; Harding, Richard

    2018-03-01

    Sub-Saharan Africa faces an increasing incidence and prevalence of life-limiting and life-threatening conditions. These conditions are associated with a significant burden of pain linked to high morbidity and disability that is poorly assessed and undertreated. Barriers to effective pain management partly relate to lack of access to opioid analgesia and challenges in their administration. To identify country-specific and broader regional barriers to access, as well as the administration of opioids, and generate recommendations for advancing pain management in Southern Africa. A parallel mixed methods design was used across three countries: Mozambique, Swaziland, and Zimbabwe. Three activities were undertaken: 1) a review of regulatory and policy documentation, 2) group interviews, and 3) a self-administered key informant survey. Barriers to accessing opioid analgesics for medical use include overly restrictive controlled medicines' laws; use of stigmatizing language in key documents; inaccurate actual opioid consumption estimation practices; knowledge gaps in the distribution, storage, and prescription of opioids; critical shortage of prescribers; and high out-of-pocket financial expenditures for patients against a backdrop of high levels of poverty. Policies and relevant laws should be updated to ensure that the legislative environment supports opioid access for pain management. Action plans for improving pain treatment for patients suffering from HIV or non-communicable diseases should address barriers at the different levels of the supply chain that involve policymakers, administrators, and service providers. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Methamphetamine: An Update on Epidemiology, Pharmacology, Clinical Phenomenology, and Treatment Literature

    Science.gov (United States)

    Courtney, Kelly E.; Ray, Lara A.

    2014-01-01

    Background Despite initial reports of a decline in use in the early 2000s, methamphetamine remains a significant public health concern with known neurotoxic and neurocognitive effects to the user. The goal of this review is to update the literature on methamphetamine use and addiction since its assent to peak popularity in 1990s. Methods Specifically, we first review recent epidemiological reports with a focus on methamphetamine accessibility, changes in use and disorder prevalence rates over time, and accurate estimates of the associated burden of care to the individual and society. Second, we review methamphetamine pharmacology literature with emphasis on the structural and functional neurotoxic effects associated with repeated use of the drug. Third, we briefly outline the findings on methamphetamine-related neurocognitive deficits as assessed via behavioral and neuroimaging paradigms. Lastly, we review the clinical presentation of methamphetamine addiction and the evidence supporting the available psychosocial and pharmacological treatments within the context of an addiction biology framework. Conclusion Taken together, this review provides a broad-based update of the available literature covering methamphetamine research over the past two decades and concludes with recommendations for future research. PMID:25176528

  11. Update of the International Consensus on Palliative Radiotherapy Endpoints for Future Clinical Trials in Bone Metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Hoskin, Peter; Mitera, Gunita; Zeng Liang; Lutz, Stephen; Roos, Daniel; Hahn, Carol; Linden, Yvette van der; Hartsell, William; Kumar, Eshwar

    2012-01-01

    Purpose: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. Methods and Materials: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Results: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. Conclusion: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

  12. Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature.

    Science.gov (United States)

    Courtney, Kelly E; Ray, Lara A

    2014-10-01

    Despite initial reports of a decline in use in the early 2000s, methamphetamine remains a significant public health concern with known neurotoxic and neurocognitive effects to the user. The goal of this review is to update the literature on methamphetamine use and addiction since its assent to peak popularity in 1990s. We first review recent epidemiological reports with a focus on methamphetamine accessibility, changes in use and disorder prevalence rates over time, and accurate estimates of the associated burden of care to the individual and society. Second, we review methamphetamine pharmacology literature with emphasis on the structural and functional neurotoxic effects associated with repeated use of the drug. Third, we briefly outline the findings on methamphetamine-related neurocognitive deficits as assessed via behavioral and neuroimaging paradigms. Lastly, we review the clinical presentation of methamphetamine addiction and the evidence supporting the available psychosocial and pharmacological treatments within the context of an addiction biology framework. Taken together, this review provides a broad-based update of the available literature covering methamphetamine research over the past two decades and concludes with recommendations for future research. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples.

    Science.gov (United States)

    Hickel, Reinhard; Peschke, Arnd; Tyas, Martin; Mjör, Ivar; Bayne, Stephen; Peters, Mathilde; Hiller, Karl-Anton; Randall, Ross; Vanherle, Guido; Heintze, Siegward D

    2010-08-01

    In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria) and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface has different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib ( www.e-calib.info ) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations which are presented as high-quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for eight of the 16 clinical criteria is available in the program: "Surface lustre"; "Staining (surface, margins)"; "Color match and translucency"; Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

  14. FDI World Dental Federation - clinical criteria for the evaluation of direct and indirect restorations. Update and clinical examples.

    Science.gov (United States)

    Hickel, Reinhard; Peschke, Arnd; Tyas, Martin; Mjör, Ivar; Bayne, Stephen; Peters, Mathilde; Hiller, Karl-Anton; Randall, Ross; Vanherle, Guido; Heintze, Siegward D

    2010-08-01

    In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria), and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface have different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib (www.e-calib.info) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations, which are presented as high quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for 8 of the 16 clinical criteria is available in the program: "Surface luster"; "Staining (surface, margins)"; "Color match and translucency"; "Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

  15. Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

    Science.gov (United States)

    Masters, Gregory A.; Temin, Sarah; Azzoli, Christopher G.; Giaccone, Giuseppe; Baker, Sherman; Brahmer, Julie R.; Ellis, Peter M.; Gajra, Ajeet; Rackear, Nancy; Schiller, Joan H.; Smith, Thomas J.; Strawn, John R.; Trent, David; Johnson, David H.

    2015-01-01

    Purpose To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non–small-cell lung cancer (NSCLC). Methods An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. Results This guideline update reflects changes in evidence since the previous guideline. Recommendations There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is

  16. Clinical Update: The Risk of Opioid Toxicity and Naloxone Use in Operational K9s.

    Science.gov (United States)

    Palmer, Lee E; Gautier, Anais

    The increasing use of opioids (e.g., fentanyl, carfentanil) for illicit drug manufacturing poses a potential life-threatening hazard to law enforcement officers and first responders (e.g., EMS, fire and rescue) who may unknowingly come into contact with these drugs during the course of their daily activities. Similarly, Operational canines (OpK9s) of all disciplines-detection (drug, explosive, accelerant), patrol, tracking, search and rescue, and others-are at risk for accidental illicit opioid exposure. The most serious adverse effect of opioid exposure is respiratory depression leading to slow, shallow breathing or complete cessation of voluntary breathing (respiratory arrest). Naloxone, an opioid antagonist, is the antidote for reversing the effects of an opioid overdose in both humans and OpK9s. This clinical update describes the potential risks associated with opioid exposure as well as the use of naloxone as it pertains to the OpK9. 2017.

  17. Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches.

    Science.gov (United States)

    Chodara, Ann M; Wattiaux, Aimée; Bartels, Christie M

    2017-04-01

    ᅟ: The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

  18. Dendritic cell-based vaccine in advanced melanoma: update of clinical outcome.

    Science.gov (United States)

    Ridolfi, Laura; Petrini, Massimiliano; Fiammenghi, Laura; Granato, Anna Maria; Ancarani, Valentina; Pancisi, Elena; Brolli, Claudia; Selva, Mirna; Scarpi, Emanuela; Valmorri, Linda; Nicoletti, Stefania Vittoria Luisa; Guidoboni, Massimo; Riccobon, Angela; Ridolfi, Ruggero

    2011-12-01

    Dendritic cells (DCs) are unique specialized antigen-presenting cells capable of priming naive T cells and inducing antigen-specific cytotoxic T lymphocytes. This study presents an update of clinical results from a DC-based phase I-II clinical vaccine trial in stage IV melanoma. From 2003 to 2010, 27 patients with metastatic melanoma were treated with mature DCs pulsed with autologous tumor lysate and keyhole limpet hemocyanin and with subcutaneous low-dose interleukin-2. Delayed-type hypersensitivity (DTH) tests for in-vivo immunomonitoring were performed at baseline and every four vaccinations thereafter. Two complete, two mixed and six partial responses, and five stable diseases were observed (overall response, 37.0%; clinical benefit, 55.5%). All 15 responders showed DTH positivity. A median overall survival of 22.9 months [95% confidence interval (CI): 13.4-61.3] for DTH-positive patients (19) and 4.8 months (95% CI: 3.9-11.9) for DTH-negative patients (8; log rank=7.26; P=0.007) was observed. The overall median overall survival was 16 months (95% CI: 9-33). Our results would seem to highlight a relationship between positive-DTH test and an improved survival.

  19. Update on clinical trials of growth factors and anabolic steroids in cachexia and wasting1234

    Science.gov (United States)

    Gullett, Norleena P; Hebbar, Gautam

    2010-01-01

    This article and others that focused on the clinical features, mechanisms, and epidemiology of skeletal muscle loss and wasting in chronic diseases, which include chronic kidney disease, cancer, and AIDS, were presented at a symposium entitled "Cachexia and Wasting: Recent Breakthroughs in Understanding and Opportunities for Intervention," held at Experimental Biology 2009. The clinical and anabolic efficacy of specific growth factors and anabolic steroids (eg, growth hormone, testosterone, megestrol acetate) in malnutrition and other catabolic states has been the subject of considerable research during the past several decades. Research on the effects of these agents in cachexia or wasting conditions, characterized by progressive loss of skeletal muscle and adipose tissue, focused on patients with AIDS in the early 1990s, when the devastating effects of the loss of body weight, lean body mass, and adipose tissue were recognized as contributors to these patients' mortality. These same agents have also been studied as methods to attenuate the catabolic responses observed in cancer-induced cachexia and in wasting induced by chronic obstructive pulmonary disease, congestive heart failure, renal failure, and other conditions. This article provides an updated review of recent clinical trials that specifically examined the potential therapeutic roles of growth hormone, testosterone, oxandrolone, and megestrol acetate and emerging data on the orexigenic peptide ghrelin, in human cachexia and wasting. PMID:20164318

  20. An update on Experimental and Clinical Psychopharmacology: Something old, something new, something borrowed, something green?

    Science.gov (United States)

    Stoops, William W

    2018-02-01

    In this editorial, the author provides an update on Experimental and Clinical Psychopharmacology in several areas. First, the journal will continue to accept original research reports and full reviews as it has in past years. The author hopes to still receive outstanding manuscripts in the journal's primary areas of strength, such as clinical research on alcohol use and cigarette smoking. The journal will also continue to publish an annual special issue on a current topic in the field. Second, the journal now accepts brief communications, brief reviews, and case reports. The authors sees these new formats as opportunities to publish cutting edge, novel findings that may not be suitable as original research reports or full reviews-such work would previously not have fit with the journal. Third, the author has borrowed an idea from colleagues who serve as editors for other journals in the field: the addition of an editorial fellowship at Experimental and Clinical Psychopharmacology . Finally, the "something green" part of the title refers to the new, bright green cover color of the print version of the journal. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  1. Assessing the potential clinical impact of reciprocal drug approval legislation on access to novel therapeutics in the USA: a cohort study.

    Science.gov (United States)

    Larochelle, Matthieu; Downing, Nicholas S; Ross, Joseph S; David, Frank S

    2017-02-08

    To quantify the potential effect of reciprocal approval legislation on access to clinically impactful therapeutics in the USA. A cohort study. New therapeutics approved by the Food and Drug Administration (FDA), European Medicines Agency (EMA) and/or Health Canada between 2000 and 2010. Characteristics of new therapeutics approved by the EMA and/or Health Canada before the FDA, including mechanistic novelty, likely clinical impact, size of the affected population and FDA review outcome. From 2001 to 2010, 282 drugs were approved in the USA, Europe or Canada, including 172 (61%) first approved in the USA, 24 (9%) never approved in the USA, and 86 (30%) approved in the USA after Europe and/or Canada. Of the 110 new drugs approved in Europe and/or Canada before the USA, 37 (34%) had a novel mechanisms of action compared with drugs already approved by the FDA, but only 10 (9%) were for conditions lacking alternate available therapies in the USA at the time of ex-US approval-of which the majority (9/10; 90%) were indicated for rare diseases. 12 of the 37 agents with novel mechanisms of action approved first in Europe and/or Canada (32%) had their initial FDA submissions rejected for safety reasons-including 2 drugs that were ultimately withdrawn from the market in Europe due to safety concerns. If enacted, reciprocal approval legislation would most likely benefit only a small number of US patients receiving treatment for rare diseases, and the benefit may be somewhat mitigated by an increased exposure to harms. 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/.

  2. Schizotypal personality questionnaire--brief revised (updated): An update of norms, factor structure, and item content in a large non-clinical young adult sample.

    Science.gov (United States)

    Davidson, Charlie A; Hoffman, Lesa; Spaulding, William D

    2016-04-30

    This study updates and provides evidence for the dimensionality, reliability, and validity of a standard instrument for detection and measurement of schizotypy in non-clinical young adults. Schizotypy represents a set of traits on which both nonclinical and schizophrenia-spectrum populations vary meaningfully. These traits are linked to biological, cognitive, and social dimensions of serious mental illness (SMI), to clinical and subclinical variation in personal and social functioning, and to risk for SMI. Reliable and valid identification of schizotypal traits has important implications for clinical practice and research. Four consecutive independent samples of undergraduates were administered the SPQ-BR (N=2552). Confirmatory factor analyses suggested a minor item wording change improved reliability, and this Updated questionnaire was implemented for three-quarters of the sample (SPQ-BRU). A, single-order, nine-factor structure had acceptable psychometric properties. The best fitting second-order structure included four higher-order factors that distinguished Social Anxiety and Interpersonal factors. This differentiation was supported by differential relationships with treatment history. The Disorganized factor had the greatest unique relationship with personal and family treatment history. With few exceptions, factor loadings showed stability across samples. Overall, the higher-order and lower-order factors of schizotypy demonstrated reliability and convergent and discriminant validity; detailed psychometric data are presented in a supplement. Copyright © 2016. Published by Elsevier Ireland Ltd.

  3. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

    NARCIS (Netherlands)

    Pappas, P.G.; Kauffman, C.A.; Andes, D.; Benjamin Jr., D.K.; Calandra, T; Edwards, J.E.; Filler, S.G.; Fisher, J.F.; Kullberg, B.J.; Ostrosky-Zeichner, L.; Reboli, A.C.; Rex, J.H.; Walsh, T.J.; Sobel, J.D.

    2009-01-01

    Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases

  4. The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features.

    Science.gov (United States)

    van Huijstee, Jytte; Vermetten, Eric

    2017-10-21

    Recently, a dissociative subtype of post-traumatic stress disorder (PTSD) has been included in the DSM-5. This review focuses on the clinical and neurobiological features that distinguish the dissociative subtype of PTSD from non-dissociative PTSD. Clinically, the dissociative subtype of PTSD is associated with high PTSD severity, predominance of derealization and depersonalization symptoms, a more significant history of early life trauma, and higher levels of comorbid psychiatric disorders. Furthermore, PTSD patients with dissociative symptoms exhibit different psychophysiological and neural responses to the recall of traumatic memories. While individuals with non-dissociative PTSD exhibit an increased heart rate, decreased activation of prefrontal regions, and increased activation of the amygdala in response to traumatic reminders, individuals with the dissociative subtype of PTSD show an opposite pattern. It has been proposed that dissociation is a regulatory strategy to restrain extreme arousal in PTSD through hyperinhibition of limbic regions. In this research update, promises and pitfalls in current research studies on the dissociative subtype of PTSD are listed. Inclusion of the dissociative subtype of PTSD in the DSM-5 stimulates research on the prevalence, symptomatology, and neurobiology of the dissociative subtype of PTSD and poses a challenge to improve treatment outcome in PTSD patients with dissociative symptoms.

  5. Hepatitis C virus drug resistance associated substitutions and their clinical relevance: Update 2018.

    Science.gov (United States)

    Sorbo, Maria C; Cento, Valeria; Di Maio, Velia C; Howe, Anita Y M; Garcia, Federico; Perno, Carlo F; Ceccherini-Silberstein, Francesca

    2018-03-01

    Nowadays, due to the development of potent Direct-Acting Antiviral Agents (DAAs) that specifically target NS3, NS5A and NS5B viral proteins, several new and highly efficacious options to treat chronic Hepatitis C virus (HCV) infection are available. The natural presence of resistance associated substitutions (RASs), as well as their rapid emergence during incomplete drug-pressure, are intrinsic characteristics of HCV that greatly affect treatment outcome and the chances to achieve a virolgical cure. To date, a high number of RASs in NS3, NS5A, and NS5B have been associated in vivo and/or in vitro with reduced susceptibility to DAAs, but no comprehensive RASs list is available. This review thus provides an updated, systematic overview of the role of RASs to currently approved DAAs or in phase II/III of clinical development against HCV-infection, discriminating their impact in different HCV-genotypes and DAAs, providing assistance for a fruitful use of HCV resistance testing in clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Basic Technology and Clinical Applications of the Updated Model of Laser Speckle Flowgraphy to Ocular Diseases

    Directory of Open Access Journals (Sweden)

    Tetsuya Sugiyama

    2014-08-01

    Full Text Available Laser speckle flowgraphy (LSFG allows for quantitative estimation of blood flow in the optic nerve head (ONH, choroid and retina, utilizing the laser speckle phenomenon. The basic technology and clinical applications of LSFG-NAVI, the updated model of LSFG, are summarized in this review. For developing a commercial version of LSFG, the special area sensor was replaced by the ordinary charge-coupled device camera. In LSFG-NAVI, the mean blur rate (MBR has been introduced as a new parameter. Compared to the original LSFG model, LSFG-NAVI demonstrates a better spatial resolution of the blood flow map of human ocular fundus. The observation area is 24 times larger than the original system. The analysis software can separately calculate MBRs in the blood vessels and tissues (capillaries of an entire ONH and the measurements have good reproducibility. The absolute values of MBR in the ONH have been shown to linearly correlate with the capillary blood flow. The Analysis of MBR pulse waveform provides parameters including skew, blowout score, blowout time, rising and falling rates, flow acceleration index, acceleration time index, and resistivity index for comparing different eyes. Recently, there have been an increasing number of reports on the clinical applications of LSFG-NAVI to ocular diseases, including glaucoma, retinal and choroidal diseases.

  7. Multiple Myeloma: Clinical Updates From the American Society of Hematology Annual Meeting 2016.

    Science.gov (United States)

    Terpos, Evangelos

    2017-06-01

    The novel clinical data for plasma cell neoplasms (smoldering myeloma, multiple myeloma (MM) and AL-amyloidosis) that were presented in the 2016 Annual Meeting of the American Society of Hematology are summarized here. Data from large phase 3 studies for newly diagnosed MM patients who are eligible for autologous transplantation (EMN02, MRC XI and StaMINA trials) are described along with the results of phase 2 studies using novel anti-myeloma drug combinations for induction, consolidation and maintenance as first line therapy. Recent updates of previous important studies in the field of both newly diagnosed (FIRST) and relapsed/refractory MM (POLLUX, CASTOR) are also reported. Moreover, the results of clinical studies with the use of anti-myeloma drugs with new mechanisms of action, including pembrolizumab, selinexor, venetoclax and monoclonal antibodies, are discussed. All these data provide the basis for possible changes in the way we manage myeloma in the near future trying to "cure" the disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. 2011 SREB Legislative Briefing

    Science.gov (United States)

    Gaines, Gale F., Comp.

    2011-01-01

    The "2011 Legislative Briefing" is a topical summary of state budget and legislative actions that affect elementary, secondary and higher education across the Southern Regional Education Board (SREB) region. It outlines actions in areas such as tax and spending legislation, assistance to local districts, tuition and fees, student…

  9. An Update on Candida tropicalis Based on Basic and Clinical Approaches

    Science.gov (United States)

    Zuza-Alves, Diana L.; Silva-Rocha, Walicyranison P.; Chaves, Guilherme M.

    2017-01-01

    Candida tropicalis has emerged as one of the most important Candida species. It has been widely considered the second most virulent Candida species, only preceded by C. albicans. Besides, this species has been recognized as a very strong biofilm producer, surpassing C. albicans in most of the studies. In addition, it produces a wide range of other virulence factors, including: adhesion to buccal epithelial and endothelial cells; the secretion of lytic enzymes, such as proteinases, phospholipases, and hemolysins, bud-to-hyphae transition (also called morphogenesis) and the phenomenon called phenotypic switching. This is a species very closely related to C. albicans and has been easily identified with both phenotypic and molecular methods. In addition, no cryptic sibling species were yet described in the literature, what is contradictory to some other medically important Candida species. C. tropicalis is a clinically relevant species and may be the second or third etiological agent of candidemia, specifically in Latin American countries and Asia. Antifungal resistance to the azoles, polyenes, and echinocandins has already been described. Apart from all these characteristics, C. tropicalis has been considered an osmotolerant microorganism and this ability to survive to high salt concentration may be important for fungal persistence in saline environments. This physiological characteristic makes this species suitable for use in biotechnology processes. Here we describe an update of C. tropicalis, focusing on all these previously mentioned subjects. PMID:29081766

  10. Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015.

    Science.gov (United States)

    Homma, Yukio; Ueda, Tomohiro; Tomoe, Hikaru; Lin, Alex Tl; Kuo, Hann-Chorng; Lee, Ming-Huei; Oh, Seung-June; Kim, Joon Chul; Lee, Kyu-Sung

    2016-07-01

    Clinical guidelines for interstitial cystitis and hypersensitive bladder have been updated as of 2015. The guidelines define interstitial cystitis by the presence of hypersensitive bladder symptoms (discomfort, pressure or pain in the bladder usually associated with urinary frequency and nocturia) and bladder pathology, after excluding other diseases explaining symptoms. Interstitial cystitis is further classified by bladder pathology; either Hunner type interstitial cystitis with Hunner lesions or non-Hunner type interstitial cystitis with mucosal bleeding after distension in the absence of Hunner lesions. Hypersensitive bladder refers to a condition, where hypersensitive bladder symptoms are present, but bladder pathology or other explainable diseases are unproven. Interstitial cystitis and hypersensitive bladder severely affect patients' quality of life as a result of disabling symptoms and/or comorbidities. Reported prevalence suggestive of these disorders varies greatly from 0.01% to >6%. Pathophysiology would be an interaction of multiple factors including urothelial dysfunction, inflammation, neural hyperactivity, exogenous substances and extrabladder disorders. Definite diagnosis of interstitial cystitis and hypersensitive bladder requires cystoscopy with or without hydrodistension. Most of the therapeutic options lack a high level of evidence, leaving a few as recommended therapeutic options. © 2016 The Japanese Urological Association.

  11. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update.

    Science.gov (United States)

    Graham, Stephen M; Cuevas, Luis E; Jean-Philippe, Patrick; Browning, Renee; Casenghi, Martina; Detjen, Anne K; Gnanashanmugam, Devasena; Hesseling, Anneke C; Kampmann, Beate; Mandalakas, Anna; Marais, Ben J; Schito, Marco; Spiegel, Hans M L; Starke, Jeffrey R; Worrell, Carol; Zar, Heather J

    2015-10-15

    Consensus case definitions for childhood tuberculosis have been proposed by an international expert panel, aiming to standardize the reporting of cases in research focusing on the diagnosis of intrathoracic tuberculosis in children. These definitions are intended for tuberculosis diagnostic evaluation studies of symptomatic children with clinical suspicion of intrathoracic tuberculosis, and were not intended to predefine inclusion criteria into such studies. Feedback from researchers suggested that further clarification was required and that these case definitions could be further improved. Particular concerns were the perceived complexity and overlap of some case definitions, as well as the potential exclusion of children with acute onset of symptoms or less severe disease. The updated case definitions proposed here incorporate a number of key changes that aim to reduce complexity and improve research performance, while maintaining the original focus on symptomatic children suspected of having intrathoracic tuberculosis. The changes proposed should enhance harmonized classification for intrathoracic tuberculosis disease in children across studies, resulting in greater comparability and the much-needed ability to pool study results. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. e-ready legislation

    DEFF Research Database (Denmark)

    Hvingel, Line; Baaner, Lasse

    In general, digital society challenges traditional modes of legislation and rulings. Dissimilar compositions of the legislation and non-comparable spatial representations of the legal content makes traditional legislation unfit for e-Government. Lacking attention may lead to the undermining...... of the trustworthiness of administration systems. On the other hand, a successful adaption of legislation to a digital setup could help promote good service towards citizens and businesses, and according to land administration theories maybe even promote societal sustainability in large. Based on studies on Denmark......, different challenges within digital land administration solutions are demonstrated. This paper discusses how legislation needs to change in order to be ‘e-Ready’....

  13. Legislative and regulatory framework of radioactive waste management in Romania

    International Nuclear Information System (INIS)

    Cutoiu, D.

    2000-01-01

    The paper intent is to present an update on the Romanian legislative and regulatory framework in the area of radioactive waste management. Based on the experiences gained by the National Commission for Nuclear Activities Control in the past years, the recent legislative initiatives related to the coherent radwaste management policy at the national level are presented. (author)

  14. Memory updating in sub-clinical eating disorder: differential effects with food and body shape words.

    Science.gov (United States)

    Fenton, Olivia; Ecker, Ullrich K H

    2015-04-01

    The present study investigated how eating disorder (ED) relevant information is updated in working memory in people with high vs. low scores on a measure of eating disorder pathology (the Eating Disorder Examination Questionnaire, EDE-Q). Participants performed two memory updating tasks. One was a neutral control task using digits; the other task involved food words and words relating to body-shape, and provided measures of updating speed and post-updating recall. We found that high EDE-Q participants (1) showed no sign of general memory updating impairment as indicated by performance in the control task; (2) showed a general recall deficit in the task involving ED-relevant stimuli, suggesting a general distraction of cognitive resources in the presence of ED-related items; (3) showed a relative facilitation in the recall of food words; and (4) showed quicker updating toward food words and relatively slower updating toward body-shape-related words. Results are discussed in the context of cognitive theories of eating disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Food Irradiation. Standing legislation

    International Nuclear Information System (INIS)

    Verdejo S, M.

    1997-01-01

    The standing legislation in Mexico on food irradiation matter has its basis on the Constitutional Policy of the Mexican United States on the 4 Th. article by its refers to Secretary of Health, 27 Th. article to the Secretary of Energy and 123 Th. of the Secretary of Work and Social Security. The laws and regulations emanated of the proper Constitution establishing the general features which gives the normative frame to this activity. The general regulations of Radiological Safety expedited by the National Commission for Nuclear Safety and Safeguards to state the specifications which must be fulfill the industrial installations which utilizing ionizing radiations, between this line is founded, just as the requirements for the responsible of the radiological protection and the operation of these establishments. The project of Regulation of the General Health Law in matter of Sanitary Control of Benefits and Services, that in short time will be officialized, include a specific chapter on food irradiation which considers the International Organizations Recommendations and the pertaining harmonization stated for Latin America, which elaboration was in charge of specialized group where Mexico was participant. Additionally, the Secretary of Health has a Mexican Official Standard NOM-033-SSA1-1993 named 'Food irradiation; permissible doses in foods, raw materials and support additives' standing from the year 1995, where is established the associated requirements to the control registers, service constancies and dose limits for different groups of foods, moreover of the specific guidelines for its process. This standard will be adequate considering the updating Regulation of Benefits and Services and the limits established the Regulation for Latin America. The associated laws that cover in general terms it would be the requirements for food irradiation although such term is not manageable. (Author)

  16. American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    OpenAIRE

    Azzoli, Christopher G.; Giaccone, Giuseppe; Temin, Sarah

    2010-01-01

    ASCO published a guideline on use of chemotherapy in advanced stage non–small-cell lung cancer in 1997. The latest update covers treatment with chemotherapy and biologic agents and reviews literature from 2002 to 2009.

  17. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies

    OpenAIRE

    Iffland, Kerstin; Grotenhermen, Franjo

    2017-01-01

    Abstract Introduction: This literature survey aims to extend the comprehensive survey performed by Bergamaschi et al. in 2011 on cannabidiol (CBD) safety and side effects. Apart from updating the literature, this article focuses on clinical studies and CBD potential interactions with other drugs. Results: In general, the often described favorable safety profile of CBD in humans was confirmed and extended by the reviewed research. The majority of studies were performed for treatment of epileps...

  18. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE-2017 UPDATE.

    Science.gov (United States)

    Cobin, Rhoda H; Goodman, Neil F

    2017-07-01

    EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1. the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for

  19. Digital Privacy Legislation Awareness

    OpenAIRE

    Henry Foulds; Magda Huisman; Gunther R. Drevin

    2013-01-01

    Privacy is regarded as a fundamental human right and it is clear that the study of digital privacy is an important field. Digital privacy is influenced by new and constantly evolving technologies and this continuous change makes it hard to create legislation to protect people's privacy from being exploited by misuse of these technologies. This study aims to benefit digital privacy legislation efforts by evaluating the awareness and perceived importance of digital privacy legislation among...

  20. Update on value of the anion gap in clinical diagnosis and laboratory evaluation.

    Science.gov (United States)

    Lolekha, P H; Vanavanan, S; Lolekha, S

    2001-05-01

    Anion gap (AG) is a calculated value commonly used in clinical practice. It approximates the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in serum. At present, the reference range of anion gap has been lowered from 8-16 to 3-11 mmol/l because of the changes in technique for measuring electrolyte. However, clinicians and textbooks still refer and use the old reference value of 8-16 mmol/l. This may lead to misinterpretation of the value of anion gap. Our study updated the value of anion gap in clinical diagnosis and laboratory evaluation. Criteria for using anion gap were also suggested. We analyzed serum electrolyte using the Beckman Synchron CX5. The anion gap was calculated from the formula: [Na(+)-(Cl(-)+HCO(3)(-))]. We estimated the reference range using the non-parametric percentile estimation method. The reference range of anion gap obtained from 124 healthy volunteers was 5-12 mmol/l, which was low and confirmed the reports from other studies (3-11 mmol/l) using ion-selective electrode. From the retrospective study on the 6868 sets of serum electrolyte among hospitalized patients, we found the incidences of normal, increased, and decreased anion gaps were 59.5%, 37.6%, and 2.9%, respectively. The mean and central 90% range of increased anion gap were 16 and 13-20 mmol/l, which was lower than those reported in previous study (25 and 19-28 mmol/l). Anion gap exceeding 24 mmol/l was rare. The mean and central 90% range of decreased anion gap were 3 and 2-4 mmol/l, which were lower than those reported in previous study (6 and 3-8 mmol/l). The value of less than 2 mmol/l was rare. The most common causes of increased anion gap (hypertensive disease, chronic renal failure, malignant neoplasms, diabetes mellitus and heart diseases) and decreased anion gap (liver cirrhosis and nephrotic syndrome) in this study were similar to those in previous studies. We found two cases of IgG multiple myeloma with anion gap of 2 mmol

  1. Legislation and regulation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-09-01

    This document presents the fulfilling of the Brazilian obligations under the Convention on Nuclear Safety. The Chapter 3 of the document contains some details about the Brazilian legislation and regulation, the legislative and regulatory framework, regulatory body and responsibility of the license holder.

  2. The 2007 Legislative Briefing

    Science.gov (United States)

    Grove, Jeffrey; Gaines, Gale F., Comp.

    2007-01-01

    "The 2007 Legislative Briefing" is a topical summary of actions during the 2006 legislative sessions that affect education in the 16 SREB states. Topics include state budgets and the economy, tax and revenue, school finance, teacher compensation, licensure, certification and evaluation of teachers, strengthening elementary and secondary…

  3. Impact of updated European Consensus Guidelines on the management of neonatal respiratory distress syndrome on clinical outcome of preterm infants.

    Science.gov (United States)

    Smolarova, S; Kocvarova, L; Matasova, K; Zibolen, M; Calkovska, A

    2015-01-01

    European Consensus Guidelines (ECG) on the management of respiratory distress syndrome (RDS) have been developed and updated twice since 2007 reflecting changes in practice as new evidence emerges. The aim of this study was to evaluate the progress in clinical outcome of babies after the implementation of the updated ECG in 2010. Forty-eight neonates born in 2002-2003 (Group 02/03; n = 15) and in 2012-2013 (Group 12/13; n = 33) at gestational age of 26.2 ± 1.7 weeks were included into this retrospective study. Resuscitation procedures, ventilation support, and postnatal administration of surfactant were assessed. In Group 12/13, compared with Group 02/03, there was a higher rate of maternal corticosteroid prophylactic treatment (33 % vs. 0 %, p newborns improved considerably over the decade resulting in a significant reduction of mortality and morbidity.

  4. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012

    DEFF Research Database (Denmark)

    Claudon, Michel; Dietrich, Christoph F; Choi, Byung Ihn

    2013-01-01

    Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some...

  5. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    Anon.

    2011-01-01

    This chapter of Nuclear Law Bulletin gathers some documents about national legislative and regulatory activities: - Belgium: Amendment of the Act on classification and security clearances, certifications and security notifications; Czech Republic: Resolution of the government of the Czech Republic on the time schedule of preparatory works for enlarging the nuclear power plant Temelin; Finland: Temporary Amendment to the Nuclear Liability Act; Ireland: Merchant Shipping Act; Romania: Emergency Ordinance on the identification, designation and protection of critical infrastructures; Emergency Ordinance on the control regime of dual-use items; Amendment to the Act on the safe conduct of nuclear activities; Nuclear safety norms on design and construction of nuclear power plants and nuclear safety norms on siting of nuclear power plants; United Kingdom: Establishment of the Office for Nuclear Regulation; United States: Waste Confidence Decision and Rule Update; Response to recent events in Japan

  6. Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery*

    OpenAIRE

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2013-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mil...

  7. CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT—2013 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY★

    OpenAIRE

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, M. Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2013-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mil...

  8. Knowledge of termination of pregnancy (TOP) legislation and attitudes toward TOP clinical training among medical students attending two South African universities.

    Science.gov (United States)

    Wheeler, Stephanie B; Zullig, Leah; Jungerwirth, Robert; Reeve, Bryce B; Buga, Geoffrey A; Morroni, Chelsea

    2012-01-01

    Provision of safe, voluntary, termination of pregnancy (TOP) in South Africa is challenged by an insufficient number of TOP-trained clinicians. Medical students' understanding of TOP legality and their attitudes toward TOP training are indicators for future service provision. We administered a 63-item questionnaire to explore these issues at the University of Cape Town and Walter Sisulu University. Ordinary least squares regression assessed predictors of TOP legislation knowledge and training attitudes. Of 1308 students, 95% knew that TOP was legal in South Africa, but few (27%) understood the specific provisions of the legislation beyond 13 weeks' gestation. Sixty-three percent desired more information about TOP. In multivariate models, female, white and sexually experienced students and students more advanced in school had better legislation knowledge (all p < .01). Attending religious services regularly (p < .01) was associated with lack of support for TOP training, whereas being in a relationship (p < .01) was associated with support for TOP training.

  9. Progress in the clinical development and utilization of vision prostheses: an update.

    Science.gov (United States)

    Brandli, Alice; Luu, Chi D; Guymer, Robyn H; Ayton, Lauren N

    2016-01-01

    Vision prostheses, or "bionic eyes", are implantable medical bionic devices with the potential to restore rudimentary sight to people with profound vision loss or blindness. In the past two decades, this field has rapidly progressed, and there are now two commercially available retinal prostheses in the US and Europe, and a number of next-generation devices in development. This review provides an update on the development of these devices and a discussion on the future directions for the field.

  10. Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

    Science.gov (United States)

    Elhoufi, Ashraf; Ahmadi, Arezoo; Asnaashari, Amir Mohammad Hashem; Davarpanah, Mohammad Ali; Bidgoli, Behrooz Farzanegan; Moghaddam, Omid Moradi; Torabi-Nami, Mohammad; Abbasi, Saeed; El-Sobky, Malak; Ghaziani, Ali; Jarrahzadeh, Mohammad Hossein; Shahrami, Reza; Shirazian, Farzad; Soltani, Farhad; Yazdinejad, Homeira; Zand, Farid

    2014-01-01

    Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of wide-spectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxiliary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients’ clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts’ opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. PMID:25374806

  11. Legislative Districts - 1990

    Data.gov (United States)

    Kansas Data Access and Support Center — Each coverage contains a COVER-ID field that defines the House or Senate district number. Kansas House and Senate districts were created by the Legislative Research...

  12. Specific Statistics of Czech Legislation

    Czech Academy of Sciences Publication Activity Database

    Novák, František

    2015-01-01

    Roč. 5, č. 3 (2015), s. 162-183 ISSN 1805-8396 Institutional support: RVO:68378122 Keywords : legislation * quantitative description of legislation * structure and development of the legislation in the CR Subject RIV: AG - Legal Sciences

  13. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2012-01-01

    This section gathers the following national legislative and regulatory activities sorted by country: Bulgaria: General legislation; Czech Republic: General legislation; France: General legislation, Regulatory infrastructure and activity; Germany: General legislation; India: Liability and compensation, Organisation and structure; Ireland: Radiation protection, General legislation; Korea (Republic of): Organisation and structure; Lithuania: Regulatory infrastructure and activity, Radioactive waste management, Radiation protection, international cooperation, Nuclear safety; Poland: General legislation; Romania: Environmental protection; Russian Federation: Radioactive waste management; Slovenia: Nuclear safety; Spain: Liability and compensation, Nuclear security; Sweden: Nuclear safety; Turkey: Radiation protection, Regulatory infrastructure and activity, Nuclear safety, Liability and compensation; United States: General legislation

  14. Status of legislation

    International Nuclear Information System (INIS)

    Warner, C.

    1982-01-01

    The status of the House legislation, the major differences between the House and Senate legislation and a preview of what is likely to take place during the lame duck session in December are presented. The House legislation provides: long-term program leading toward permanent disposal of nuclear waste; an interim program for storage and for expansion of storage space for spent fuel; provides an R and D component through what is called a test and evaluation facility; an alternative long-term storage program based on a proposal to be completed by the Department of Energy on what's called Monitored Retrievable Storage; full upfront financing of the program through user fees based on contracts between the government and the users of the nuclear waste disposal services

  15. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

    OpenAIRE

    Waldman, Amy; Ghezzi, Angelo; Bar-Or, Amit; Mikaeloff, Yann; Tardieu, Marc; Banwell, Brenda

    2014-01-01

    The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood—and adolescent—onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sc...

  16. Status of legislation

    International Nuclear Information System (INIS)

    Gilman, P.

    1982-01-01

    The Senate passed 69 to 6 legislation to provide a comprehensive nuclear waste policy. This legislation restates some things the Department of Energy is already doing. It modifies some others, and in some cases it provides new authorities, principally in those areas of state participation and in the area of financing of the program. Some of the provisions of the Senate bill are: schedule for a number of items in the disposal of nuclear waste, the first being an area referred to as away-from reactor storage; a timetable for geologic disposal; a plan for the long-term storage of nuclear waste for spent fuels; a financing mechanism; and states participation

  17. Implementing the legislation

    International Nuclear Information System (INIS)

    Silverstrom, L.

    1982-01-01

    Leon Silverstrom explained how nuclear waste disposal legislation would be implemented. The legislation provides a framework that recognizes the tremendous number of views and opinions on the subject and provides a mechanism that will allow all these interests to be expressed before final decisions are reached. Implementing procedures are outlined for: (1) the final repository; (2) interim or last resort storage; (3) research and development; (4) the monitored retrievable storage phases. The whole process will involve: environmental assessments and licensing requirements for each phase; construction of a test and evaluation facility; provision for sharing information with the states and interested parties; and procedures for public hearings and state rejection of propoped sites

  18. Progress in the clinical development and utilization of vision prostheses: an update

    Directory of Open Access Journals (Sweden)

    Brandli A

    2016-05-01

    Full Text Available Alice Brandli, Chi D Luu, Robyn H Guymer, Lauren N Ayton Centre for Eye Research Australia, Department of Surgery (Ophthalmology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia Abstract: Vision prostheses, or “bionic eyes”, are implantable medical bionic devices with the potential to restore rudimentary sight to people with profound vision loss or blindness. In the past two decades, this field has rapidly progressed, and there are now two commercially available retinal prostheses in the US and Europe, and a number of next-generation devices in development. This review provides an update on the development of these devices and a discussion on the future directions for the field. Keywords: vision prostheses, bionic eye, vision restoration, blindness, medical bionics, retinitis pigmentosa

  19. Acute colonic diverticulitis: an update on clinical classification and management with MDCT correlation.

    Science.gov (United States)

    Barat, Maxime; Dohan, Anthony; Pautrat, Karine; Boudiaf, Mourad; Dautry, Raphael; Guerrache, Youcef; Pocard, Marc; Hoeffel, Christine; Eveno, Clarisse; Soyer, Philippe

    2016-09-01

    Currently, the most commonly used classification of acute colonic diverticulitis (ACD) is the modified Hinchey classification, which corresponds to a slightly more complex classification by comparison with the original description. This modified classification allows to categorize patients with ACD into four major categories (I, II, III, IV) and two additional subcategories (Ia and Ib), depending on the severity of the disease. Several studies have clearly demonstrated the impact of this classification for determining the best therapeutic approach and predicting perioperative complications for patients who need surgery. This review provides an update on the classification of ACD along with a special emphasis on the corresponding MDCT features of the different categories and subcategories. This modified Hinchey classification should be known by emergency physicians, radiologists, and surgeons in order to improve patient care and management because each category has a specific therapeutic approach.

  20. Molecular mechanisms and clinical applications of nordihydroguaiaretic acid (NDGA) and its derivatives: An update

    Science.gov (United States)

    Lü, Jian-Ming; Nurko, Jacobo; Weakley, Sarah M.; Jiang, Jun; Kougias, Panagiotis; Lin, Peter H.; Yao, Qizhi; Chen, Changyi

    2010-01-01

    Summary Creosote bush, Larrea tridentata, is known as chaparral or greasewood in the United States and as gobernadora or hediondilla in Mexico. Nordihydroguaiaretic acid (NDGA), the main metabolite of the creosote bush, has been shown to have promising applications in the treatment of multiple diseases, including cardiovascular diseases, neurological disorders and cancers. Creosote bush is a promising agent of North American herbal medicine, and it has extensive pharmacological effects and specific mechanisms of actions. This review provides an update of recent in vitro and in vivo research about NDGA and describes experimental studies using NDGA as antioxidant. Also, potential medical uses based on the effects of NDGA on the cardiovascular, immune and neurological systems; cancer; tissue engineering; as well as pharmacokinetics and toxicity are discussed. PMID:20424564

  1. The impact of marijuana policies on youth: clinical, research, and legal update.

    Science.gov (United States)

    Ammerman, Seth; Ryan, Sheryl; Adelman, William P

    2015-03-01

    This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement. Copyright © 2015 by the American Academy of Pediatrics.

  2. A systematic decision-making process on the need for updating clinical practice guidelines proved to be feasible in a pilot study.

    Science.gov (United States)

    Becker, Monika; Jaschinski, Thomas; Eikermann, Michaela; Mathes, Tim; Bühn, Stefanie; Koppert, Wolfgang; Leffler, Andreas; Neugebauer, Edmund; Pieper, Dawid

    2018-04-01

    The objective of this study was to test and evaluate a new decision-making process on the need for updating within the update of a German clinical practice guideline (CPG). The pilot study comprised (1) limited searches in Pubmed to identify new potentially relevant evidence, (2) an online survey among the members of the CPG group to assess the need for update, and (3) a consensus conference for determination and prioritization of guideline sections with a high need for update. Subsequently, we conducted a second online survey to evaluate the procedure. The searches resulted in 902 abstracts that were graded as new potentially relevant evidence. Twenty five of 39 members of the CPG group (64%) participated in the online survey. Seventy six percent of those took part in the second online survey. The evaluation study found on average a grade of support of the procedure regarding the determination of the need for update of 3.65 (standard deviation: 0.76) on a likert scale with 1 = "no support" to 5 = "very strong support." The conducted procedure presents a systematic approach for assessing whether and to what extent a CPG requires updating and enables setting priorities for which particular guideline section to update within a CPG. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Recent US legislative actions

    International Nuclear Information System (INIS)

    Daniel, P.

    1987-01-01

    A view on legislative events in the US from the outside is presented. The author comments on the general principles and advantages of free trade against the possibility of an embargo into the US on uranium, on the issue of sanctions against South Africa, and Namibia, and how these issues affect the world market for uranium

  4. Nuclear Regulatory legislation

    International Nuclear Information System (INIS)

    1984-06-01

    This compilation of statutes and material pertaining to nuclear regulatory legislation through the 97th Congress, 2nd Session, has been prepared by the Office of the Executive Legal Director, U.S. Nuclear Regulatory Commission, with the assistance of staff, for use as an internal resource document

  5. Notoriety for Profit Legislation.

    Science.gov (United States)

    1987-01-01

    this study is a relatively new and important area in victimology known as "Notoriety For Profit Legislation". The study contains descrip- tions...in the area of victimology require further study. I BIBLIOGRAPHY Books Bard, Morton, and Dawn Sangrey. The Crime Victims Book. New York: Basic Books

  6. Clinical applications of scanning electron microscopy and energy dispersive X-ray analysis in dermatology--an up-date

    International Nuclear Information System (INIS)

    Forslind, B.

    1988-01-01

    Dermatological papers comprising scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) analysis data published 1983 through 1986 in international journals are reviewed, as an update to our 1984 paper on Clinical applications of scanning electron microscopy and X-ray microanalysis in dermatology. The present paper not only deals with a review of recent publications in this area but also presents the application of microincineration to hair and cryosectioned freeze-dried skin specimens. Examples of the increased contrast obtained in hair cross sections are presented and a discussion on the feasibility of microincineration at analysis of hair and skin cross sections is given. Particle probe analysis (EDX: energy dispersive X-ray analysis and PMP: proton microprobe analysis) as applied to hair and skin samples are presented with stress put on the proton probe analysis. The complementarity of EDX and PMP is demonstrated and future applications are suggested. 75 references

  7. An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

    Science.gov (United States)

    Friedman, Melissa A.; Fernandez, Mercedes; Backer, Lorraine C.; Dickey, Robert W.; Bernstein, Jeffrey; Schrank, Kathleen; Kibler, Steven; Stephan, Wendy; Gribble, Matthew O.; Bienfang, Paul; Bowen, Robert E.; Degrasse, Stacey; Flores Quintana, Harold A.; Loeffler, Christopher R.; Weisman, Richard; Blythe, Donna; Berdalet, Elisa; Ayyar, Ram; Clarkson-Townsend, Danielle; Swajian, Karen; Benner, Ronald; Brewer, Tom; Fleming, Lora E.

    2017-01-01

    Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties. PMID:28335428

  8. An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

    Directory of Open Access Journals (Sweden)

    Melissa A. Friedman

    2017-03-01

    Full Text Available Ciguatera Fish Poisoning (CFP is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs, diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008 and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

  9. Challenges in translating plasma proteomics from bench to bedside: update from the NHLBI Clinical Proteomics Programs

    OpenAIRE

    Gerszten, Robert E.; Accurso, Frank; Bernard, Gordon R.; Caprioli, Richard M.; Klee, Eric W.; Klee, George G.; Kullo, Iftikhar; Laguna, Theresa A.; Roth, Frederick P.; Sabatine, Marc; Srinivas, Pothur; Wang, Thomas J.; Ware, Lorraine B.

    2008-01-01

    The emerging scientific field of proteomics encompasses the identification, characterization, and quantification of the protein content or proteome of whole cells, tissues, or body fluids. The potential for proteomic technologies to identify and quantify novel proteins in the plasma that can function as biomarkers of the presence or severity of clinical disease states holds great promise for clinical use. However, there are many challenges in translating plasma proteomics from bench to bedsid...

  10. AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION): 5-Year Update.

    Science.gov (United States)

    Barbhaiya, Medha; Andrade, Danieli; Erkan, Doruk

    2016-10-01

    Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) is the first-ever international network created to design and conduct large-scale, multicenter clinical trials and research in persistently antiphospholipid antibody (aPL)-positive patients. Since its inception in 2010, the APS ACTION has made important strides toward our goal of international research collaboration and data sharing. Through the dedication and hard work of 50 APS ACTION members, collaborative international projects are currently underway including a multicenter web-based registry and repository of aPL-positive patients, a randomized controlled clinical trial assessing the efficacy of hydroxychloroquine for primary thrombosis prevention in persistently aPL-positive but thrombosis-free patients, standardization of aPL testing through the use of core laboratories worldwide, identification of the limitations in the existing aPL/APS literature, and conducting observational research studies to further our understanding of the disease. Thus far, APS ACTION has held annual workshops and summits with the aim of facilitating international collaboration and developing initiatives to recruit young scholars to APS research. This paper describes updates related to the organization's structure, ongoing research efforts, and recent accomplishments and discusses future directions.

  11. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.

    Science.gov (United States)

    Iffland, Kerstin; Grotenhermen, Franjo

    2017-01-01

    Introduction: This literature survey aims to extend the comprehensive survey performed by Bergamaschi et al. in 2011 on cannabidiol (CBD) safety and side effects. Apart from updating the literature, this article focuses on clinical studies and CBD potential interactions with other drugs. Results: In general, the often described favorable safety profile of CBD in humans was confirmed and extended by the reviewed research. The majority of studies were performed for treatment of epilepsy and psychotic disorders. Here, the most commonly reported side effects were tiredness, diarrhea, and changes of appetite/weight. In comparison with other drugs, used for the treatment of these medical conditions, CBD has a better side effect profile. This could improve patients' compliance and adherence to treatment. CBD is often used as adjunct therapy. Therefore, more clinical research is warranted on CBD action on hepatic enzymes, drug transporters, and interactions with other drugs and to see if this mainly leads to positive or negative effects, for example, reducing the needed clobazam doses in epilepsy and therefore clobazam's side effects. Conclusion: This review also illustrates that some important toxicological parameters are yet to be studied, for example, if CBD has an effect on hormones. Additionally, more clinical trials with a greater number of participants and longer chronic CBD administration are still lacking.

  12. Nuclear Regulatory Legislation

    International Nuclear Information System (INIS)

    1989-08-01

    This compilation of statutes and material pertaining to nuclear regulatory legislation through the 100th Congress, 2nd Session, has been prepared by the Office of the General Counsel, US Nuclear Regulatory Commission, with the assistance of staff, for use as an internal resource document. Persons using this document are placed on notice that it may not be used as an authoritative citation in lieu of the primary legislative sources. Furthermore, while every effort has been made to ensure the completeness and accuracy of this material, neither the United States Government, the Nuclear Regulatory Commission, nor any of their employees makes any expressed or implied warranty or assumes liability for the accuracy or completeness of the material presented in this compilation

  13. Mesenchymal stem cell therapy in retinal and optic nerve diseases: An update of clinical trials.

    Science.gov (United States)

    Labrador-Velandia, Sonia; Alonso-Alonso, María Luz; Alvarez-Sanchez, Sara; González-Zamora, Jorge; Carretero-Barrio, Irene; Pastor, José Carlos; Fernandez-Bueno, Iván; Srivastava, Girish Kumar

    2016-11-26

    Retinal and optic nerve diseases are degenerative ocular pathologies which lead to irreversible visual loss. Since the advanced therapies availability, cell-based therapies offer a new all-encompassing approach. Advances in the knowledge of neuroprotection, immunomodulation and regenerative properties of mesenchymal stem cells (MSCs) have been obtained by several preclinical studies of various neurodegenerative diseases. It has provided the opportunity to perform the translation of this knowledge to prospective treatment approaches for clinical practice. Since 2008, several first steps projecting new treatment approaches, have been taken regarding the use of cell therapy in patients with neurodegenerative pathologies of optic nerve and retina. Most of the clinical trials using MSCs are in I/II phase, recruiting patients or ongoing, and they have as main objective the safety assessment of MSCs using various routes of administration. However, it is important to recognize that, there is still a long way to go to reach clinical trials phase III-IV. Hence, it is necessary to continue preclinical and clinical studies to improve this new therapeutic tool. This paper reviews the latest progress of MSCs in human clinical trials for retinal and optic nerve diseases.

  14. Draft Legislative Proposals

    DEFF Research Database (Denmark)

    Turcan, Romeo V.; Bugaian, Larisa; Niculita, Angela

    2015-01-01

    the objectives of the legislative proposals; discusses risks and challenges that HE in Moldova faces today and in the next 10-15 years; identifies expected outcomes; identifies basic principles on which the process will be founded; proposes a new structure for the HE sector; offers an example...... and responsibilities; suggests a distinct separation between governance and management; suggests teaching and research funding formulae based on inputs and outputs; and outlines a new National Qualifications Framework....

  15. Nuclear regulatory legislation: 102d Congress

    International Nuclear Information System (INIS)

    1993-10-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include: The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection

  16. Nuclear regulatory legislation, 102d Congress

    International Nuclear Information System (INIS)

    1993-10-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection

  17. Nuclear regulatory legislation, 101st Congress

    International Nuclear Information System (INIS)

    1991-06-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 101st Congress, 2nd Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include The Atomic Energy Act of 1954, as amended: Energy Reorganization Act of 1974, as amended; Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statues and treaties on export licensing, nuclear non-proliferation, and environmental protection

  18. Neuroimaging in psychiatry: an update on neuroimaging in the clinical setting.

    Science.gov (United States)

    Power, Brian D; Nguyen, T; Hayhow, B; Looi, Jcl

    2016-04-01

    We offered guidance on the role of structural and functional neuroimaging modalities for the general psychiatrist and for trainees in the clinical setting. We outlined the utility of neuroimaging modalities in the clinical setting, specifically with a view to understanding the pathophysiology of manifestations of disease. Both structural and functional neuroimaging modalities have a clear role in diagnostic evaluation in the spectrum of neurodegenerative disorders. Whilst the role of neuroimaging in patients with mood, anxiety and psychotic disorders is less clear, structural and functional imaging modalities have utility in the clinical setting in the form of diagnostic refinement and in understanding the pathophysiology of disorders, towards explaining manifestations and planning treatment. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  19. Diffuse intrinsic pontine gliomas: A systematic update on clinical trials and biology

    NARCIS (Netherlands)

    Jansen, M. H. A.; van Vuurden, D. G.; Vandertop, W. P.; Kaspers, G. J. L.

    2012-01-01

    Patients with diffuse intrinsic pontine gliomas (DIPG) have a poor prognosis. Although DIPG constitute only 10-15% of all pediatric brain tumors, they are the main cause of death in this group. Despite 26 clinical trials in newly diagnosed DIPG in the past 5 years (including several targeted

  20. Cartilage repair by mesenchymal stem cells: Clinical trial update and perspectives

    Directory of Open Access Journals (Sweden)

    Wayne Yuk-wai Lee

    2017-04-01

    The translational potential of this article: This review summarises recent MSC-related clinical research that focuses on cartilage repair. We also propose a novel possible translational direction for hyaline cartilage formation and a new paradigm making use of extra-cellular signalling and epigenetic regulation in the application of MSCs for cartilage repair.

  1. Malaria Vaccine Adjuvants: Latest Update and Challenges in Preclinical and Clinical Research

    Directory of Open Access Journals (Sweden)

    Elena Mata

    2013-01-01

    Full Text Available There is no malaria vaccine currently available, and the most advanced candidate has recently reported a modest 30% efficacy against clinical malaria. Although many efforts have been dedicated to achieve this goal, the research was mainly directed to identify antigenic targets. Nevertheless, the latest progresses on understanding how immune system works and the data recovered from vaccination studies have conferred to the vaccine formulation its deserved relevance. Additionally to the antigen nature, the manner in which it is presented (delivery adjuvants as well as the immunostimulatory effect of the formulation components (immunostimulants modulates the immune response elicited. Protective immunity against malaria requires the induction of humoral, antibody-dependent cellular inhibition (ADCI and effector and memory cell responses. This review summarizes the status of adjuvants that have been or are being employed in the malaria vaccine development, focusing on the pharmaceutical and immunological aspects, as well as on their immunization outcomings at clinical and preclinical stages.

  2. Malaria vaccine adjuvants: latest update and challenges in preclinical and clinical research.

    Science.gov (United States)

    Mata, Elena; Salvador, Aiala; Igartua, Manoli; Hernández, Rosa María; Pedraz, José Luis

    2013-01-01

    There is no malaria vaccine currently available, and the most advanced candidate has recently reported a modest 30% efficacy against clinical malaria. Although many efforts have been dedicated to achieve this goal, the research was mainly directed to identify antigenic targets. Nevertheless, the latest progresses on understanding how immune system works and the data recovered from vaccination studies have conferred to the vaccine formulation its deserved relevance. Additionally to the antigen nature, the manner in which it is presented (delivery adjuvants) as well as the immunostimulatory effect of the formulation components (immunostimulants) modulates the immune response elicited. Protective immunity against malaria requires the induction of humoral, antibody-dependent cellular inhibition (ADCI) and effector and memory cell responses. This review summarizes the status of adjuvants that have been or are being employed in the malaria vaccine development, focusing on the pharmaceutical and immunological aspects, as well as on their immunization outcomings at clinical and preclinical stages.

  3. Clinical Use and Mechanisms of Infliximab Treatment on Inflammatory Bowel Disease: A Recent Update

    Science.gov (United States)

    Guo, Yuan; Lu, Nonghua; Bai, Aiping

    2013-01-01

    The pathogenesis and treatment of inflammatory bowel disease (IBD) have been recently advanced, while it is still challenged with high morbidity and poor prognosis. Infliximab, a monoclonal antibody of tumor necrosis factor (TNF), has emerged as an efficient treatment with many clinical benefits such as quick disease activity reduction and IBD patient life quality improvement. However, the biological effects of infliximab on IBD need to be elucidated. This paper reviewed the clinical use and recently advanced biological action of infliximab on IBD. By forming the stable complex with the soluble or the membrane form of TNF in fluid environment or on cell surface of immune cell, fibroblast, endothelium, and epithelium, infliximab quenches TNF activity and performs the important biological actions which lead to amelioration and remission of immune responses. The mechanisms of infliximab treatment for IBD were intensively discussed. The recent advances on two topics including predictors and side effects of infliximab treatment were also reviewed. PMID:23484133

  4. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2015-01-01

    This section treats of the following National legislative and regulatory activities: 1 - Canada: Liability and compensation; 2 - France: Liability and compensation; Nuclear safety and radiological protection; 3 - Greece: Organisation and structure; 4 - Hungary: General legislation; 5 - India: Liability and compensation; 6 - Japan: Liability and compensation; 7 - Korea: Liability and compensation; 8 - Lithuania: General legislation; Transport of radioactive material; 9 - Slovak Republic: International co-operation; Liability and compensation; 10 - Slovenia: General legislation; 11 - Switzerland: Liability and compensation; 12 - United States: Radioactive waste management

  5. Information report on state legislation

    International Nuclear Information System (INIS)

    Landau, M.

    1983-06-01

    Legislation that would consent to the Central Interstate Low-Level Radioactive Waste Compact has been introduced into Congress as H.R. 3002. Similar legislation is expected to be introduced into the Senate soon. This is the second compact consent legislation to be introduced into Congress this year - the first was the Northwest Compact, introduced in January. States in the Central Compact are AR, KS, LA, NE and OK. Enacted and introduced radioactive waste management legislation in various states is summarized

  6. International environmental legislation; Internationales Umweltrecht

    Energy Technology Data Exchange (ETDEWEB)

    Proelss, Alexander (ed.) [Trier Univ. (Germany)

    2017-07-01

    The book on international environmental legislation includes the following contributions: Development, sources and actors concerning the international environmental legislation, cross-national environmental justice, principles of the international environmental legislation, environmental protection by lawsuit, environmental protection and human right, environmental protection and trading, responsibility and liability, peaceful settlement of disputes, climatic change, preservation and sustainable use of the biodiversity, protection of air and space, oceanic protection, protection of inland waters, protection of the Antarctic and Arctic environment, waste and hazardous materials legislation.

  7. Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application.

    Science.gov (United States)

    Schulte, Brian C; Wu, Wesley; Rosen, Ted

    2015-09-01

    Azelaic acid is a complex molecule with many diverse activities. The latter include anti-infective and anti-inflammatory action. The agent also inhibits follicular keratinization and epidermal melanogenesis. Due to the wide variety of biological activities, azelaic acid has been utilized as a management tool in a broad spectrum of disease states and cutaneous disorders. This paper reviews the clinical utility of azelaic acid, noting the quality of the evidence supporting each potential use.

  8. Clinical review: Update on neurally adjusted ventilatory assist - report of a round-table conference

    Science.gov (United States)

    2012-01-01

    Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA. PMID:22715815

  9. [Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use].

    Science.gov (United States)

    Arbizu, J; Luquin, M R; Abella, J; de la Fuente-Fernández, R; Fernandez-Torrón, R; García-Solís, D; Garrastachu, P; Jiménez-Hoyuela, J M; Llaneza, M; Lomeña, F; Lorenzo-Bosquet, C; Martí, M J; Martinez-Castrillo, J C; Mir, P; Mitjavila, M; Ruiz-Martínez, J; Vela, L

    2014-01-01

    Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson's disease progression. Copyright © 2014 Elsevier España, S.L. and SEMNIM. All rights reserved.

  10. Update on Clinical Trials in Dry Age-related Macular Degeneration

    Science.gov (United States)

    Taskintuna, Ibrahim; Elsayed, M. E. A. Abdalla; Schatz, Patrik

    2016-01-01

    This review article summarizes the most recent clinical trials for dry age-related macular degeneration (AMD), the most common cause of vision loss in the elderly in developed countries. A literature search through websites https://www.pubmed.org and https://www.clinicaltrials.gov/, both accessed no later than November 04, 2015, was performed. We identified three Phase III clinical trials that were completed over the recent 5 years Age-Related Eye Disease Study 2 (AREDS2), implantable miniature telescope and tandospirone, and several other trials targeting a variety of mechanisms including, oxidative stress, complement inhibition, visual cycle inhibition, retinal and choroidal blood flow, stem cells, gene therapy, and visual rehabilitation. To date, none of the biologically oriented therapies have resulted in improved vision. Vision improvement was reported with an implantable mini telescope. Stem cells therapy holds a potential for vision improvement. The AREDS2 formulas did not add any further reduced risk of progression to advanced AMD, compared to the original AREDS formula. Several recently discovered pathogenetic mechanisms in dry AMD have enabled development of new treatment strategies, and several of these have been tested in recent clinical trials and are currently being tested in ongoing trials. The rapid development and understanding of pathogenesis holds promise for the future. PMID:26957835

  11. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research.

    Science.gov (United States)

    Waldman, Amy; Ghezzi, Angelo; Bar-Or, Amit; Mikaeloff, Yann; Tardieu, Marc; Banwell, Brenda

    2014-09-01

    The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood-and adolescent-onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States.

    Science.gov (United States)

    Acharya, Amit; Schroeder, Dixie; Schwei, Kelsey; Chyou, Po-Huang

    2017-12-01

    This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low. © 2017 Marshfield Clinic.

  13. The Clinical Diagnosis and Management of Kawasaki Disease: a Review and Update.

    Science.gov (United States)

    Zhu, Frank H; Ang, Jocelyn Y

    2016-09-01

    Kawasaki disease is an acute, self-limited vasculitis of childhood and has become the leading cause of acquired pediatric heart disease in the USA. Prompt treatment is essential in reducing cardiac-related morbidity and mortality. The underlying etiology remains unknown. The disease itself may be the characteristic manifestation of a common pathway of immune-mediated vascular inflammation in susceptible hosts. The characteristic clinical features of fever for at least 5 days with bilateral nonpurulent conjunctivitis, rash, changes in lips and oral cavity, changes in peripheral extremities, and cervical lymphadenopathy remain the mainstay of diagnosis. Supplementary laboratory criteria can aid in the diagnosis, particularly in cases of incomplete clinical presentation. Diagnosis of Kawasaki disease can be challenging as the clinical presentation can be mistaken for a variety of other pediatric illnesses. Standard of care consists of intravenous immune globulin and aspirin. Corticosteroids, infliximab, and cyclosporine A have been used as adjunct therapy for Kawasaki disease refractory to initial treatment. There is ongoing research into the use of these agents in the initial therapy of Kawasaki disease.

  14. Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation.

    Science.gov (United States)

    Barón-Esquivias, Gonzalo; Manito, Nicolás; López Díaz, Javier; Martín Santana, Antonio; García Pinilla, José Manuel; Gómez Doblas, Juan José; Gómez Bueno, Manuel; Barrios Alonso, Vivencio; Lambert, José Luis

    2015-04-01

    In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Multiple sclerosis in children: an update on clinical diagnosis, therapeutic strategies, and research

    Science.gov (United States)

    Waldman, Amy; Ghezzi, Angelo; Bar-Or, Amit; Mikaeloff, Yann; Tardieu, Marc; Banwell, Brenda

    2015-01-01

    The clinical features, diagnostic challenges, neuroimaging appearance, therapeutic options, and pathobiological research progress in childhood—and adolescent—onset multiple sclerosis have been informed by many new insights in the past 7 years. National programmes in several countries, collaborative research efforts, and an established international paediatric multiple sclerosis study group have contributed to revised clinical diagnostic definitions, identified clinical features of multiple sclerosis that differ by age of onset, and made recommendations regarding the treatment of paediatric multiple sclerosis. The relative risks conveyed by genetic and environmental factors to paediatric multiple sclerosis have been the subject of several large cohort studies. MRI features have been characterised in terms of qualitative descriptions of lesion distribution and applicability of MRI aspects to multiple sclerosis diagnostic criteria, and quantitative studies have assessed total lesion burden and the effect of the disease on global and regional brain volume. Humoral-based and cell-based assays have identified antibodies against myelin, potassium-channel proteins, and T-cell profiles that support an adult-like T-cell repertoire and cellular reactivity against myelin in paediatric patients with multiple sclerosis. Finally, the safety and efficacy of standard first-line therapies in paediatric multiple sclerosis populations are now appreciated in more detail, and consensus views on the future conduct and feasibility of phase 3 trials for new drugs have been proposed. PMID:25142460

  16. Clinical review: Update on neurally adjusted ventilatory assist--report of a round-table conference.

    Science.gov (United States)

    Terzi, Nicolas; Piquilloud, Lise; Rozé, Hadrien; Mercat, Alain; Lofaso, Frédéric; Delisle, Stéphane; Jolliet, Philippe; Sottiaux, Thierry; Tassaux, Didier; Roesler, Jean; Demoule, Alexandre; Jaber, Samir; Mancebo, Jordi; Brochard, Laurent; Richard, Jean-Christophe Marie

    2012-06-20

    Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA.

  17. Clinical and preclinical treatment of urologic diseases with phosphodiesterase isoenzymes 5 inhibitors: an update

    Directory of Open Access Journals (Sweden)

    Wen-Hao Zhang

    2016-01-01

    Full Text Available Phosphodiesterase isoenzymes 5 inhibitors (PDE5-Is are the first-line therapy for erectile dysfunction (ED. The constant discoveries of nitric oxide (NO/cyclic guanosine monophosphate (cGMP cell-signaling pathway for smooth muscle (SM control in other urogenital tracts (UGTs make PDE5-Is promising pharmacologic agents against other benign urological diseases. This article reviews the literature and contains some previously unpublished data about characterizations and activities of PDE5 and its inhibitors in treating urological disorders. Scientific discoveries have improved our understanding of cell-signaling pathway in NO/cGMP-mediated SM relaxation in UGTs. Moreover, the clinical applications of PDE5-Is have been widely recognized. On-demand PDE5-Is are efficacious for most cases of ED, while daily-dosing and combination with testosterone are recommended for refractory cases. Soluble guanylate cyclase (sGC stimulators also have promising role in the management of severe ED conditions. PDE5-Is are also the first rehabilitation strategy for postoperation or postradiotherapy ED for prostate cancer patients. PDE5-Is, especially combined with α-adrenoceptor antagonists, are very effective for benign prostatic hyperplasia (BPH except on maximum urinary flow rate (Q max with tadalafil recently proved for BPH with/without ED. Furthermore, PDE5-Is are currently under various phases of clinical or preclinical researches with promising potential for other urinary and genital illnesses, such as priapism, premature ejaculation, urinary tract calculi, overactive bladder, Peyronie′s disease, and female sexual dysfunction. Inhibition of PDE5 is expected to be an effective strategy in treating benign urological diseases. However, further clinical studies and basic researches investigating mechanisms of PDE5-Is in disorders of UGTs are required.

  18. U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update.

    Science.gov (United States)

    Herstein, Jocelyn J; Iwen, Peter C; Jelden, Katelyn C; Biddinger, Paul D; Gibbs, Shawn G; Le, Aurora B; Hewlett, Angela L; Lowe, John J

    2018-02-01

    In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to care for patients with highly hazardous communicable diseases (HHCDs), such as Ebola virus disease. This survey describes the clinical laboratory support capabilities of U.S. HLIUs, including the specific test menus that HLIUs have identified to safely manage HHCD patients and the locations where such testing would be performed. In spring 2016, a survey was electronically distributed, as a fillable pdf file, to the 56 U.S. HLIUs. Site representatives completed the surveys, and data were coded and analyzed in an electronic spreadsheet, using descriptive statistics. Thirty-six HLIUs (64%) responded, and 33 completed the laboratory capabilities section. Thirty-one HLIUs (94%) had performed risk analyses for all laboratory procedures and equipment. Twenty-nine (88%) had decontamination procedures specified for all laboratory equipment used for patients with suspected or confirmed HHCDs. On-site laboratories in 27 HLIUs (81%) had the capacity to inventory and to securely store HHCD patient specimens. Ten HLIUs (31%) had at least one test they would conduct within the patient isolation room. The high-risk nature of HHCDs and the occupational exposures that may occur in clinical laboratories demand advanced preparation and risk assessment of work practices, laboratory equipment, and instrumentation by HLIU laboratories. Although risk analyses of clinical laboratory testing and equipment that HLIUs have conducted have likely focused on those for Ebola virus, HLIUs must be prepared to revise their current procedures for other HHCDs. Copyright © 2018 American Society for Microbiology.

  19. Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice

    Science.gov (United States)

    Dixon-Gordon, Katherine L.; Peters, Jessica R.; Fertuck, Eric A.; Yen, Shirley

    2016-01-01

    Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD. PMID:29527105

  20. Radotinib and its clinical potential in chronic-phase chronic myeloid leukemia patients: an update.

    Science.gov (United States)

    Eskazan, Ahmet Emre; Keskin, Dilek

    2017-09-01

    Although imatinib has dramatically improved major outcomes in patients with chronic myeloid leukemia (CML), there are newer tyrosine kinase inhibitors (TKIs) approved worldwide for the treatment of resistant cases, and two second-generation TKIs (dasatinib, nilotinib) are approved in some nations for treating patients in the upfront setting. Radotinib (IY5511HCL, Supect® ) is a novel and selective second-generation BCR-ABL1 TKI, which is currently approved in Korea for the treatment of patients with CML both in the upfront and salvage settings. This review mainly focuses on the clinical potential of radotinib in patients with CML in chronic phase in terms of efficacy and safety.

  1. Severe sepsis and septic shock: clinical overview and update on management.

    Science.gov (United States)

    Cawcutt, Kelly A; Peters, Steve G

    2014-11-01

    Sepsis is among the oldest themes in medicine; however, despite modern advances, it remains a leading cause of death in the United States. Every clinician should be able to recognize the signs and symptoms of sepsis, along with early management strategies, to expeditiously provide appropriate care and decrease resultant morbidity and mortality. This review addresses the definitions, pathogenesis, clinical manifestations, management, and outcomes of patients with sepsis, severe sepsis, and septic shock. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  2. An update of human mesenchymal stem cell biology and their clinical uses

    DEFF Research Database (Denmark)

    Zaher, Walid; Harkness, Linda; Kermani, Abbas Jafari

    2014-01-01

    In the past decade, an increasing urge to develop new and novel methods for the treatment of degenerative diseases where there is currently no effective therapy has lead to the emerging of the cell therapy or cellular therapeutics approach for the management of those conditions where organ...... and in vivo. Consequently, stromal (mesenchymal) stem cells (MSCs) are being introduced into many clinical trials due to their ease of isolation and efficacy in treating a number of disease conditions in animal preclinical disease models. The aim of this review is to revise MSC biology, their potential...

  3. GM1 gangliosidosis and Morquio B disease: an update on genetic alterations and clinical findings

    OpenAIRE

    Caciotti, Anna; Garman, Scott C; Rivera-Colón, Yadilette; Procopio, Elena; Catarzi, Serena; Ferri, Lorenzo; Guido, Carmen; Martelli, Paola; Parini, Rossella; Antuzzi, Daniela; Battini, Roberta; Sibilio, Michela; Simonati, Alessandro; Fontana, Elena; Salviati, Alessandro

    2011-01-01

    Abstract GM1 gangliosidosis and Morquio B syndrome, both arising from beta-galactosidase (GLB1) deficiency, are very rare lysosomal storage diseases with an incidence of about 1:100,000- 1:200,000 live births worldwide. Here we report the beta-galactosidase gene (GLB1) mutation analysis of 21 unrelated GM1 gangliosidosis patients, and of 4 Morquio B patients, of whom two are brothers. Clinical features of the patients were collected and compared with those in literature. In silico ...

  4. Richter syndrome in chronic lymphocytic leukemia: updates on biology, clinical features and therapy.

    Science.gov (United States)

    Jamroziak, Krzysztof; Tadmor, Tamar; Robak, Tadeusz; Polliack, Aaron

    2015-07-01

    Richter syndrome (RS) or Richter transformation is the development of secondary aggressive lymphoma in the setting of underlying chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Most frequently CLL transforms into diffuse large B-cell lymphoma (DLBCL) (90%) and rarely (10%) into Hodgkin lymphoma, termed Hodgkin variant of Richter syndrome (HvRS). RS is generally characterized by an aggressive clinical course and poor prognosis. In recent years, major advances have been made in understanding genetic events which relate to the progression of CLL or transformation into RS. Better understanding of the molecular pathways has revealed that RS is not a single homogeneous entity. The majority of cases are clonally related to the original CLL clone, while a minority develop from an unrelated clone. This review summarizes new data relating to the molecular biology and the genetic/epigenetic changes occurring during Richter transformation, and also considers the clinical features and therapy for both DLBCL-RS and Hodgkin variant-RS.

  5. Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches.

    Science.gov (United States)

    Noya, Belkisyolé Alarcón de; Díaz-Bello, Zoraida; Colmenares, Cecilia; Ruiz-Guevara, Raiza; Mauriello, Luciano; Muñoz-Calderón, Arturo; Noya, Oscar

    2015-05-01

    Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas) with 249 cases (73.5% children) and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana's signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatus has been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission.

  6. Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches

    Science.gov (United States)

    de Noya, Belkisyolé Alarcón; Díaz-Bello, Zoraida; Colmenares, Cecilia; Ruiz-Guevara, Raiza; Mauriello, Luciano; Muñoz-Calderón, Arturo; Noya, Oscar

    2015-01-01

    Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas) with 249 cases (73.5% children) and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana’s signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatus has been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission. PMID:25946155

  7. Update on the clinical use of the low-molecular-weight heparin, parnaparin

    Directory of Open Access Journals (Sweden)

    Giuseppe Camporese

    2009-09-01

    Full Text Available Giuseppe Camporese1, Enrico Bernardi2, Franco Noventa31Unit of Angiology and 3Department of Clinical and Experimental Medicine, Clinical Epidemiology Group, University Hospital of Padua, Italy; 2Department of Emergency and Accident Medicine, Hospital of Conegliano Veneto, ItalyAbstract: Parnaparin is a low-molecular-weight heparin that has widely shown its efficacy and safety in prevention of venous thromboembolism, in the treatment of chronic venous disorders, and in the treatment of venous and arterial (stable and unstable angina, acute ST-segment elevation myocardial infarction thrombosis. Parnaparin at the respective dosages of 3200, 4250, 6400, or 12800 IUaXa for a period ranging from 3 to 5 days to 6 months, is usually administered subcutaneously by means of once-daily regimen and is better tolerated than unfractionated heparin at the injection site. In the variety of commercially available low-molecular-weight heparins, parnaparin represents a useful therapeutic option, even though little evidence is available comparing the superiority or the equivalent efficacy and safety of parnaparin to that of the unfractionated heparin or placebo. This review summarizes the available literature on the use of parnaparin in different settings of cardiovascular diseases, including papers published during the past year and ongoing studies.Keywords: low-molecular-weight heparin, heparin, parnaparin, acute coronary syndromes, venous thromboembolism

  8. Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches

    Directory of Open Access Journals (Sweden)

    Belkisyolé Alarcón de Noya

    2015-05-01

    Full Text Available Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas with 249 cases (73.5% children and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana’s signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatus has been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission.

  9. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

    Science.gov (United States)

    Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

    2014-03-01

    This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  10. Fluoride Rinses, Gels and Foams: An Update of Controlled Clinical Trials.

    Science.gov (United States)

    Twetman, Svante; Keller, Mette K

    2016-01-01

    The aim of this conference paper was to systematically review the quality of evidence and summarize the findings of clinical trials published after 2002 using fluoride mouth rinses, fluoride gels or foams for the prevention of dental caries. Relevant papers were selected after an electronic search for literature published in English between 2003 and 2014. The included papers were assessed for their risk of bias and the results were narratively synthesized due to study heterogeneity. The quality of evidence was expressed according to GRADE. A total of 19 papers were included (6 on fluoride mouth rinse, 10 on fluoride gel and 3 on fluoride foam); 6 had a low risk of bias while 2 had a moderate risk. All fluoride measures appeared to be beneficial in preventing crown caries and reversing root caries, but the quality of evidence was graded as low for fluoride mouth rinse, moderate for fluoride gel and very low for acidulated fluoride foam. No conclusions could be drawn on the cost-effectiveness. This review, covering the recent decade, has further substantiated the evidence for a caries-preventive effect of fluoride mouth rinse, fluoride gel and foam, previously established in systematic reviews. The lack of clinical trials free from bias is, however, still a concern, especially for fluoride mouth rinses and fluoride foam. There is also a scientific knowledge gap on the benefit and optimal use of these fluoride supplements in combination with daily tooth brushing with fluoride toothpaste. © 2016 The Author(s) Published by S. Karger AG, Basel.

  11. Oral Lichen Planus: An Update on Etiology, Pathogenesis, Clinical Presentation, Diagnosis and Management

    Science.gov (United States)

    Gupta, Sonia; Jawanda, Manveen Kaur

    2015-01-01

    The mouth is a mirror of health or disease, a sentinel or early warning system. The oral cavity might well be thought as a window to the body because oral manifestations accompany many systemic diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. Oral lichen planus (OLP) is a chronic mucocutaneous disorder of stratified squamous epithelium of uncertain etiology that affects oral and genital mucous membranes, skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. This disease has most often been reported in middle-aged patients with 30-60 years of age and is more common in females than in males. The disease seems to be mediated by an antigen-specific mechanism, activating cytotoxic T cells, and non-specific mechanisms like mast cell degranulation and matrix metalloproteinase activation. A proper understanding of the pathogenesis, clinical presentation, diagnosis of the disease becomes important for providing the right treatment. This article discusses the prevalence, etiology, clinical features, oral manifestations, diagnosis, complications and treatment of oral LP. PMID:26120146

  12. MLL-Rearranged Leukemias-An Update on Science and Clinical Approaches.

    Science.gov (United States)

    Winters, Amanda C; Bernt, Kathrin M

    2017-01-01

    The mixed-lineage leukemia 1 (MLL1) gene (now renamed Lysine [K]-specific MethylTransferase 2A or KMT2A ) on chromosome 11q23 is disrupted in a unique group of acute leukemias. More than 80 different partner genes in these fusions have been described, although the majority of leukemias result from MLL1 fusions with one of about six common partner genes. Approximately 10% of all leukemias harbor MLL1 translocations. Of these, two patient populations comprise the majority of cases: patients younger than 1 year of age at diagnosis (primarily acute lymphoblastic leukemias) and young- to-middle-aged adults (primarily acute myeloid leukemias). A much rarer subgroup of patients with MLL1 rearrangements develop leukemia that is attributable to prior treatment with certain chemotherapeutic agents-so-called therapy-related leukemias. In general, outcomes for all of these patients remain poor when compared to patients with non- MLL1 rearranged leukemias. In this review, we will discuss the normal biological roles of MLL1 and its fusion partners, how these roles are hypothesized to be dysregulated in the context of MLL1 rearrangements, and the clinical manifestations of this group of leukemias. We will go on to discuss the progress in clinical management and promising new avenues of research, which may lead to more effective targeted therapies for affected patients.

  13. MLL-Rearranged Leukemias—An Update on Science and Clinical Approaches

    Science.gov (United States)

    Winters, Amanda C.; Bernt, Kathrin M.

    2017-01-01

    The mixed-lineage leukemia 1 (MLL1) gene (now renamed Lysine [K]-specific MethylTransferase 2A or KMT2A) on chromosome 11q23 is disrupted in a unique group of acute leukemias. More than 80 different partner genes in these fusions have been described, although the majority of leukemias result from MLL1 fusions with one of about six common partner genes. Approximately 10% of all leukemias harbor MLL1 translocations. Of these, two patient populations comprise the majority of cases: patients younger than 1 year of age at diagnosis (primarily acute lymphoblastic leukemias) and young- to-middle-aged adults (primarily acute myeloid leukemias). A much rarer subgroup of patients with MLL1 rearrangements develop leukemia that is attributable to prior treatment with certain chemotherapeutic agents—so-called therapy-related leukemias. In general, outcomes for all of these patients remain poor when compared to patients with non-MLL1 rearranged leukemias. In this review, we will discuss the normal biological roles of MLL1 and its fusion partners, how these roles are hypothesized to be dysregulated in the context of MLL1 rearrangements, and the clinical manifestations of this group of leukemias. We will go on to discuss the progress in clinical management and promising new avenues of research, which may lead to more effective targeted therapies for affected patients. PMID:28232907

  14. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    José F. Tellez-Zenteno

    2008-10-01

    Full Text Available José F. Tellez-Zenteno1, Cesar Serrano-Almeida2, Farzad Moien-Afshari11Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 2Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, CanadaAbstract: Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Autonomic features such as flushing, tachycardia, and altered respiration are widely recognized. Conscious state may not be impaired, although this is often difficult to asses particularly in young children. Gelastic seizures have been associated classically to hypothalamic hamartomas, although different extrahypothalamic localizations have been described. Hypothalamic hamartomas are rare congenital lesions presenting with the classic triad of gelastic epilepsy, precocious puberty and developmental delay. The clinical course of patients with gelastic seizures associated with hypothalamic hamartomas is progressive, commencing with gelastic seizures in infancy, deteriorating into more complex seizure disorder resulting in intractable epilepsy. Electrophysiological, radiological, and pathophysiological studies have confirmed the intrinsic epileptogenicity of the hypothalamic hamartoma. Currently the most effective surgical approach is the trancallosal anterior interforniceal approach, however newer approaches including the endoscopic and other treatment such as radiosurgery and gamma knife have been used with success. This review focuses on the syndrome of gelastic seizures associated with hypothalamic hamartomas, but it also reviews other concepts such as status gelasticus and some aspects of gelastic seizures in other locations.Keywords: epilepsy, gelastic seizures, epilepsy surgery, hypothalamic hamartoma, intractable epilepsy

  15. A Clinical Update on Delirium: From Early Recognition to Effective Management

    Directory of Open Access Journals (Sweden)

    Joaquim Cerejeira

    2011-01-01

    Full Text Available Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.

  16. An Update of Patents, Preclinical and Clinical Outcomes of Lipid Nanoparticulate Systems.

    Science.gov (United States)

    Pathak, Kamla; Shankar, Ravi; Joshi, Monika

    2017-11-21

    Lipid nanoparticles have attracted increased degree of scientific and commercial attention in the last decade. The lipidic nanoparticles have emerged as a potential alternative to other nano-scale systems due to their various advantages over them and also due to overcoming the shortcomings of the already available colloidal systems like liposomes, niosomes and polymeric nanoparticles. These have been investigated for delivery of macromolecules, genes, siRNA and other therapeutic agents for oral, topical, parenteral administration and target site specific delivery for various diseases like cancer, ocular diseases and brain disorders. The lipid nanoparticles have evolved from SLNs, then NLCs and lipid drug conjugates overcoming any issues related to production and formulation and adding advantages, if any. The current review article focuses on the lipid nanoparticles, their formulation approaches and current advancements in the field through recent clinical trials and patents. This manuscript embodies various patents, preclinical and clinical aspects related to the lipidic nanocarriers. Over the years the lipidic nanoparticulate systems have evolved as significant carriers for improved therapeutics and in diagnostic field. The large number of patents and preclinical trials in the recent years suggests that these systems will find immense potential in near future. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  17. Mantle cell lymphoma: 2017 update on diagnosis, risk-stratification, and clinical management.

    Science.gov (United States)

    Vose, Julie M

    2017-08-01

    Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood and bone marrow with a short remission duration to standard therapies and a median overall survival (OS) of 4-5 years. Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t (11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. The MCL International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median OS for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytotoxic Regimen followed by autologous stem cell transplantation should be considered. Rituximab maintenance after autologous stem cell transplantation has also improved the progression-free and overall survival. For older symptomatic MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. In addition, rituximab maintenance therapy may prolong the progression-free survival. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), lenalidamide (anti-angiogenesis) and

  18. Mantle cell lymphoma: 2015 update on diagnosis, risk-stratification, and clinical management.

    Science.gov (United States)

    Vose, Julie M

    2015-08-01

    Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood and bone marrow with a short remission duration to standard therapies and a median overall survival (OS) of 4-5 years. Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t (11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. The MCL International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median OS for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytotoxic regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. In addition, rituximab maintenance therapy may prolong the progression-free survival. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), lenalidamide (anti-angiogenesis) and Ibruitinib (Bruton's Tyrosine Kinase [BTK] inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or allogeneic stem cell

  19. Mantle cell lymphoma: 2013 Update on diagnosis, risk-stratification, and clinical management.

    Science.gov (United States)

    Vose, Julie M

    2013-12-01

    Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood, and bone marrow with a short remission duration to standard therapies and a median overall survival of 4-5 years. Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t(11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. The Mantle Cell Lymphoma International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median overall survival (OS) for the low risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytarabine containing regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor) or lenalidamide (anti-angiogenesis) are approved agents. Clinical trials with Ibruitinib (Bruton's Tyrosine Kinase inhibitor) or Idelalisib (PI3K inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or

  20. Clinical Options in Relapsed or Refractory Hodgkin Lymphoma: An Updated Review

    Directory of Open Access Journals (Sweden)

    Roberta Fedele

    2015-01-01

    Full Text Available Hodgkin lymphoma (HL is a potentially curable lymphoma, and modern therapy is expected to successfully cure more than 80% of the patients. Second-line salvage high-dose chemotherapy and autologous stem cell transplantation (auto-SCT have an established role in the management of refractory and relapsed HL, leading to long-lasting responses in approximately 50% of relapsed patients and a minority of refractory patients. Patients progressing after intensive treatments, such as auto-SCT, have a very poor outcome. Allogeneic SCT represents the only strategy with a curative potential for these patients; however, its role is controversial. Based on recent knowledge of HL pathology, biology, and immunology, antibody-drug conjugates targeting CD30, small molecule inhibitors of cell signaling, and antibodies that inhibit immune checkpoints are currently explored. This review will discuss the clinical results regarding auto-SCT and allo-SCT as well as the current role of emerging new treatment strategies.

  1. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity.

    Science.gov (United States)

    Martorell, A; García-Martínez, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodriguez, J; Salgado, L; Vilarrasa, E

    2015-11-01

    Hidradenitis suppurativa is a chronic inflammatory disorder that has attracted increasing attention in recent years due to underestimations of prevalence and the considerable impact of the condition on interpersonal relationships, physical appearance, self-esteem, and body image. Although hidradenitis suppurative has a significant psychological impact on patients and can even cause physical limitations when thick scarring results in limb mobility limitation, until very recently little evidence was available relating to its epidemiology, etiology, or pathogenesis. In this review, we highlight the latest advances in our understanding of the epidemiological and clinical aspects of hidradenitis suppurativa. We will also look at the different classification systems for hidradenitis suppurativa and discuss the emergence of skin ultrasound as a promising technique for monitoring the course of this chronic inflammatory disease. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  2. Left Ventricular Hypertrophy: Major Risk Factor in Patients with Hypertension: Update and Practical Clinical Applications

    Directory of Open Access Journals (Sweden)

    Richard E. Katholi

    2011-01-01

    Full Text Available Left ventricular hypertrophy is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic heart failure, systolic heart failure, and sudden death in patients with hypertension. Since not all patients with hypertension develop left ventricular hypertrophy, there are clinical findings that should be kept in mind that may alert the physician to the presence of left ventricular hypertrophy so a more definitive evaluation can be performed using an echocardiogram or cardiovascular magnetic resonance. Controlling arterial pressure, sodium restriction, and weight loss independently facilitate the regression of left ventricular hypertrophy. Choice of antihypertensive agents may be important when treating a patient with hypertensive left ventricular hypertrophy. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers followed by calcium channel antagonists most rapidly facilitate the regression of left ventricular hypertrophy. With the regression of left ventricular hypertrophy, diastolic function and coronary flow reserve usually improve, and cardiovascular risk decreases.

  3. Feline bacterial urinary tract infections: An update on an evolving clinical problem.

    Science.gov (United States)

    Litster, Annette; Thompson, Mary; Moss, Susan; Trott, Darren

    2011-01-01

    Although feline urine is increasingly submitted for bacterial culture and susceptibility testing as part of a more general diagnostic work-up for a range of presentations in veterinary practice, bacterial urinary tract infections (UTIs) are relatively uncommon due to a variety of physical and immunological barriers to infection. Culture positive urine is most often obtained from older female cats and the clinical history may include hematuria, dysuria and pollakiuria, or the infection may be occult. Urinalysis usually reveals hematuria and pyuria, and Escherichia coli and Gram-positive cocci are cultured most frequently. Most feline UTIs can be successfully treated using oral amoxicillin or amoxicillin/clavulanic acid administered for at least 14days, but the prevalence of antimicrobial resistance amongst infecting bacterial species is a growing concern. There is currently no conclusive information on the safety and efficacy of alternative therapeutic agents for the treatment of feline UTIs. 2009 Elsevier Ltd. All rights reserved.

  4. An Updated Review on the Phytochemistry, Pharmacology, and Clinical Trials ofSalacia oblonga.

    Science.gov (United States)

    Kushwaha, Priya Singh; Singh, Ashok K; Keshari, Amit K; Maity, Siddhartha; Saha, Sudipta

    2016-01-01

    Salacia oblonga ( S. oblonga ), a perennial herb, has been used for thousands of years in ayurvedic medicine and is closely associated with prevention, treatment, and cure of various human ailments such as obesity and diabetes. A vast and wide range of chemical compounds such as polyphenols, friedelane-type triterpenes, norfriedelane-type triterpenes, eudesmane-type sesquiterpenes including various glycosides had been isolated from this plant. This review is aimed to survey the literature covering the phytochemistry and pharmacology of S. oblonga and to review the scientific data including active components and their multi-targeted mechanisms of action against various metabolic syndromes. We also included clinical trials related to this plant in this review. The overview would assist researchers to gather scientific information related to S. oblonga in future.

  5. Mantle cell lymphoma: 2012 update on diagnosis, risk-stratification, and clinical management.

    Science.gov (United States)

    Vose, Julie M

    2012-06-01

    Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood, and bone marrow with a short remission duration to standard therapies and a median overall survival of 4-5 years. Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t(11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. The mantle cell lymphoma international prognostic index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median overall survival (OS) for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 and 29 months for the high-risk group. For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytarabine containing regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), BTK inhibitors or CAL-101 (B-cell receptor inhibitors) or lenalidamide (antiangiogenesis) have clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients. Copyright © 2012

  6. Optical diagnostics based on elastic scattering: An update of clinical demonstrations with the Optical Biopsy System

    Energy Technology Data Exchange (ETDEWEB)

    Bigio, I.J.; Boyer, J.; Johnson, T.M.; Lacey, J.; Mourant, J.R. [Los Alamos National Lab., NM (United States); Conn, R. [Lovelace Medical Center, Albuquerque, NM (United States); Bohorfoush, A. [Wisconsin Medical School, Milwaukee, WI (United States)

    1994-10-01

    The Los Alamos National Laboratory has continued the development of the Optical Biopsy System (OBS) for noninvasive, real-time in situ diagnosis of tissue pathologies. Our clinical studies have expanded since the last Biomedical Optics Europe conference (Budapest, September 1993), and we report here on the latest results of clinical tests in gastrointestinal tract. The OBS invokes a unique approach to optical diagnosis of tissue pathologies based on the elastic scattering properties, over a wide range of wavelengths, of the tissue. The use of elastic scattering as the key to optical tissue diagnostics in the OBS is based on the fact that many tissue pathologies, including a majority of cancer forms, manifest significant architectural changes at the cellular and sub-cellular level. Since the cellular components that cause elastic scattering have dimensions typically on the order of visible to near-IR wavelengths, the elastic (Mie) scattering properties will be wavelength dependent. Thus, morphology and size changes can be expected to cause significant changes in an optical signature that is derived from the wavelength-dependence of elastic scattering. The OBS employs a small fiberoptic probe that is amenable to use with any endoscope or catheter, or to direct surface examination. The probe is designed to be used in optical contact with the tissue under examination and has separate illuminating and collecting fibers. Thus, the light that is collected and transmitted to the analyzing spectrometer must first scatter through a small volume of the tissue before entering the collection fiber(s). Consequently, the system is also sensitive to the optical absorption spectrum of the tissue, over an effective operating range of <300 to 950 nm, and such absorption adds valuable complexity to the scattering spectral signature.

  7. Treatment of diverticular disease: an update on latest evidence and clinical implications

    Directory of Open Access Journals (Sweden)

    Marilia Carabotti

    2018-03-01

    Full Text Available Background: Diverticular disease (DD is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis, while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD and, eventually complications as acute diverticulitis (AD. The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations. Scope: To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis. Findings: The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines. Conclusion: Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the

  8. Treatment of diverticular disease: an update on latest evidence and clinical implications.

    Science.gov (United States)

    Carabotti, Marilia; Annibale, Bruno

    2018-01-01

    Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations. To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis. The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines. Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.

  9. An update on the clinical trial of BNCT at the BMRR

    International Nuclear Information System (INIS)

    Ma, R.; Capala, J.; Chanana, A.D.; Coderre, J.A.; Diaz, A.Z.

    1999-01-01

    Boron neutron capture therapy (BNCT) was proposed more than six decades ago. It is a binary treatment modality that requires selective delivery of a 10 B-labeled compound to a tumor and slow neutron irradiation of the tumor-bearing tissues. In order to improve the penetration of the neutron beam, an epithermal neutron beam was developed at the Brookhaven Medical Research Reactor (BMRR). This epithermal neutron beam can deliver relatively high thermal neutron fluence at depth without severe skin damage. Boronophenylalanine-fructose (BPA-F), a nontoxic boron carrier, was found to preferentially accumulate in tumor cells following intravenous infusion in patients with GBM. In preclinical BNCT studies in rats bearing 9L gliosarcoma, BPA-mediated BNCT was shown to be more efficacious than photon irradiation. In 1994, improvements in the neutron beam and in the understanding of the radiobiology of BPA-mediated BNCT led to the initiation of BNCT trials for human GBM at BMRR using BPA-F and epithermal neutrons. The primary objective of the phase I/II clinical trial of BPA-mediated BNCT at BMRR is to evaluate the safety of the BPA-F-mediated BNCT using epithermal neutrons in patients with GBM at a series of escalating BNCT doses. An incidental objective is to evaluate the therapeutic effectiveness of BNCT at each dose level. For each dose escalation group, the average brain dose (ABD) is escalated, as well as the minimum tumor dose. In summary, the BNCT procedure employed in the phase I/II clinical trial of BPA-F-mediated BNCT for GBM at BNL was found to be safe in all patients. The palliation afforded by a single session of BNCT compares favorably with palliation provided by fractionated photon therapy and adjuvant chemotherapy. If no evidence of radiation-induced brain toxicity is found in the current protocol, BNCT radiation dose will be further escalated

  10. Neuropathic pain: an updated grading system for research and clinical practice

    Science.gov (United States)

    Finnerup, Nanna B.; Haroutounian, Simon; Kamerman, Peter; Baron, Ralf; Bennett, David L.H.; Bouhassira, Didier; Cruccu, Giorgio; Freeman, Roy; Hansson, Per; Nurmikko, Turo; Raja, Srinivasa N.; Rice, Andrew S.C.; Serra, Jordi; Smith, Blair H.; Treede, Rolf-Detlef; Jensen, Troels S.

    2016-01-01

    Abstract The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research. PMID:27115670

  11. GM1 gangliosidosis and Morquio B disease: an update on genetic alterations and clinical findings.

    Science.gov (United States)

    Caciotti, Anna; Garman, Scott C; Rivera-Colón, Yadilette; Procopio, Elena; Catarzi, Serena; Ferri, Lorenzo; Guido, Carmen; Martelli, Paola; Parini, Rossella; Antuzzi, Daniela; Battini, Roberta; Sibilio, Michela; Simonati, Alessandro; Fontana, Elena; Salviati, Alessandro; Akinci, Gulcin; Cereda, Cristina; Dionisi-Vici, Carlo; Deodato, Francesca; d'Amico, Adele; d'Azzo, Alessandra; Bertini, Enrico; Filocamo, Mirella; Scarpa, Maurizio; di Rocco, Maja; Tifft, Cynthia J; Ciani, Federica; Gasperini, Serena; Pasquini, Elisabetta; Guerrini, Renzo; Donati, Maria Alice; Morrone, Amelia

    2011-07-01

    GM1 gangliosidosis and Morquio B syndrome, both arising from beta-galactosidase (GLB1) deficiency, are very rare lysosomal storage diseases with an incidence of about 1:100,000-1:200,000 live births worldwide. Here we report the beta-galactosidase gene (GLB1) mutation analysis of 21 unrelated GM1 gangliosidosis patients, and of 4 Morquio B patients, of whom two are brothers. Clinical features of the patients were collected and compared with those in literature. In silico analyses were performed by standard alignments tools and by an improved version of GLB1 three-dimensional models. The analysed cohort includes remarkable cases. One patient with GM1 gangliosidosis had a triple X syndrome. One patient with juvenile GM1 gangliosidosis was homozygous for a mutation previously identified in Morquio type B. A patient with infantile GM1 gangliosidosis carried a complex GLB1 allele harbouring two genetic variants leading to p.R68W and p.R109W amino acid changes, in trans with the known p.R148C mutation. Molecular analysis showed 27 mutations, 9 of which are new: 5 missense, 3 microdeletions and a nonsense mutation. We also identified four new genetic variants with a predicted polymorphic nature that was further investigated by in silico analyses. Three-dimensional structural analysis of GLB1 homology models including the new missense mutations and the p.R68W and p.R109W amino acid changes showed that all the amino acid replacements affected the resulting protein structures in different ways, from changes in polarity to folding alterations. Genetic and clinical associations led us to undertake a critical review of the classifications of late-onset GM1 gangliosidosis and Morquio B disease. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Transcatheter embolization therapy in liver cancer: an update of clinical evidences.

    Science.gov (United States)

    Wáng, Yì-Xiáng J; De Baere, Thierry; Idée, Jean-Marc; Ballet, Sébastien

    2015-04-01

    Transarterial chemoembolization (TACE) is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma (HCC) patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients' life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival (OS) with TACE was similar to that with hepatic resection and radiofrequency ablation. Although being used for decades, Lipiodol(®) (Lipiodol(®) Ultra Fluid(®), Guerbet, France) remains important as a tumor-seeking and radio-opaque drug delivery vector in interventional oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead (DEB) is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem(®) (CeloNova Biosciences Inc., USA), DC-Beads(®) (BTG, UK) and HepaSphere(®) (BioSphere Medical, Inc., USA). Transarterial radioembolization (TARE) technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres(®) (Sirtex Medical Limited, Australia) and TheraSphere(®) (BTG, UK). This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical

  13. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

    Science.gov (United States)

    Ramar, Kannan; Dort, Leslie C.; Katz, Sheri G.; Lettieri, Christopher J.; Harrod, Christopher G.; Thomas, Sherene M.; Chervin, Ronald D.

    2015-01-01

    Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing

  14. Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology-Cancer Care Ontario Focused Guideline Update.

    Science.gov (United States)

    Van Poznak, Catherine; Somerfield, Mark R; Barlow, William E; Biermann, J Sybil; Bosserman, Linda D; Clemons, Mark J; Dhesy-Thind, Sukhbinder K; Dillmon, Melissa S; Eisen, Andrea; Frank, Elizabeth S; Jagsi, Reshma; Jimenez, Rachel; Theriault, Richard L; Vandenberg, Theodore A; Yee, Gary C; Moy, Beverly

    2017-12-10

    Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management-analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management-be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .

  15. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature

    Directory of Open Access Journals (Sweden)

    Mark Messina

    2016-11-01

    Full Text Available Soyfoods have long been recognized as sources of high-quality protein and healthful fat, but over the past 25 years these foods have been rigorously investigated for their role in chronic disease prevention and treatment. There is evidence, for example, that they reduce risk of coronary heart disease and breast and prostate cancer. In addition, soy alleviates hot flashes and may favorably affect renal function, alleviate depressive symptoms and improve skin health. Much of the focus on soyfoods is because they are uniquely-rich sources of isoflavones. Isoflavones are classified as both phytoestrogens and selective estrogen receptor modulators. Despite the many proposed benefits, the presence of isoflavones has led to concerns that soy may exert untoward effects in some individuals. However, these concerns are based primarily on animal studies, whereas the human research supports the safety and benefits of soyfoods. In support of safety is the recent conclusion of the European Food Safety Authority that isoflavones do not adversely affect the breast, thyroid or uterus of postmenopausal women. This review covers each of the major research areas involving soy focusing primarily on the clinical and epidemiologic research. Background information on Asian soy intake, isoflavones, and nutrient content is also provided.

  16. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature.

    Science.gov (United States)

    Messina, Mark

    2016-11-24

    Soyfoods have long been recognized as sources of high-quality protein and healthful fat, but over the past 25 years these foods have been rigorously investigated for their role in chronic disease prevention and treatment. There is evidence, for example, that they reduce risk of coronary heart disease and breast and prostate cancer. In addition, soy alleviates hot flashes and may favorably affect renal function, alleviate depressive symptoms and improve skin health. Much of the focus on soyfoods is because they are uniquely-rich sources of isoflavones. Isoflavones are classified as both phytoestrogens and selective estrogen receptor modulators. Despite the many proposed benefits, the presence of isoflavones has led to concerns that soy may exert untoward effects in some individuals. However, these concerns are based primarily on animal studies, whereas the human research supports the safety and benefits of soyfoods. In support of safety is the recent conclusion of the European Food Safety Authority that isoflavones do not adversely affect the breast, thyroid or uterus of postmenopausal women. This review covers each of the major research areas involving soy focusing primarily on the clinical and epidemiologic research. Background information on Asian soy intake, isoflavones, and nutrient content is also provided.

  17. Heart regeneration for clinical application update 2016: from induced pluripotent stem cells to direct cardiac reprogramming.

    Science.gov (United States)

    Yamakawa, Hiroyuki

    2016-01-01

    Cardiovascular disease remains a major cause of death for which current therapeutic regimens are limited. Following myocardial injury, endogenous cardiac fibroblasts, which account for more than half of the cells in the heart, proliferate and synthesize extracellular matrix, leading to fibrosis and heart failure. As terminally differentiated cardiomyocytes have little regenerative capacity following injury, the development of cardiac regenerative therapy is highly desired. Embryonic stem and induced pluripotent stem (iPS) cells are promising tools for regenerative medicine. However, these stem cells demonstrate variable cardiac differentiation efficiency and tumorigenicity, which must be resolved prior to clinical regenerative applications. Until the last decade, an established theory was that cardiomyocytes could only be produced from fibroblasts through iPS cell generation. In 2010, we first reported cardiac differentiation from fibroblasts by direct reprogramming, and we demonstrated that various cardiac reprogramming pathways exist. This review summarizes the latest trends in stem cell and regenerative research regarding iPS cells, a partial reprogramming strategy, and direct cardiac reprogramming. We also examine the many recent advances in direct cardiac reprogramming and explore the suitable utilization of these methods for regenerative medicine in the cardiovascular field.

  18. Clinical efficacy issues in the treatment of multiple sclerosis: update of natalizumab

    Directory of Open Access Journals (Sweden)

    Francesco Patti

    2009-08-01

    Full Text Available Francesco Patti, Angelo PappalardoMultiple Sclerosis Center, University of Catania, Catania, Italy; Physical Medicine and Rehabilitation Unit, Hospital of Acireale, Catania, ItalyAbstract: Multiple sclerosis is a frequent neurologic disease, which causes sensory impairment, fatigue, cognitive deficits, imbalance, loss of mobility, spasticity, and bladder and bowel dysfunction. Several new therapies have been introduced in the past decade, but additional drugs are needed to slow disease progression and reduce disability. Natalizumab (NA is an α4 integrin antagonist, effective in decreasing the development of brain lesions in experimental models and in several studies of patients with MS. Six randomized controlled trials of NA in MS have been published in the last 10 years. Overall, 2,688 relapsing-remitting MS subjects have been enrolled in these studies. Hence, there are already sufficient data to draw some conclusions about the effectiveness of NA in the treatment of MS, although for definitive considerations it would be reasonable to wait for the observational phase IV studies of clinical practice to complete. Moreover, the medical community is concerned with the safety of NA, particularly with the risk of developing progressive multifocal leukoencephalopathy while on NA therapy. From the analyses of the six cases, it seems that the overall risk is around 1/1,000 and could increase with the number of NA infusions.Keywords: multiple sclerosis, disease-modifying drugs, natalizumab, progressive multifocal leukoencephalopathy

  19. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature

    Science.gov (United States)

    Messina, Mark

    2016-01-01

    Soyfoods have long been recognized as sources of high-quality protein and healthful fat, but over the past 25 years these foods have been rigorously investigated for their role in chronic disease prevention and treatment. There is evidence, for example, that they reduce risk of coronary heart disease and breast and prostate cancer. In addition, soy alleviates hot flashes and may favorably affect renal function, alleviate depressive symptoms and improve skin health. Much of the focus on soyfoods is because they are uniquely-rich sources of isoflavones. Isoflavones are classified as both phytoestrogens and selective estrogen receptor modulators. Despite the many proposed benefits, the presence of isoflavones has led to concerns that soy may exert untoward effects in some individuals. However, these concerns are based primarily on animal studies, whereas the human research supports the safety and benefits of soyfoods. In support of safety is the recent conclusion of the European Food Safety Authority that isoflavones do not adversely affect the breast, thyroid or uterus of postmenopausal women. This review covers each of the major research areas involving soy focusing primarily on the clinical and epidemiologic research. Background information on Asian soy intake, isoflavones, and nutrient content is also provided. PMID:27886135

  20. Clinical Update on Dengue, Chikungunya, and Zika: What We Know at the Time of Article Submission.

    Science.gov (United States)

    Liu, Liang E; Dehning, Meaghan; Phipps, Ashley; Swienton, Ray E; Harris, Curtis A; Klein, Kelly R

    2017-06-01

    Mosquito-borne diseases pose a threat to individual health and population health on both a local and a global level. The threat is even more exaggerated during disasters, whether manmade or environmental. With the recent Zika virus outbreak, it is important to highlight other infections that can mimic the Zika virus and to better understand what can be done as public health officials and health care providers. This article reviews the recent literature on the Zika virus as well as chikungunya virus and dengue virus. The present findings give a better understanding of the similarities and differences between the 3 infections in terms of their characteristics, clinical presentation, diagnosis methodology, and treatment and what can be done for prevention. Additionally, the article highlights a special population that has received much focus in the latest outbreak, the pregnant individual. Education and training are instrumental in controlling the outbreak, and early detection can be lifesaving. (Disaster Med Public Health Preparedness. 2017;11:290-299).

  1. Clinical uses of GM-CSF, a critical appraisal and update

    Directory of Open Access Journals (Sweden)

    Martha Arellano

    2008-03-01

    Full Text Available Martha Arellano, Sagar LonialEmory University, Winship Cancer Institute, Atlanta, GA, USAAbstract: The role of granulocyte-macrophage-colony-stimulating factor (GM-CSF in the supportive care of cancer patients has been evaluated with promising results. More recently, GM-CSF has been added to regimens for the mobilization of hematopoietic progenitor cells. An expanding role for GM-CSF in regulating immune responses has been recognized based upon its activity on the development and maturation of antigen presenting cells and its capability for skewing the immune system toward Th1-type responses. GM-CSF has been shown to preferentially enhance both the numbers and activity of type 1 dendritic cells (DC1, the subsets of dendritic cells responsible for initiating cytotoxic immune responses. The increase in DC1 content and activity following local and systemic GM-CSF administration support a role for GM-CSF as an immune stimulant and vaccine adjuvant in cancer patients. GM-CSF has shown clinical activity as an immune stimulant in tumor cell and dendritic cell vaccines, and may increase antibody-dependent cellular cytotoxicity. The successful use of myeloid acting cytokines to enhance anti-tumor responses will likely require the utilization of GM-CSF in combination with cytotoxic or other targeted therapies.Keywords: GM-CSF, G-CSF, cancer, hematopoietic cytokines

  2. Clinical update on linezolid in the treatment of Gram-positive bacterial infections

    Directory of Open Access Journals (Sweden)

    Ager S

    2012-06-01

    Full Text Available Sally Ager, Kate GouldDepartment of Microbiology, Newcastle upon Tyne Hospitals Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, UKAbstract: Gram-positive pathogens are a significant cause of morbidity and mortality in both community and health care settings. Glycopeptides have traditionally been the antibiotics of choice for multiresistant Gram-positive pathogens but there are problems with their use, including the emergence of glycopeptide-resistant strains, tissue penetration, and achieving and monitoring adequate serum levels. Newer antibiotics such as linezolid, a synthetic oxazolidinone, are available for the treatment of resistant Gram-positive bacteria. Linezolid is active against a wide range of Gram-positive bacteria and has been generally available for the treatment of Gram-positive infections since 2000. There are potential problems with linezolid use, including its bacteriostatic action and the relatively high incidence of reported adverse effects, particularly with long-term use. Long-term use may also be complicated by the development of resistance. However, linezolid has been shown to be clinically useful in the treatment of several serious infections where traditionally bacteriocidal agents have been required and many of its adverse effects are reversible on cessation. It has also been shown to be a cost-effective treatment option in several studies, with its high oral bioavailability allowing an early change from intravenous to oral formulations with consequent earlier patient discharge and lower inpatient costs.Keywords: linezolid, oxazolidinone, multi-resistant, gram-positive, MRSA, VRE, cost-benefit

  3. Controversy clarified: an updated review of clinical psychology and tele-health.

    Science.gov (United States)

    Perle, Jonathan G; Langsam, Leah C; Nierenberg, Barry

    2011-12-01

    One of the most controversial topics in the field of clinical psychology, online tele-health, or the integration of computers and the internet with therapeutic techniques, remains at the forefront of many debates. Despite potential interest, there are numerous factors that a psychologist must consider before integrating an online tele-health intervention into their own practice. This article outlines literature pertinent to the debate. The article begins with a brief history of the use of non-face-to-face interventions as well as the earliest recorded use of "tele-health" before discussing the modern benefits and risks associated with usage. Considerations for the psychologist as well as the client are detailed; incorporating ethical implications. The authors conclude that the utilization of tele-health interventions is an exponentially expanding field that should continue to be explored. Despite many well-conceived studies, a psychologist should educate themselves in all aspects of the new modes of intervention (e.g., ethical, legal, evidence-based treatments) before attempting to implement them into everyday practice. The article ends with a discussion on the acceptance among psychologists, as well as the outlook for the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. [Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles].

    Science.gov (United States)

    Eich, W; Bär, K-J; Bernateck, M; Burgmer, M; Dexl, C; Petzke, F; Sommer, C; Winkelmann, A; Häuser, W

    2017-06-01

    The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

  5. Update on the clinical utility of once-daily tacrolimus in the management of transplantation

    Directory of Open Access Journals (Sweden)

    Revollo J

    2015-05-01

    Full Text Available Jane Revollo Department of Pharmacy, Jackson Memorial Hospital, University of Miami Leonard M Miller School of Medicine Miami, FL, USAThe review by Posadas Salas and Srinivas of the clinical utility of once-daily tacrolimus formulations in the management of transplant patients1 was timely and relevant. It is worth noting, however, the data were presented in a way that overlooked several key differences between two distinct once-daily tacrolimus formulations. These formulations differ in bioavailability, Cmax, Tmax, dose required to achieve target trough levels, and time to reach target trough. The specific formulation and dosing information of one product was detailed in this review (described as modified release 4 [MR-4]; Astagraf®, Astellas Pharma Inc., Tokyo, Japan, but no formulation or dosing details were provided for a very different once-daily tacrolimus formulation (LCP-Tacro™; Veloxis Pharmaceuticals A/S, Hørsholm, Denmark for which a thorough review was recently published.2 The latter product is currently approved in Europe and under review by the US Food and Drug Administration in the US. In presenting data in this review, the authors did not identify which product was investigated in each of the studies discussed. This could easily lead to misinterpretation of results or erroneous conclusions, ie, that both once-daily formulations are the same. In fact, a careful parsing of the data clearly demonstrates that they are not equivalent. Misunderstanding of this point could have a potentially serious impact on appropriate dosing, safety, and patient management in the post-transplant setting. Differentiation between the two products is needed to clarify what appear to be conflicting results of the studies presented in this review.View original paper by Posadas Salas and Srinivas

  6. [Li-Fraumeni syndrome: update, new data and guidelines for clinical management].

    Science.gov (United States)

    Frebourg, T; Abel, A; Bonaiti-Pellie, C; Brugières, L; Berthet, P; Bressac-de Paillerets, B; Chevrier, A; Chompret, A; Cohen-Haguenauer, O; Delattre, O; Feingold, J; Feunteun, J; Frappaz, D; Fricker, J P; Gesta, P; Jonveaux, P; Kalifa, C; Lasset, C; Leheup, B; Limacher, J M; Longy, M; Nogues, C; Oppenheim, D; Sommelet, D; Soubrier, F; Stoll, C; Stoppa-Lyonnet, D; Tristant, H

    2001-06-01

    The Li-Fraumeni syndrome (LFS) is an inherited form of cancer, affecting children and young adults, and characterized by a wide spectrum of tumors, including soft-tissue and bone sarcomas, brain tumours, adenocortical tumours and premenopausal breast cancers. In most of the families, LFS results from germline mutations of the tumor suppressor TP53 gene encoding a transcriptional factor able to regulate cell cycle and apoptosis when DNA damage occurs. Recently, germline mutations of hCHK2 encoding a kinase, regulating cell cycle via Cdc25C and TP53, were identified in affected families. The LFS working group recommendations are the following: (i) positive testing (screening for a germline TP53 mutation in a patient with a tumor) can be offered both to children and adults in the context of genetic counseling associated to psychological support, to confirm the diagnosis of LFS on a molecular basis. This will allow to offer to the patient a regular clinical review in order to avoid a delay to the diagnosis of another tumor; (ii) the 3 indications for positive testing are: a proband with a tumor belonging to the narrow LFS spectrum and developed before age 36 and, at least, first- or second-degree relative with a LFS spectrum tumor, before age 46, or a patient with multiple primary tumors, 2 of which belonging to the narrow LFS spectrum, the first being developed before 36 or a child with an adenocortical tumour; (iii) presymptomatic testing must be restricted to adults; (iv) the young age of onset of the LFS tumors the prognosis of some tumors, the impossibility to ensure an efficient early detection and the risk for mutation carriers to develop multiple primary tumors justify that prenatal diagnosis might be considered in affected families.

  7. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.

    Science.gov (United States)

    Ramar, Kannan; Dort, Leslie C; Katz, Sheri G; Lettieri, Christopher J; Harrod, Christopher G; Thomas, Sherene M; Chervin, Ronald D

    2015-07-15

    Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm

  8. Conflicts of Interest in Clinical Guidelines: Update of U.S. Preventive Services Task Force Policies and Procedures.

    Science.gov (United States)

    Ngo-Metzger, Quyen; Moyer, Virginia; Grossman, David; Ebell, Mark; Woo, Meghan; Miller, Therese; Brummer, Tana; Chowdhury, Joya; Kato, Elisabeth; Siu, Albert; Phillips, William; Davidson, Karina; Phipps, Maureen; Bibbins-Domingo, Kirsten

    2018-01-01

    The U.S. Preventive Services Task Force (USPSTF) provides independent, objective, and scientifically rigorous recommendations for clinical preventive services. A primary concern is to avoid even the appearance of members having special interests that might influence their ability to judge evidence and formulate unbiased recommendations. The conflicts of interest policy for the USPSTF is described, as is the formal process by which best practices were incorporated to update the policy. The USPSTF performed a literature review, conducted key informant interviews, and reviewed conflicts of interest policies of ten similar organizations. Important findings included transparency and public accessibility; full disclosure of financial relationships; disclosure of non-financial relationships (that create the potential for bias and compromise a member's objective judgment); disclosure of family members' conflicts of interests; and establishment of appropriate reporting periods. Controversies in best practices include the threshold of financial disclosures, ease of access to conflicts of interest policies and declarations, vague definition of non-financial biases, and request for family members' conflicts of interests (particularly those that are non-financial in nature). The USPSTF conflicts of interest policy includes disclosures for immediate family members, a clear non-financial conflicts of interest definition, long look-back period and application of the policy to prospective members. Conflicts of interest is solicited from all members every 4 months, formally reviewed, adjudicated, and made publicly available. The USPSTF conflicts of interest policy is publicly available as part of the USPSTF Procedure Manual. A continuous improvement process can be applied to conflicts of interest policies to enhance public trust in members of panels, such as the USPSTF, that produce clinical guidelines and recommendations. Copyright © 2018 American Journal of Preventive Medicine

  9. Phospholipase C zeta (PLCζ) and male infertility: Clinical update and topical developments.

    Science.gov (United States)

    Amdani, Siti Nornadhirah; Yeste, Marc; Jones, Celine; Coward, Kevin

    2016-05-01

    The development of a mammalian embryo is initiated by a sequence of molecular events collectively referred to as 'oocyte activation' and regulated by the release of intracellular calcium in the ooplasm. Over the last decade, phospholipase C zeta (PLCζ), a sperm protein introduced into the oocyte upon gamete fusion, has gained almost universal acceptance as the protein factor responsible for initiating oocyte activation. A large body of consistent and reproducible evidence, from both biochemical and clinical settings, confers support for the role of PLCζ in this fundamental biological context, which has significant ramifications for the management of human male infertility. Oocyte activation deficiency (OAD) and total fertilisation failure (TFF) are known causes of infertility and have both been linked to abnormalities in the structure, expression, and localisation pattern of PLCζ in human sperm. Assisted oocyte activators (AOAs) represent the only therapeutic option available for OAD at present, although these agents have been the source of much debate recently, particularly with regard to their potential epigenetic effects upon the embryo. Consequently, there is much interest in the deployment of sensitive PLCζ assays as prognostic/diagnostic tests and human recombinant PLCζ protein as an alternative form of therapy. Although PLCζ deficiency has been directly linked to a cohort of infertile cases, we have yet to identify the specific causal mechanisms involved. While two genetic mutations have been identified which link defective PLCζ protein to an infertile phenotype, both were observed in the same patient, and have yet to be described in other patients. Consequently, some researchers are investigating the possibility that genetic variations in the form of single nucleotide polymorphisms (SNPs) could provide some explanation, especially since >6000 SNPs have been identified in the PLCζ gene. As yet, however, there is no consistent data to suggest that any

  10. Bisphosphonates, atherosclerosis and vascular calcification: update and systematic review of clinical studies

    Directory of Open Access Journals (Sweden)

    Caffarelli C

    2017-10-01

    Full Text Available Carla Caffarelli,1 Andrea Montagnani,2 Ranuccio Nuti,1 Stefano Gonnelli1 1Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; 2Division of Internal Medicine, General Hospital Misericordia, Grosseto, Italy Background: Epidemiologic and clinical data have suggested the existence of a biologic linkage between the bone system and the vascular system. Bisphosphonates (BPs are effective inhibitors of bone resorption and are currently considered the drugs of choice for the prevention and treatment of osteoporosis and related fractures. Data from several publications have suggested that BPs may also be effective in reducing the atherosclerotic process and vascular calcification, but the results of these studies are contrasting. This review aimed to allow a better understanding of the relationships between BPs and atherosclerosis in humans.Materials and methods: Electronic databases of Pubmed-Medline, Cochrane Library and SCOPUS from inception to June 30, 2016 were searched. The full texts of the articles potentially eligible were carefully assessed and reviewed. Finally, 20 studies were found to be eligible and were included in the systematic review. All included studies were published between 2000 and 2014.Results: In several studies, etidronate limited the progression of aortic and coronary calcification in hemodialysis patients, whereas the nitrogen-containing-BPs given orally did not significantly reduce vascular calcifications in patients with chronic kidney disease, kidney trasplant or in those with osteoporosis. Nitrogen-containing-BPs present favorable effects both on vessel wall thickness and on arterial elasticity due to both a reduction in serum lipids and the interaction of BPs with the bone tissue, with the consequent release of bone turnover markers and cytokines into the bloodstream.Conclusion: To sum up, the BPs seem to have the potential of influencing atherosclerosis and calcium homeostasis at the level of

  11. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine

    Directory of Open Access Journals (Sweden)

    Andreucci M

    2017-05-01

    Full Text Available Michele Andreucci,1 Teresa Faga,1 Raffaele Serra,2 Giovambattista De Sarro,3 Ashour Michael1 1Renal Unit, Department of Health Sciences, 2Interuniversity Center of Phlebolymphology (CIFL, International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Medical and Surgical Sciences, 3Pharmacology Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy Abstract: An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function occurring 48–72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate <30 mL/min/1.73 m2 are at significant risk of CI-AKI. Most agree that when renal function is normal, there is no CI-AKI risk. Many experimental studies, however, are in favor of the existence of CI-AKI. Contrast drugs have been shown to cause the following changes: renal vasoconstriction, resulting in a rise in intrarenal resistance (decrease in renal blood flow and glomerular filtration rate and medullary hypoxia; epithelial vacuolization and dilatation and necrosis of proximal tubules; potentiation of angiotensin II effects, reducing nitric oxide (NO and causing direct constriction of descending vasa recta, leading to formation of reactive oxygen species in isolated descending vasa recta of rats microperfused with a solution of iodixanol; increasing active sodium reabsorption in the thick ascending limbs of Henle’s loop (increasing O2 demand and consequently medullary hypoxia; direct cytotoxic effects on endothelial and tubular epithelial cells (decrease

  12. Governance, veterinary legislation and quality.

    Science.gov (United States)

    Petitclerc, M

    2012-08-01

    This review of governance distinguishes between ends and means and, by highlighting the complexity and differing definitions of the concept, defines its scope and focuses discussion on its characteristics in order to establish an interrelationship between veterinary legislation and governance. Good governance must be backed by legislation, and good legislation must incorporate the principles and instruments of good governance. This article lists some of the main characteristics of governance and then reviews them in parallel with the methodology used to draft veterinary legislation, emphasising the importance of goal-setting and stakeholder participation. This article describes the criteria developed by the Veterinary Legislation Support Programme (VLSP) of the World Organisation for Animal Health (OIE) for assessing the quality of veterinary legislation. It then makes a comparison between the quality assurance process and the good governance process in order to demonstrate that the introduction and proper use of the tools for developing veterinary legislation offered by the OIE VLSP leads to a virtuous circle linking legislation with good governance. Ultimately, the most important point remains the implementation of legislation. Consequently, the author points out that satisfactory implementation relies not only on legislation that is technically and legally appropriate, acceptable, applicable, sustainable, correctly drafted, well thought through and designed for the long term, but also on the physical and legal capacity of official Veterinary Services to perform their administrative and enforcement duties, and on there being the means available for all those involved to discharge their responsibilities.

  13. Legislative developments in radioactive materials transportation, April 1993--August 1993

    International Nuclear Information System (INIS)

    Reed, J.B.; Cummins, J.

    1993-09-01

    This is the seventh report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the April 1993 report on Legislative Developments in Radioactive Materials Transportation and describes activities for the period April 1, 1993--August 31, 1993. NCSL currently is updating an on-line data base that contains abstracts of federal, state and local laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Limited availability of on-line capability is anticipated by the end of 1993. Users approved by DOE and NCSL will have access to the data base. A copy of any legislation listed in this report can be obtained by contacting the people listed below. This report contains the current status of legislation introduced in the 1993 state legislative sessions, not previously reviewed in past reports. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness are described. (General nuclear waste legislation with no transportation element is no longer tracked.) Also included are Federal Register notices pertinent to radioactive waste and hazardous materials transportation

  14. Navigating SA's climate change legislation

    International Nuclear Information System (INIS)

    Dickey, Suzanne

    2006-01-01

    It is proposed that there should be a legislation to address climate change and Greenhouse Gas Emission Reduction Bill. South Australian Government Greenhouse Strategy and climate change legislation in light of the far-reaching implications this legislation could have on clients, who face the impacts of climate change in the business and natural environment. It is a commitment to reduce greenhouse gas emissions in South Australia by 2050 to 60 per cent of 1990 levels

  15. Chapter No.2. Legislation

    International Nuclear Information System (INIS)

    2002-01-01

    UJD as the central body of state administration prepares legislation within their competency and sets also binding criteria in the field of nuclear safety. Based on provisions of the 'Atomic Act' the preparation of rest regulations has continued. Following drafts of 5 were prepared regulations in 2001 and then they were sent for comments to various ministries by UJD: (a) Regulation on safety requirements for design of nuclear installations; (b) Regulation on safety requirements for commissioning and operation of nuclear installations; (c) Regulation on safety documentation; (d) Regulation on periodic safety assessment; (e) Regulation on safety requirements for siting of nuclear installations. Two following UJD safety guides were published in 2001 as the part of edition 'Safety of Nuclear Installations': (a) BNS I. 11.2/1999 'Requirements for performance of safety analyses for ATWS' (b) BNS II.3.1/2000 'Evaluation of acceptability of faults detected during the operation inspection of nuclear installation selected equipment'. As UJD is responsible for performance of such reviews according to law No. 264/1999 Coll. on conformance assessment of products about 10 drafts of technical standards were reviewed. UJD provided documentation to the Slovak Republic position document related to Chapter 14 - Energy which was submitted to the European Union (EU). The set of recommendations related to nuclear safety was elaborated by the special working group on atomic question which was established by the EU Council. Their implementation is required as a prerequisite to close negotiations on Chapter 14 - Energy. The schedule of necessary safety related measures was agreed in co-operation with the SE a.s. and the Ministry of Economy and submitted as additional information for negotiations to the EC. The negotiations on Chapter 14 - Energy were successfully closed in October 2001. The activities in the area of Chapter 22 - Environment were concentrated on submission of necessary data

  16. A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression

    International Nuclear Information System (INIS)

    Loblaw, D. Andrew; Mitera, Gunita; Ford, Michael; Laperriere, Normand J.

    2012-01-01

    Purpose: To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC). Methods: A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies. Results: An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes. Conclusions: If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.

  17. A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression

    Energy Technology Data Exchange (ETDEWEB)

    Loblaw, D. Andrew, E-mail: andrew.loblaw@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto (Canada); Mitera, Gunita [Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto (Canada); Ford, Michael [Division of Orthopedic Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto (Canada); Laperriere, Normand J. [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto (Canada)

    2012-10-01

    Purpose: To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC). Methods: A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies. Results: An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes. Conclusions: If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.

  18. Clinical Voices - an update

    DEFF Research Database (Denmark)

    Fusaroli, Riccardo; Weed, Ethan

    Anomalous aspects of speech and voice, including pitch, fluency, and voice quality, are reported to characterise many mental disorders. However, it has proven difficult to quantify and explain this oddness of speech by employing traditional statistical methods. In this talk we will show how the t...... the temporal dynamics of the voice in Asperger's patients enable us to automatically reconstruct the diagnosis, and assess the Autism quotient score. We then generalise the findings to Danish and American children with autism....

  19. Stricter antitrust legislation?

    International Nuclear Information System (INIS)

    Heller, W.

    2007-01-01

    In November 2006, the German Federal Ministry of Economics sent a ministerial draft bill on combating price abuses in the energy supply and food trade sectors to the trade associations for comment. The bill must be seen as part of a set of measures of the federal government seeking to improve conditions for more competition in the energy sector. An omnibus law is to add a new Section 29 to the Act against Restrictions on Competition (Antitrust Act). The addition is to bear the heading of 'Power Economy' and has been designed to prevent a utility (vendor of electricity, gas, and district heat) from abusing its position on a market which it dominates either alone or together with other utility companies. Depending on the interests involved, comments on the draft bills differ. On the whole, this tightening up of antitrust legislation is preceived more as a repair job. Stricter antitrust provisions absolutely must also be seen in their European dimension. European firms not falling under this stricter antitrust law enjoy advantages over German firms. (orig.)

  20. The impact of safety legislation

    International Nuclear Information System (INIS)

    Turner, J.L.; Gill, J.R.

    1989-01-01

    The impact of medicines legislation for radiopharmaceuticals is discussed with regard to product licensing, production and quality control, marketing authorisation within the EC, licensing exemptions and authorisation for administration. As regards safety legislation for radiopharmaceuticals the requirements of the Ionising Radiations Regulations 1985 are outlined. (UK)

  1. Legal Principles and Legislative Instrumentalism

    NARCIS (Netherlands)

    Gribnau, J.L.M.; Soeteman, A.

    2003-01-01

    Instrumentalist legislation usually underestimates the importance of legal principles in modern law. Legal principles are the normative core of a value oriented conception of law. They function as essential criteria of evaluation for lawmaking by the legislator and the executive. In fact,

  2. Trends in outdoor recreation legislation

    Science.gov (United States)

    George H. Siehl

    1980-01-01

    The two decades which have passed since the era of the Outdoor Recreation Resources Review Commission (ORRRC) have been active and fruitful in terms of Federal recreation legislation. The Commission and its final report "Outdoor Recreation for America" strongly influenced the burst of recreation legislation in the 1960's. Even today, the studies prepared...

  3. Legislative and Judicial Information Systems.

    Science.gov (United States)

    Becker, Louise Giovane

    1983-01-01

    Reviews computer applications in judicial, legal, and legislative information activities being used to support litigation and court administration, assist in searching for legislation and laws, aid criminal justice information systems, and provide appropriate bibliographic and reference assistance. Management issues in automating systems are…

  4. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2013-01-01

    - International co-operation: Law ratifying the agreement between the International Atomic Energy Agency and Greece in the area of education and training; - Nuclear safety and radiological protection: Ministerial decision establishing requirements for nuclear safety and regulatory control of research reactors; Moldova - General legislation: New comprehensive law governing nuclear and radiological activities; United States - Issuance of the 'Strategy for the Management and Disposal of Used Nuclear Fuel and High-Level Radioactive Waste'; - Ongoing activities: The Blue Ribbon Commission noted the need for near-term actions that can lay the groundwork for the next generation of nuclear waste policies and programmes included in its recommendations; - Physical protection of by-product material final rulemaking: On 19 March 2013, the NRC published a final rule amending its regulations to establish security requirements for the use and transport of category 1 and category 2 quantities of radioactive material; - Update on the NRC's response to the events at the Fukushima Daiichi nuclear site regarding filtered vents and consideration of economic consequences

  5. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE.

    Science.gov (United States)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R; Duick, Daniel S; Harrell, R Mack; Hegedüs, Laszlo; Paschke, Ralf; Valcavi, Roberto; Vitti, Paolo

    2016-05-01

    malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).

  6. Homelessness: Issues and Legislation in the 101st Congress. Updated.

    Science.gov (United States)

    Wasem, Ruth Ellen

    This report discusses the nature of homelessness and the homeless in America, recent programs that have been implemented to help the homeless, and issues concerning the Federal government's role in helping these people. The following topics concerning the characteristics of the homeless and the causes of homelessness are covered: (1) "Mental…

  7. An update on U.S. export legislation

    International Nuclear Information System (INIS)

    Doub, W.O.

    1978-01-01

    This paper provides an in-depth analysis of the U.S. Nuclear Non-proliferation Act of 1978. It reviews the essential amendments that Act has made to the 1954 Atomic Energy Act. These concern redefinition of the NRC's role, its relations with the Executive Branch and governmental agencies, new conditions imposed by the U.S. on importing countries and the advantages provided in return. (NEA) [fr

  8. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery.

    Science.gov (United States)

    Mechanick, Jeffrey I; Youdim, Adrienne; Jones, Daniel B; Garvey, W Timothy; Hurley, Daniel L; McMahon, M Molly; Heinberg, Leslie J; Kushner, Robert; Adams, Ted D; Shikora, Scott; Dixon, John B; Brethauer, Stacy

    2013-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

  9. CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT—2013 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY★

    Science.gov (United States)

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, M. Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2014-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE- TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. PMID:23529351

  10. Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery*

    Science.gov (United States)

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2014-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. PMID:23529939

  11. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

    Science.gov (United States)

    Ketteler, Markus; Block, Geoffrey A; Evenepoel, Pieter; Fukagawa, Masafumi; Herzog, Charles A; McCann, Linda; Moe, Sharon M; Shroff, Rukshana; Tonelli, Marcello A; Toussaint, Nigel D; Vervloet, Marc G; Leonard, Mary B

    2018-02-20

    The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update and the original publication are intended to assist practitioners caring for adults with CKD and those receiving long-term dialysis. Development of the guideline update followed an explicit process of evidence review and appraisal. The approach adopted by the Work Group and the evidence review team was based on systematic reviews of relevant trials, appraisal of the quality of the evidence, and rating of the strength of recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Searches of the English-language literature were conducted through September 2015 and were supplemented with targeted searches through February 2017. Final modification of the guidelines was informed by a public review process involving numerous stakeholders, including patients, subject matter experts, and industry and national organizations. The update process resulted in the revision of 15 recommendations. This synopsis focuses primarily on recommendations for diagnosis of and testing for CKD-MBD and treatment of CKD-MBD that emphasizes decreasing phosphate levels, maintaining calcium levels, and addressing elevated parathyroid hormone levels in adults with CKD stage G3a to G5 and those receiving dialysis. Key elements include basing treatment on trends in laboratory values rather than a single abnormal result and being cautious to avoid hypercalcemia when treating secondary hyperparathyroidism.

  12. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Relative Value Scale Update Committee.

    Science.gov (United States)

    Barbieri, John S; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; Collins, Scott A B

    2018-04-01

    The American Medical Association-Specialty Society Relative Value Scale Update Committee, also known as the RUC, plays a critical role in assessing the relative value of physician services and procedures. This committee provides access for all physicians, including dermatologists, to the reimbursement process. Since the introduction of the Resource-Based Relative Value Scale by Medicare, the RUC has done important work to evaluate and refine reimbursement for physician services. The RUC recommendations have also led the Current Procedural Terminology (CPT) Editorial Panel to develop additional reimbursement codes as new procedures and services are developed. In this article (from the series Future Considerations for Clinical Dermatology in the Setting of 21st Century American Policy Reform), we will review the RUC, including its history and membership, the RUC update process, and a brief discussion of a few issues of particular importance to dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Chapter 3. Legislation

    International Nuclear Information System (INIS)

    2000-01-01

    The Nuclear Regulatory Authority of the Slovak Republic (UJD) as central body of state administration prepares legislation within their competency and sets also binding criteria in the filed of nuclear safety. Based on provisions of the 'Atomic Act' there are 16 binding regulations under preparation. In 199 the following regulations were issued by UJD (1) Regulation No. 29/1999 Collection laws (Coll. l.) by which a list special materials and equipment is published. It came into force on 1 March 1999; (2) ) Regulation No. 30/1999 Coll. l. which defines details on maximum limits on quantities for nuclear materials for which there is no presumption of causing nuclear damage. It came into force on 1 March 1999; (3) Regulation No. 186/1999, which determines details to assure physical protection of nuclear installations, nuclear materials and radioactive waste. It came into force on 1 August 1999; (4) Regulations No. 187/1999 Coll. l. on professional competence of employees of nuclear installations. It came into force on 1 August 1999; (5) Regulation No. 198/1999 Coll. l. on accounting and inspection of nuclear materials. It came into force on 1 September 1999; (6) Regulation No. 245/1999 Coll. l. on emergency planning in case in incident or accident. It came into force on 1 October 1999; (7) Regulation No. 246/1999 Coll. l. on documentation of nuclear installations for decommissioning. It came into force on 1 October; (8) Regulation No. 284/1999 Coll. l. on details on transportation of nuclear materials and radioactive waste. It came into force on 15 November 1999. Six UJD safety guide were published last year as the part of edition 'Safety of Nuclear Installations'. UJD provides documentation for screening process of Energy sector and Environment sector as contribution to the accession process to the European Union. The most important subject within the negotiations with the European Commission were safety and operation of the NPP V-1 Bohunice. UJD grants

  14. Nuclear liability legislation in Slovenia

    International Nuclear Information System (INIS)

    Skraban, A.

    2000-01-01

    This paper gives some basic data about nuclear installations in Slovenia, reviews Slovenian national legislation in the field of third-party liability for nuclear damage, applicability of the international nuclear liability treaties in the Slovenian legal system and outlines some main provisions of national legislation. It also aims to give some facts about history and present status of nuclear insurance pool and the insurance of nuclear risks in Slovenia. Paper finally indicates also some future legislative steps with respect to nuclear third party liability, at national and international level. (author)

  15. An Update on Neurofibromatosis Type 1: Not Just Café-au-Lait Spots, Freckling, and Neurofibromas. An Update. Part I. Dermatological Clinical Criteria Diagnostic of the Disease.

    Science.gov (United States)

    Hernández-Martín, A; Duat-Rodríguez, A

    2016-01-01

    Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome and probably the one best known to dermatologists, who are generally the first physicians to suspect its diagnosis. Although the genetic locus of NF1 was identified on chromosome 17 in 1987, diagnosis of the disease is still mainly based on clinical observations and the diagnostic criteria of the National Institute of Health, dating from 1988. Cutaneous manifestations are particularly important because café-au-lait spots, freckling on flexural areas, and cutaneous neurofibromas comprise 3 of the 7 clinical diagnostic criteria. However, café-au-lait spots and freckling can also be present in other diseases. These manifestations are therefore not pathognomonic and are insufficient for definitive diagnosis in the early years of life. NF1 is a multisystemic disease associated with a predisposition to cancer. A multidisciplinary follow-up is necessary and dermatologists play an important role. Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  16. Legislative developments in radioactive materials transportation, September 1993--June 1994

    International Nuclear Information System (INIS)

    Worthley, J.A.; Reed, J.B.; Cummins, J.

    1994-07-01

    This is the eighth report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the September 1993 report on Legislative Developments in Radioactive Materials Transportation and describes activities for the period September 1, 1993--June 30, 1994. NCSL currently is updating an on-line data base that contains abstracts of federal, state and local laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Availability of on-line capability is anticipated by the end of August 1994. Users approved by DOE and NCSL will have access to the data base. This report contains the current status of legislation introduced in the 1993 and 1994 state legislative sessions, not previously reviewed in past reports. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness are described. (General nuclear waste legislation with no transportation element is no longer tracked.) Also included are Federal Register notices and changes in federal regulations pertinent to radioactive waste and hazardous materials transportation

  17. Chapter 3. Legislation

    International Nuclear Information System (INIS)

    2001-01-01

    The Nuclear Regulatory Authority of the Slovak Republic (UJD) as the central authority of state administration prepares legislation within their competency and sets also binding criteria in the field of nuclear safety. Based on provisions of the 'Atomic Act' a preparation of remaining 8 decrees have continued. In 2000 the following decrees were issued by UJD: (1) Decree No. 31/2000 Coll on events at nuclear installations. It came into force on 15 February 2000. (2) Decree No. 190/2000 Coll by which details of radioactive waste management and spent fuel management are regulated. It came into force on 1-st July 2000. The following six decrees are at the process of preparation: (a) Decree on quality assurance of nuclear installations, (b) Decree on safety requirements for design of nuclear installations, (c) Decree on safety requirements for commissioning and operation of nuclear installations, (d) Decree on safety documentation, (e) Decree on periodic safety assessment, (f) Decree on safety requirements for siting of nuclear installations. Following five UJD safety guides were published in 2000 as the part of edition 'Safety of Nuclear Installations': (1) BNS I.9.1/1999 Safety of nuclear facilities during decommissioning (issued in April 2000). (2) BNS III.4.1/2000 Requirements on UJD SR permit issue for fuel use in WWER 440 reactors (issued in September 2000). (3) BNS III.4.3/2000 Requirements on assessment of fuel loading for WWER 440 reactors (issued in September 2000). (4) BNS I.2.6/2000 UJD SR requirements on chapter 4 of Safety analysis report 'Core design' (issued in September 2000). (5) NS I.4.2/1996 Use of PSA methodology in the process of regulation by regulatory authority (issued in September 2000). About thirty-five drafts of technical standards were reviewed as UJD is responsible for performance such review according to the law No. 264/1999 Coll. on conformance assessment of products. UJD provided necessary documentation for negotiation positions of the

  18. Montgomery County Council Legislation - Bills

    Data.gov (United States)

    Montgomery County of Maryland — The Council enacts local public laws for the ‘peace, good government, health, and welfare of the county’. The bills dataset contains all legislation considered by...

  19. Information report on state legislation

    International Nuclear Information System (INIS)

    1982-01-01

    Summaries of laws enacted by states, during 1982, dealing with the management of low-level radioactive wastes are presented in this report. Also included are adopted resolutions, introduced legislation and introduced resolutions

  20. Swiss legislation on dog ownership

    CERN Multimedia

    DSU Department

    2008-01-01

    The Swiss Permanent Mission in Geneva has requested CERN to inform the members of its personnel that a notice relating to Swiss legislation on dog ownership has been published on-line at the following address: http://www.eda.admin.ch/eda/en/home/topics/intorg/un/unge/gepri/pet.html This legislation is applicable to all international civil servants who own a dog. Relations with the Host States Service mailto:relations.secretariat@cern.ch http://www.cern.ch/relations/

  1. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    Anon.

    2009-01-01

    This part gathers the national legislative and regulatory activities. The subjects tackled are as follow: radiological protection (Belgium), transport of radioactive materials (Belgium, France), general legislation (Brazil, Ireland, Republic of Moldova, Serbia, Turkey), third part liability (Japan), radioactive waste management (Korea, Romania, Slovenia, Usa), regime of radioactive materials (Romania), organisation and structure (Switzerland), regime of nuclear installations (Usa), regulations on nuclear trade (Usa). (N.C)

  2. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine

    Science.gov (United States)

    Brierley, Joe; Carcillo, Joseph A.; Choong, Karen; Cornell, Tim; DeCaen, Allan; Deymann, Andreas; Doctor, Allan; Davis, Alan; Duff, John; Dugas, Marc-Andre; Duncan, Alan; Evans, Barry; Feldman, Jonathan; Felmet, Kathryn; Fisher, Gene; Frankel, Lorry; Jeffries, Howard; Greenwald, Bruce; Gutierrez, Juan; Hall, Mark; Han, Yong Y.; Hanson, James; Hazelzet, Jan; Hernan, Lynn; Kiff, Jane; Kissoon, Niranjan; Kon, Alexander; Irazusta, Jose; Lin, John; Lorts, Angie; Mariscalco, Michelle; Mehta, Renuka; Nadel, Simon; Nguyen, Trung; Nicholson, Carol; Peters, Mark; Okhuysen-Cawley, Regina; Poulton, Tom; Relves, Monica; Rodriguez, Agustin; Rozenfeld, Ranna; Schnitzler, Eduardo; Shanley, Tom; Skache, Sara; Skippen, Peter; Torres, Adalberto; von Dessauer, Bettina; Weingarten, Jacki; Yeh, Timothy; Zaritsky, Arno; Stojadinovic, Bonnie; Zimmerman, Jerry; Zuckerberg, Aaron

    2013-01-01

    Background The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote “best practices” and to improve patient outcomes. Objective 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. Participants Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001–2006). Methods The Pubmed/MEDLINE literature database (1966–2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus. Results The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%–3% in previously healthy, and 7%– 10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that

  3. Updating protocols prodigy.

    Science.gov (United States)

    Ambrose, Kate

    2005-04-01

    If you are updating protocols, why not try the Prodigy website, at www.prodigy.nhs.uk ? It is a source of clinical knowledge on a range oftopics that is based on best evidence and organised to support clinical decision making.

  4. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines.

    Science.gov (United States)

    Ferraris, Victor A; Brown, Jeremiah R; Despotis, George J; Hammon, John W; Reece, T Brett; Saha, Sibu P; Song, Howard K; Clough, Ellen R; Shore-Lesserson, Linda J; Goodnough, Lawrence T; Mazer, C David; Shander, Aryeh; Stafford-Smith, Mark; Waters, Jonathan; Baker, Robert A; Dickinson, Timothy A; FitzGerald, Daniel J; Likosky, Donald S; Shann, Kenneth G

    2011-03-01

    Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007. The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector. In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management. Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations. Copyright © 2011 The Society of Thoracic

  5. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    Belarus: general legislation with amendments to laws on the use of atomic energy (2009) and criminal law on acts concerning the use of radioactive sources and administrative law for non criminal violations of radiation safety requirement (2009). Egypt: general legislation with law on activities in the nuclear and radiation field (2010). France: radioactive waste management with a decree establishing a committee on industrial co-ordination of radioactive waste (2010) and third part liability with a law on the recognition and indemnification of victims of nuclear tests conducted by France (2010). Germany: general legislation with a tenth amendment to the atomic energy act (2010), and act on environmental impact assessment (2009) concerning organisation and structure we find a revised version of statutes of the Radiation Protection Commission (2009), about radiation protection we find an act on the protection against non-ionizing radiation (2009), and for transport of radioactive materials we have an ordinance on the international transport of dangerous goods by road (2009). Ireland: In radiation protection we have an order to amend Regulations on active implantable medical devices (2010). Italy: general legislation we have a decree setting out rules for the sitting, construction and operation of nuclear installations (2010). Romania: general legislation with a law on the reorganisation of public authorities (2009). Slovak Republic: general legislation with an amendment of the atomic act (2009). spain: radioactive waste management with a law regulation limited investment companies quoted on the real estate market (2009). Ukraine: general legislation with an overview of recent amendments to laws in the field of nuclear energy (2009). (N.C.)

  6. Effectiveness of Inhalant Abuse Legislation.

    Science.gov (United States)

    Batis, Jeffery C

    2017-01-28

    Since peaking in the 1990s, inhalant abuse has steadily decreased over the past two decades. Concurrently, nearly every state has passed legislation aimed at minimizing inhalant abuse. While males have historically been more likely to abuse inhalants than females, there is no longer a sex effect in self-reported rates of inhalant abuse. The objective of the present study is to evaluate the effect of anti-inhalant abuse legislation on self-reported rates of inhalant abuse, in high school age males and females. Beginning in 1993, the CDC's biannual Youth Risk Behavior Surveillance Survey asked respondents if they have ever used inhalants to get high. Data from these surveys were collected, along with the date of passage of anti-inhalant abuse legislation in 46 of 50 states. ANOVAs were conducted to assess the effect of legislation on self-reported inhalant abuse rates. There were no significant main effects or interactions that demonstrated that inhalant abuse rates decreased in males or females following passage of legislation aimed at decreasing inhalant abuse. Conclusion/Importance: To date, 46 of 50 states have passed laws aimed at minimizing inhalant abuse, and while inhalant abuse rates have been decreasing for the past two decades, there is no evidence that this decline is related to enactment of these laws. Further research is needed to determine the cause of the decrease in inhalant abuse. The laws may benefit from amendments to include options for treatment.

  7. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology.

    Science.gov (United States)

    Neuss, Michael N; Gilmore, Terry R; Belderson, Kristin M; Billett, Amy L; Conti-Kalchik, Tara; Harvey, Brittany E; Hendricks, Carolyn; LeFebvre, Kristine B; Mangu, Pamela B; McNiff, Kristen; Olsen, MiKaela; Schulmeister, Lisa; Von Gehr, Ann; Polovich, Martha

    2016-12-01

    Purpose To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards .

  8. Dissolution Threats and Legislative Bargaining

    DEFF Research Database (Denmark)

    Becher, Michael; Christiansen, Flemming Juul

    2015-01-01

    Chief executives in many parliamentary democracies have the power to dissolve the legislature. Despite a well-developed literature on the endogenous timing of parliamentary elections, political scientists know remarkably little about the strategic use of dissolution power to influence policymaking....... To address this gap, we propose and empirically evaluate a theoretical model of legislative bargaining in the shadow of executive dissolution power. The model implies that the chief executive's public support and legislative strength, as well as the time until the next constitutionally mandated election...

  9. Nuclear Liability Legislation in Slovenia

    International Nuclear Information System (INIS)

    Skraban, A.

    1998-01-01

    This paper reviews Slovenian national legislation in the field of third party liability for nuclear damage, applicability of the international nuclear liability treaties in Slovenia legal system and outlines some main provisions of national legislation. It is worth mentioning that legal instruments covering third party liability and compulsory insurance of such liability exist in Slovenia for almost 20 years and that our nuclear facilities are covered by relevant international treaties and conventions in this field, among them also by the Vienna Convention on Civil Liability for Nuclear Damage (from 1977) and the Joint Protocol Relating to the Application of the Vienna Convention and the Paris Convention (from 1994). (author)

  10. 40 CFR 1508.17 - Legislation.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Legislation. 1508.17 Section 1508.17 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY TERMINOLOGY AND INDEX § 1508.17 Legislation. Legislation includes a bill or legislative proposal to Congress developed by or with the significant...

  11. Commented review of the Colombian legislation regarding the ethics of health research.

    Science.gov (United States)

    Lopera, Mónica María

    2017-12-01

    The scope of ethics in health research transcends its legal framework and the regulations established in Resolution 8430 of 1993. These norms represent a fundamental tool to determine the minimum protection standards for research subjects, and, therefore, they should be known, applied properly, and reflect upon by all researchers in the field.Here I present and discuss from an analytical point of view the regulations that guide research in health. In this framework, health is understood as a multidimensional process, and research in health as a multidisciplinary exercise involving basic, clinical and public health research, collective health, and other related sciences.The main analytical categories are related to the principles and actors involved in research (regulatory authorities, ethical committees, and special or vulnerable subjects and populations), and to professional ethics codes, in addition to informed consents and data management.Despite the contribution of this legislation to the qualification of health research, my conclusion is that the national legislation in ethics for health research requires updating regarding technological and scientific developments, as well as specifications from the multiple types of health studies.

  12. Legislative vulnerability of minority groups.

    Science.gov (United States)

    Paula, Carlos Eduardo Artiaga; Silva, Ana Paula da; Bittar, Cléria Maria Lôbo

    2017-12-01

    Minorities are in an inferior position in society and therefore vulnerable in many aspects. This study analyzes legislative vulnerability and aims to categorize as "weak" or "strong" the protection conferred by law to the following minorities: elderly, disabled, LGBT, Indians, women, children/ adolescents and black people. In order to do so, it was developed a documental research in 30 federal laws in which legal provisions were searched to protect minorities. Next, the articles were organized in the following categories: civil, criminal, administrative, labor and procedural, to be analyzed afterwards. Legal protection was considered "strong" when there were legal provisions that observed the five categories and "weak" when it did not meet this criterion. It was noted that six groups have "strong" legislative protection, which elides the assertion that minorities are outside the law. The exception is the LGBT group, whose legislative protection is weak. In addition, consecrating rights through laws strengthens the institutional channels for minorities to demand their rights. Finally, it was observed that the legislative protection granted tominorities is not homogeneous but rather discriminatory, and there is an interference by the majority group in the rights regulation of vulnerable groups.

  13. Model Legislation on Student Residency.

    Science.gov (United States)

    Higher Education in the States, 1971

    1971-01-01

    Because of the radical variance in residency requirements from state to state and sometimes from institution to institution, and because of several court cases involving this issue, the Education Commission of the States appointed a Committee to develop (1) a statement of principles for consideration in drafting legislation in connection with…

  14. Seismic maps foster landmark legislation

    Science.gov (United States)

    Borcherdt, Roger D.; Brown, Robert B.; Page, Robert A.; Wentworth, Carl M.; Hendley, James W.

    1995-01-01

    When a powerful earthquake strikes an urban region, damage concentrates not only near the quake's source. Damage can also occur many miles from the source in areas of soft ground. In recent years, scientists have developed ways to identify and map these areas of high seismic hazard. This advance has spurred pioneering legislation to reduce earthquake losses in areas of greatest hazard.

  15. New Legislation on Capitol Hill

    Science.gov (United States)

    Wertman, John

    2016-01-01

    In this brief article, John Wertman describes the evolution of the Every Student Succeeds Act (ESSA) of 2015, the role the American Association of Geographers (AAG) played over the last decade in getting it passed, and the impact the Act has on funding for K-12 geography education. The legislation, while not perfect, includes promising new…

  16. Copyright Updates for K-12 Librarians

    Science.gov (United States)

    Johnson, Wendell G.

    2016-01-01

    Copyright concerns continue to bedevil K-12 librarians, who are often called upon to act as the copyright officers in public schools. This article describes recent copyright developments of concern to these librarians in three areas: a recent court case involving a university library, pending legislation supported by ALA, and a regulatory update.…

  17. Circular Updates

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Circular Updates are periodic sequentially numbered instructions to debriefing staff and observers informing them of changes or additions to scientific and specimen...

  18. User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update.

    Science.gov (United States)

    Pollock, Alex; Campbell, Pauline; Baer, Gillian; Choo, Pei Ling; Morris, Jacqui; Forster, Anne

    2015-04-20

    This paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement. We sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review. The stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups. We involved a stakeholder group in the update of a Cochrane systematic review, using clearly

  19. Legislative developments in radioactive materials transportation, November 1992--March 1993

    International Nuclear Information System (INIS)

    Reed, J.B.; Cummins, J.

    1993-04-01

    This is the sixth report prepared by the National Conference of State Legislatures (NCSL) on developments in radioactive materials transportation. It updates information contained in the November 1992 Legislative and Legal Developments in Radioactive Materials Transportation report and describes activities for the period November 1, 1992--March 31, 1993. NCSL is working to bring on-line a data base that contains abstracts of state laws and regulations relating to the transportation of radioactive materials. The data base will be operated by NCSL under a cooperative agreement with the Department of Energy's (DOE) Office of Civilian Radioactive Waste Management. Limited availability of on-line capability is anticipated by the end of July 1993. Users approved by DOE and NCSL will have access to the data base. Hard copy of any legislation listed in this report can be obtained by contacting the people listed below. This report contains summaries of legislation introduced in the 1993 state legislative sessions. Bills that address nuclear materials transportation and the broader area of hazardous materials transportation are grouped by state according to their status--enacted, pending or failed. In addition, bills that deal with emergency preparedness and general nuclear waste issues are described. Also included are Federal Register notices pertinent to radioactive waste and hazardous materials transportation. A recent court decision is also summarized

  20. Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non-Small-Cell Lung Cancers: American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update.

    Science.gov (United States)

    Kris, Mark G; Gaspar, Laurie E; Chaft, Jamie E; Kennedy, Erin B; Azzoli, Christopher G; Ellis, Peter M; Lin, Steven H; Pass, Harvey I; Seth, Rahul; Shepherd, Frances A; Spigel, David R; Strawn, John R; Ung, Yee C; Weyant, Michael

    2017-09-01

    Purpose The panel updated the American Society of Clinical Oncology (ASCO) adjuvant therapy guideline for resected non-small-cell lung cancers. Methods ASCO convened an update panel and conducted a systematic review of the literature, investigating adjuvant therapy in resected non-small-cell lung cancers. Results The updated evidence base covered questions related to adjuvant systemic therapy and included a systematic review conducted by Cancer Care Ontario current to January 2016. A recent American Society for Radiation Oncology guideline and systematic review, previously endorsed by ASCO, was used as the basis for recommendations for adjuvant radiation therapy. An update of these systematic reviews and a search for studies related to radiation therapy found no additional randomized controlled trials. Recommendations Adjuvant cisplatin-based chemotherapy is recommended for routine use in patients with stage IIA, IIB, or IIIA disease who have undergone complete surgical resections. For individuals with stage IB, adjuvant cisplatin-based chemotherapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant chemotherapy for each patient. The guideline provides information on factors other than stage to consider when making a recommendation for adjuvant chemotherapy, including tumor size, histopathologic features, and genetic alterations. Adjuvant chemotherapy is not recommended for patients with stage IA disease. Adjuvant radiation therapy is not recommended for patients with resected stage I or II disease. In patients with stage IIIA N2 disease, adjuvant radiation therapy is not recommended for routine use. However, a postoperative multimodality evaluation, including a consultation with a radiation oncologist, is recommended to assess benefits and risks of adjuvant radiation therapy for each patient with N2 disease. Additional

  1. 2017 Position Paper of the Italian Society for Cardiovascular Prevention (SIPREC) for an Updated Clinical Management of Hypercholesterolemia and Cardiovascular Risk: Executive Document.

    Science.gov (United States)

    Volpe, Massimo; Volpe, Roberto; Gallo, Giovanna; Presta, Vivianne; Tocci, Giuliano; Folco, Emanuela; Peracino, Andrea; Tremoli, Elena; Trimarco, Bruno

    2017-09-01

    The benefits achieved by implementing cardiovascular prevention strategies in terms of reduced incidence of atherosclerotic diseases and mortality are accepted, worldwide. In particular, the clinical management of hypercholesterolemia has a fundamental role for all preventive strategies, both in primary and secondary prevention, at each stage of cardiovascular risk. Since the net clinical benefit of lipid-lowering therapy largely depends on baseline individual cardiovascular risk profile, the assessment of individual risk is essential to establish type and intensity of both preventive and therapeutic strategies. Thus, the real challenge in a setting of clinical practice is not only to identify whom to treat among individuals at low-to-moderate risk, but mostly how much and how long to treat high or very-high risk patients. This manuscript, which reflects concepts and positions that have been published in a more extensive document of the Italian Society for Cardiovascular Prevention (SIPREC), deals with the diagnostic and therapeutic management of patients with dyslipidaemia, with an evidence-based approach adapted and updated from recent guidelines of the European Society of Cardiology and very recent results of randomized clinical trials. The purpose is to suggest a multidimensional and integrated actions aimed at eliminating or minimizing the impact of cardiovascular diseases and their related disabilities and mortality in patients with hypercholesterolemia.

  2. A Clinical Practice Update on the Latest AAOS/ADA Guideline (December 2012) on Prevention of Orthopaedic Implant Infection in Dental Patients.

    Science.gov (United States)

    Hamedani, Sh

    2013-03-01

    The American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA), along with 10 other academic associations and societies recently (December 2012) published their mutual clinical practice guideline "Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures." This evidence-based guideline ,detailed in 325 pages, has three recommendations and substitutes the previous AAOS guideline. The new published clinical guideline is a protocol to prevent patients undertaking dental procedures from orthopaedic implant infection. The guideline is developed on the basis of a collaborative systematic review to provide practical advice for training clinicians, dentists and any qualified physicians who need to consider prevention of orthopaedic implant (prosthesis) infection in their patients. This systematic review found no explicit evidence of cause-and-effect relationship between dental procedures and periprosthetic joint infection (PJI). This LTTE wishes to present a vivid summary of AAOS/ADA clinical practice guideline as a clinical update and an academic implementation to inform and assist Iranian competent clinicians and dentists in the course of their treatment decisions, to enrich the value and quality of health care on the latest international basis.

  3. Update of the Grupo Español de Leucemia Linfocítica Crónica clinical guidelines of the management of chronic lymphocytic leukemia.

    Science.gov (United States)

    García-Marco, José A; Delgado, Julio; Hernández-Rivas, José A; Ramírez Payer, Ángel; Loscertales Pueyo, Javier; Jarque, Isidro; Abrisqueta, Pau; Giraldo, Pilar; Martínez, Rafael; Yáñez, Lucrecia; Terol, Mª José; González, Marcos; Bosch, Francesc

    2017-04-21

    The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax). A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience. The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL. There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  4. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy.

    Science.gov (United States)

    Neuss, Michael N; Polovich, Martha; McNiff, Kristen; Esper, Peg; Gilmore, Terry R; LeFebvre, Kristine B; Schulmeister, Lisa; Jacobson, Joseph O

    2013-05-01

    In 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.

  5. A Century of Environmental Legislation

    DEFF Research Database (Denmark)

    Cain, Louis P.; Kaiser, Brooks

    2016-01-01

    At the beginning of the 20th century, three intertwined ambitions drove federal legislation over wildlife and biodiversity: establishment of multiple-use federal lands, the economic development of natural resources, and the maintenance of option values. We examine this federal intervention in nat...... depends on the community’s resource endowments. These endowments are defined not only in terms of users’ current wealth accumulation but also from their expected ability to extract utility from natural resources over time....

  6. TENORM legislation - Theory and practice

    International Nuclear Information System (INIS)

    Tsurikov, N.; Koperski, J.

    2002-01-01

    Processing of minerals often increases concentrations of naturally occurring radioactive materials (NORM) in mineral concentrates, products and waste streams. This so-called TENORM (Technologically Enhanced Naturally Occurring Radioactive Materials) phenomenon can result in usually very small increases of radiation exposures to workers and the public. However, proposed international radiation protection standards are likely to bring the TENORM issue into the realm of regulatory concern. Verbatim adoption by the national legislation's of the radiation protection standards like those proposed in the IAEA's 1996 Basic Safety Standards (BSS) would present enormous practical problems. Many industries and industrial practices would, for the first time, become subjected to the provisions of radiation protection legislation. Consequently, registration, licensing, occupational and environmental monitoring, statutory reporting, appointment of appropriately qualified staff, new approaches to the management of minerals and waste labeled as 'radioactive', etc. would be required. This would be mirrored by corresponding demands on the regulatory authorities, needing to provide an increased radiation protection regulatory control. In response to new Australian and other national radiation protection legislation that have incorporated the BSS criteria, this paper illustrates their impact on a number of industries that historically have not been considered as dealing with radioactive materials. The paper also proposes a number of initiatives that could be considered. Nationally, those initiatives should aim at adopting radiation protection legislation that is commensurate with the nature of the minerals industry operations, national circumstances, conditions and interests without compromising rational radiation protection practices. Otherwise, non-judicious application of the BSS would result in major diversions of resources from well recognized occupational health and safety issues

  7. Legislators Urge Carbon Emissions Cuts

    Science.gov (United States)

    Kumar, Mohi

    2007-02-01

    Legislators from the world's largest carbon dioxide (CO2) emitting countries met on 14-15 February in Washington, D.C., to discuss the future of the global climate and strategies to mitigate temperature increases resulting from global warming. The world faces a ``double challenge-how to reduce damaging carbon emissions while still meeting the energy demand that the world's poor need to escape poverty,'' said World Bank President Paul Wolfowitz during a keynote talk.

  8. 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management.

    Science.gov (United States)

    Joy, Elizabeth; Kussman, Andrea; Nattiv, Aurelia

    2016-02-01

    Eating disorders, such as anorexia nervosa and bulimia nervosa, can have devastating effects on both the health and performance of athletes. Compared to non-athletes, both female and male athletes are at higher risk of developing an eating disorder. This is especially true for athletes participating in sports where low body weight or leanness confers a competitive advantage. Screening for disordered eating behaviours, eating disorders and for related health consequences should be a standard component of preparticipation examinations, and team physicians should be knowledgeable of the updated diagnostic criteria for eating disorders in the Diagnostic and Statistical Manual-V. Athletes with eating disorders should undergo thorough evaluation and treatment by an experienced multidisciplinary team. Team physicians play a critical role in decision-making on clearance for participation and return to play. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health. 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/

  9. Liquor legislation, last drinks, and lockouts: the Newcastle (Australia) solution.

    Science.gov (United States)

    Hoffman, G R; Palazzi, K; Oteng Boateng, B K; Oldmeadow, C

    2017-06-01

    The aim of this study was to determine whether the regional implementation of prohibitive liquor legislation, introduced in order to limit the sale of and access to alcohol, can lead to a sustained reduction in the incidence of assault occasioning facial injury, as seen in patients presenting to a level 1 trauma hospital. A retrospective observational cohort study was conducted to document patients who were identified as an acute hospital presentation of assault occasioning facial injury. The period of study was 2003-2015; this ensured a similar period of time before and after the implementation of the legislation in 2008. A statistical analysis was undertaken to assess the rates of change in oral and maxillofacial (OMF) assault admissions pre and post legislation. The study found that pre-legislation numbers of OMF assaults increased at a rate of 14% per annum and then decreased at a rate of 21% per annum post legislation (31% relative rate ratio reduction). Similar trends were seen for all males, males aged 18-35 years, and males where alcohol was recorded at clinical presentation. The introduction of 'last drinks' and 'lock out' legislation has led to a significant and sustained reduction in assaultive alcohol-related facial injury in Newcastle. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Nuclear Regulatory legislation: 103d Congress. Volume 1, No. 3

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 103d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include the Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection.

  11. Nuclear Regulatory legislation: 103d Congress. Volume 2, No. 3

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 103d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include the Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection.

  12. Nuclear Regulatory legislation: 103d Congress. Volume 1, No. 3

    International Nuclear Information System (INIS)

    1995-08-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 103d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include the Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection

  13. Nuclear regulatory legislation, 102d Congress. Volume 2, No. 2

    Energy Technology Data Exchange (ETDEWEB)

    1993-10-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection.

  14. Nuclear legislation in Central and Eastern Europe and the NIS

    CERN Document Server

    2000-01-01

    This publication examines the legislation and regulations governing the peaceful uses of nuclear energy in eastern European countries. It covers 11 countries from Central and Eastern Europe and 11 countries from the New Independent States. The chapters follow a systematic format making it easier for the reader to carry out research and compare information. This study will be updated regularly. Albania Kazakhstan Armenia Latvia Belarus Lithuania Bosnia and Herzegovina Poland Bulgaria Republic of Moldova Croatia Romania Czech Republic Russian Federation Estonia Slovak Republic Former Yugoslav Re

  15. Nuclear Regulatory legislation: 103d Congress. Volume 2, No. 3

    International Nuclear Information System (INIS)

    1995-08-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 103d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include the Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection

  16. Nuclear regulatory legislation: 102d Congress. Volume 1, No. 2

    Energy Technology Data Exchange (ETDEWEB)

    1993-10-01

    This document is a compilation of nuclear regulatory legislation and other relevant material through the 102d Congress, 2d Session. This compilation has been prepared for use as a resource document, which the NRC intends to update at the end of every Congress. The contents of NUREG-0980 include: The Atomic Energy Act of 1954, as amended; Energy Reorganization Act of 1974, as amended, Uranium Mill Tailings Radiation Control Act of 1978; Low-Level Radioactive Waste Policy Act; Nuclear Waste Policy Act of 1982; and NRC Authorization and Appropriations Acts. Other materials included are statutes and treaties on export licensing, nuclear non-proliferation, and environmental protection.

  17. Climate Legislation in the 111th Congress: The Role of Climate Science and the ACC Reports

    Science.gov (United States)

    Rennert, K. J.

    2010-12-01

    The 111th Congress has been a dramatic one for climate legislation. With the passage of H.R. 2454, the House of Representatives reached a legislative milestone by becoming the first congressional body to pass comprehensive energy and climate legislation. Despite momentum gained from the passage of H.R. 2454 and pressure from the international community in advance of COP-15 in Copenhagen, sufficient support for a comprehensive energy and climate package failed to materialize in the Senate. Throughout the legislative debate, proponents of climate legislation cited the findings of climate science to support the case for limiting domestic greenhouse gas emissions. Some opponents of climate legislation were critical of climate science, and argued that events such as the so-called “Climategate” called into question the integrity of the climate science community and cast doubt upon its results. It was in the critical, later stages of this debate in the Senate that the America’s Climate Choices series of reports were released, providing an updated assessment of the state of climate science and policy recommendations for addressing climate change. I will discuss how climate science was used in the development of and debate on climate legislation in the 111th Congress, as well as the role of the ACC reports in informing the legislative process. I will also discuss the ACC report release process from the perspective of a congressional staffer, and give recommendations for ensuring that such reports receive maximal attention by Congress.

  18. A legislator`s guide to municipal solid waste management

    Energy Technology Data Exchange (ETDEWEB)

    Starkey, D; Hill, K

    1996-08-01

    The purpose of this guide is to allow individual state legislators to gain a better understanding of municipal solid waste (MSW) management issues in general, and examine the applicability of these concerns to their state. This guide incorporates a discussion of MSW management issues and a comprehensive overview of the components of an integrated solid waste management system. Major MSW topics discussed include current management issues affecting states, federal activities, and state laws and local activities. Solid waste characteristics and management approaches are also detailed.

  19. Institutional Constraints, Legislative Activism, and Policy Change

    DEFF Research Database (Denmark)

    Citi, Manuele; Justesen, Mogens Kamp

    of regulatory reform in the EU. The rise in the number of legislative proposal, in turn, is affected by the extent of gridlock between the EU’s legislative bodies. These findings show that the Commission steps up its legislative activity when the institutional opportunity space allows for greater policy change.......This paper studies how institutional constraints affect legislative activism, and how legislative activism affects policy change, analyzing the case of the European Union’s legislative process. Our argument revolves around the key role of the Commission in advancing policy change, and emphasizes...... that the Commission can successfully push for increased policy change by increasing its legislative activity when the institutional opportunity space widens. Using a novel panel dataset covering eight policy sectors from 1984--‐2012, we find that the number of legislative proposals significantly affects the extent...

  20. Institutional Constraints, Legislative Activism and Policy Change

    DEFF Research Database (Denmark)

    Citi, Manuele; Justesen, Mogens Kamp

    2016-01-01

    This article presents a study of how institutional constraints affect legislative activism and how legislative activism in turn affects policy change through an analysis of the European Union's legislative process. The argument revolves around the key role of the European Commission in advancing...... policy change, and emphasises that the Commission can successfully push for increased policy change by increasing its legislative activity when the institutional opportunity space widens. Using a novel panel dataset covering eight policy sectors from the period 1984–2012, the article shows...... that the number of legislative proposals significantly affects the extent of regulatory reform in the EU. The rise in the number of legislative proposals, in turn, is affected by the extent of gridlock between the EU's legislative bodies. These findings show that the Commission steps up its legislative activity...

  1. Legislations the field of food irradiation

    International Nuclear Information System (INIS)

    1987-05-01

    An outline is given of the national legislation in 39 countries in the field of food irradiation. Where available the following information is given for each country: form of legislation, object of legislation including information on the irradiation treatment, the import and export trade of irradiated food, the package labelling and the authorization and control of the irradiation procedures

  2. 38 CFR 13.3 - State legislation.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false State legislation. 13.3... ADMINISTRATION, FIDUCIARY ACTIVITIES § 13.3 State legislation. Field facility Directors are authorized to... regarding any proposed legislation relating to fiduciary matters will be taken without the approval of the...

  3. 46 CFR 67.132 - Special legislation.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Special legislation. 67.132 Section 67.132 Shipping... legislation. (a) Vessels not otherwise entitled to be operated in the coastwise trade or in the fisheries may obtain these privileges as a result of special legislation by the Congress of the United States. (b) In...

  4. 29 CFR 11.14 - Legislation.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Legislation. 11.14 Section 11.14 Labor Office of the... Administrative Procedures § 11.14 Legislation. Notwithstanding any provisions of this part, environmental assessments or impact statements prepared in connection with requests for new legislation or modification of...

  5. 50 CFR 80.3 - Assent legislation.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Assent legislation. 80.3 Section 80.3... WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS § 80.3 Assent legislation. A State may participate in the benefits of the Act(s) only after it has passed legislation which assents to the provisions...

  6. Legislative Basis of Pedagogical Education in Japan

    Science.gov (United States)

    Kuchai, Tetiana

    2014-01-01

    Legal framework policy of Japan in the field of education has been analyzed. The problem of influence of legislative materials on the development of education in Japan, its legislative support has been considered. It has been defined that directive materials affect the development of education system in Japan. Legislation policy of the country is…

  7. 33 CFR 276.5 - Legislative history.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Legislative history. 276.5 Section 276.5 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF... Legislative history. Discussion of this legislation is contained in the reports by the Senate Committee on...

  8. Guidelines for seizure management in palliative care: Proposal for an updated clinical practice model based on a systematic literature review.

    Science.gov (United States)

    León Ruiz, M; Rodríguez Sarasa, M L; Sanjuán Rodríguez, L; Pérez Nieves, M T; Ibáñez Estéllez, F; Arce Arce, S; García-Albea Ristol, E; Benito-León, J

    2017-02-27

    Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC. We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies. Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment. These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

    Science.gov (United States)

    Pappas, Peter G.; Kauffman, Carol A.; Andes, David R.; Clancy, Cornelius J.; Marr, Kieren A.; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Schuster, Mindy G.; Vazquez, Jose A.; Walsh, Thomas J.; Zaoutis, Theoklis E.; Sobel, Jack D.

    2016-01-01

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. PMID:26679628

  10. Aarskog-Scott syndrome: clinical update and report of nine novel mutations of the FGD1 gene

    DEFF Research Database (Denmark)

    Orrico, A; Galli, L; Faivre, L

    2010-01-01

    Mutations in the FGD1 gene have been shown to cause Aarskog-Scott syndrome (AAS), or facio-digito-genital dysplasia (OMIM#305400), an X-linked disorder characterized by distinctive genital and skeletal developmental abnormalities with a broad spectrum of clinical phenotypes. To date, 20 distinct ...

  11. Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan - 2013 update.

    Science.gov (United States)

    Kitamura, Ken; Iino, Yukiko; Kamide, Yosuke; Kudo, Fumiyo; Nakayama, Takeo; Suzuki, Kenji; Taiji, Hidenobu; Takahashi, Haruo; Yamanaka, Noboru; Uno, Yoshifumi

    2015-04-01

    To (1) indicate methods of diagnosis and testing for childhood (otitis media (AOM) and (2) recommend methods of treatment in accordance with the evidence-based consensus reached by the Subcommittee of Clinical Practice Guideline for Diagnosis and Management of AOM in Children (Subcommittee of Clinical Practice Guideline), in light of the causative bacteria and their drug sensitivity of AOM in Japan. We investigated the most recently detected bacteria causing childhood AOM in Japan as well as antibacterial sensitivity and the worldwide distinct progress of vaccination, produced Clinical Questions concerning the diagnosis, testing methods, and treatment of AOM, searched literature published during 2000-2004, and issued the 2006 Guidelines. In the 2009 and 2013 Guidelines, we performed the same investigation with the addition of literature, which were not included in the 2006 Guidelines and published during 2005-2008 and during 2009-2012, respectively. We categorized AOM as mild, moderate, or severe on the basis of tympanic membrane findings and clinical symptoms, and presented recommended treatment for each degree of severity. Accurate assessment of tympanic membrane findings is important for judging the degree of severity and selecting a method of treatment. Some of new antimicrobial agents and pneumococcal vaccination are recommended as new treatment options. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Update and clinical utility of alcaftadine ophthalmic solution 0.25% in the treatment of allergic conjunctivitis

    Directory of Open Access Journals (Sweden)

    Chigbu DI

    2015-07-01

    Full Text Available DeGaulle I Chigbu, Alissa M Coyne Pennsylvania College of Optometry Salus University, Elkins Park, PA, USA Abstract: Allergic disorders of the ocular surface are primarily characterized as IgE- and/or T-lymphocyte-mediated disorders that affect the cornea, conjunctiva, and eyelid. Approximately 40% of individuals in the developed countries have allergic conjunctivitis, and as such, it is the most common form of ocular allergy. Seasonal allergic conjunctivitis is the most prevalent type of allergic conjunctivitis that impacts the quality of life of patients. This article reviews the pharmacology, pharmacodynamics, pharmacokinetics, clinical trials, clinical efficacy, and safety of alcaftadine. Histamine and the pathological mechanism of ocular allergy will be briefly reviewed with the intent of providing a background for the detailed discussion on the clinical utility of alcaftadine in allergic conjunctivitis. The Medline PubMed, Elsevier Science Direct, and Google Scholar databases were used to search for evidence-based literature on histamine and immunopathological mechanism of allergic conjunctivitis, as well as on pharmacology, pharmacodynamics, pharmacokinetics, clinical trials, and clinical efficacy of alcaftadine. The treatment and management goals of allergic conjunctivitis are to prevent or minimize the inflammatory cascade associated with allergic response in the early stages of the pathological mechanism. It is of note that activation of histamine receptors on immune and nonimmune cells are associated with allergen-induced inflammation of the conjunctiva and its associated ocular allergic manifestations, including itching, edema, hyperemia, and tearing. Alcaftadine is an efficacious multiple action antiallergic therapeutic agent with inverse agonist activity on H1, H2, and H4 receptors, as well as anti-inflammatory and mast cell stabilizing effects that could provide therapeutic benefits to patients with allergic conjunctivitis

  13. ALCOHOL RELATED TRAFFIC SAFETY LEGISLATION

    Directory of Open Access Journals (Sweden)

    E.B.R. DESAPRIYA

    2002-01-01

    Full Text Available There is a substantial amount of evidence from experimental studies to indicate that a variety of individual skills are impaired at blood alcohol concentrations (BACs well below 0.05%. Epidemiological studies indicate that the risk of a crash increases sharply for drivers with BACs below 0.05%. The correlation between drunk driving and the risk of traffic accidents has been established on the individual as well as the aggregate level. The BAC level legally permitted is a public policy decision by legislators, while scientists can present experimental and epidemiological evidence indicating the BAC level at which psychomotor skills deteriorate and accident probabilities increase. There is considerable epidemiological evidence to support the fact that the risk of alcohol impaired drivers being involved in traffic crashes rises with increasing BAC's. By contrast, the evidence on the BAC at which a driver should be regarded as committing an offence has been the subject of much debate and various legislative decisions. Historically, per se laws specify BAC levels which are a compromise figure intended to reflect both the point at which a driver becomes significantly more likely to be involved in an accident than a comparative driver with a zero BAC and that which is politically acceptable, but falls within the BAC region of increased accident liability. Therefore, the per se legislation in most countries has not kept pace with scientific progress. This study suggests that if saving lives on the road is an important issue, then, passing laws that incorporate scientific and epidemiological studies, is necessary.

  14. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2014-01-01

    This section treats of the following activities sorted by country: 1 - Belarus: International cooperation, Organisation and structure, Licensing and regulatory infrastructure, Nuclear safety and radiological protection; 2 - France: Nuclear safety and radiological protection, Radioactive waste management, Environmental protection, Liability and compensation, International co-operation; 3 - Hungary: General legislation, Radioactive waste management, Nuclear security; 4 - Ireland: Nuclear safety and radiological protection (including emergency planning); 5 - Lithuania: Licensing and regulatory infrastructure; 6 - Moldova: Nuclear safety and radiological protection; 7 - Portugal: Radioactive waste management, Nuclear safety and radiological protection; 8 - Slovak Republic: Radioactive waste management, Liability and compensation; 9 - Spain: Radioactive waste management; 10 - Ukraine: Radioactive waste management; 11 - United Kingdom: Organisation and structure

  15. Peer Effects in Legislative Voting

    DEFF Research Database (Denmark)

    Harmon, Nikolaj Arpe; Fisman, Raymond; Kamenica, Emir

    2016-01-01

    Abstract We exploit seating rules in the European Parliament to estimate causal peer effects in legislative voting. We find that sitting next to each other reduces by 13 percent the likelihood that two Members of the European Parliament (MEPs) from the same party differ in their vote. Using...... variation in seating across the two venues of the Parliament (Brussels and Strasbourg), we show that this effect reflects persistent peer influence: a pair of MEPs who have sat together in the past are less likely to disagree on a vote even if they do not sit together during that particular vote....

  16. Evaluating current knowledge of legislation and practice of ...

    African Journals Online (AJOL)

    Background. In the clinical setting, the main legislative provisions governing the management and 'disposal' of fetal remains in South Africa are the Choice on Termination of Pregnancy Act 92 of 1996 and the Births and Deaths Registration Act 51 of 1992. Objectives. To determine obstetricians' and gynaecologists' current ...

  17. Female Obesity and Clinical Outcomes of Assisted Reproductive Technologies (ART): an Updated Systematic Review and Meta-analysis

    OpenAIRE

    Heidar Heidari Khoei

    2016-01-01

    Assisted Reproductive Technology (ART) has been developed to be used for reproductive-age women with primary and secondary infertilities. Obesity is a worldwide epidemic for both women and men and a major global health concern. The direct effect of Body Mass Index (BMI) increase on the outcomes of ART is still unclear. This study aimed to carry out a systematic review of the available scientific evidence to assess the effects of obesity on the clinical outcome of ART treatment. Numerous studi...

  18. Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: technology and clinical update

    Directory of Open Access Journals (Sweden)

    Nakanishi R

    2016-06-01

    Full Text Available Rine Nakanishi, Mathew J Budoff Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA Abstract: After a decade of clinical use of coronary computed tomographic angiography (CCTA to evaluate the anatomic severity of coronary artery disease, new methods of deriving functional information from CCTA have been developed. These methods utilize the anatomic information provided by CCTA in conjunction with computational fluid dynamics to calculate fractional flow reserve (FFR values from CCTA image data sets. Computed tomography-derived FFR (CT-FFR enables the identification of lesion-specific drop noninvasively. A three-dimensional CT-FFR modeling technique, which provides FFR values throughout the coronary tree (HeartFlow FFRCT analysis, has been validated against measured FFR and is now approved by the US Food and Drug Administration for clinical use. This technique requires off-site supercomputer analysis. More recently, a one-dimensional computational analysis technique (Siemens cFFR, which can be performed on on-site workstations, has been developed and is currently under investigation. This article reviews CT-FFR technology and clinical evidence for its use in stable patients with suspected coronary artery disease. Keywords: fractional flow reserve, coronary computed tomographic angiography, FFRCT, cFFR

  19. Employment protection legislation in Croatia

    Directory of Open Access Journals (Sweden)

    Marina Kunovac

    2014-06-01

    Full Text Available According to business climate and competitiveness indicators published by international organisations, Croatia is a country with a rigid labour market and a high level of the legal protection of employees. Given that an Act on Amendments to the Labour Act (OG 73/13 entered into force in Croatia in June 2013, this paper examines changes in employment protection legislation in Croatia and Central and Eastern European (CEE countries, as well as in Croatia's main trading partners during the period between 2008 and 2013. A cross-country comparison shows a strong downward trend in legal employment protection in most CEE countries during the observed period, primarily as concerns individual dismissal in the cases of regular employment contracts, while in the case of temporary employment the protection strengthened slightly. On the other hand, despite the adoption of amendments to the Labour Act (LA, Croatian labour legislation governing employment protection for regular employment contracts remains relatively inflexible compared to that in other countries.

  20. GHG legislation: Lessons from Taiwan

    International Nuclear Information System (INIS)

    Huang, W.M.; Lee, Grace W.M.

    2009-01-01

    Taiwan has drafted a Greenhouse Gas (GHG) Reduction Bill in 2006, which is currently undergoing the legislative process in the Congress. The purpose of this study is to reexamine the legal framework and contents of this Bill, evaluate potential problems and propose recommendations. This study advocates that setting the GHG reduction targets should be settled in this Bill. In addition, based on the analysis of international experiences, it is recommenced that emissions trading scheme in the Bill should be focused on large emission sources and the share of allowance auction should be increased to reduce gratis allocation. Furthermore, from the calculation results based on the long-range energy alternative planning (LEAP) model, a conflict is observed for the existing energy policy and GHG reduction efforts in Taiwan. That is, coal-burning power plants will be the most important source of energy for Taiwan in the future. In order to reduce this conflict, the authors have recommended that the Bill should also be integrated with other relevant existing legislation to achieve a complementary effect.

  1. Legislation hampers medical research in acute situations

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John

    2015-01-01

    INTRODUCTION: Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation...... and subsequent proxy consent, as soon as possible. The aim of this study was to describe the delay associated with obtaining consent and to assess whether consent from NOK or GP/Danish Health and Medicines Authority is obtained with delays beyond the intervention. METHODS: In a prospective study, 171 comatose...... days (IQR: 6-23, max. 527 days). CONCLUSION: NOK fully accepted participation in a clinical trial after OHCA with short delays in consent. Consent from GPs was associated with long delays beyond the intervention, which make GPs less appropriate for proxy consent of incapacitated adults in acute...

  2. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2015-01-01

    This section treats of the following National legislative and regulatory activities: 1 - Australia: General legislation - Bill to amend the Australian Radiation Protection and Nuclear Safety Act 1998; 2 - France: General legislation - Law No. 2015-992 of 17 August 2015 on the energy transition for green growth; ASN Report on the state of nuclear safety and radiation protection in France in 2014; 3 - Germany: Radioactive waste management - First Ordinance to amend the 2005 Gorleben Development Freeze Ordinance (2015); 4 - Greece: Radioactive waste management - Joint Ministerial Decision establishing the national policy on the management of spent fuel and radioactive waste; 5 - Lithuania: Nuclear safety and radiological protection - Revised requirements for modifications, Plan for enhancement of nuclear safety, New requirements for the commissioning of nuclear power plants, Revised requirements regulating the provision of information on abnormal events; Radioactive waste management - Revised requirements for acceptance criteria for near surface repository; Nuclear security - Revised requirements for physical protection; 6 - Romania: Licensing and regulatory infrastructure - Government Decision No. 600/2014 for approval of National Nuclear Safety and Security; International co-operation - Government Decision No. 525/2014 for approval of the Co-operation Agreement on the radioactive waste management between the French National Radioactive Waste Management Agency (ANDRA) and Nuclear Agency and Radioactive Waste (ANDR) Strategy; Memorandum of Understanding for Co-operation and Exchange of Information in Nuclear Regulatory Matters between the National Commission for Nuclear Activities Control (CNCAN) of Romania and the President of National Atomic Energy Agency (PAA) of Poland; Government Decision No. 540/2015 for approval of the Agreement between the Government of Romania and the Government of the People's Republic of China regarding co-operation in the peaceful

  3. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2017-01-01

    This section treats of the following National legislative and regulatory activities: 1 - Algeria, Nuclear safety and radiological protection, Executive Decree No. 17-126 of 27 March 2017; 2 - Belgium, Liability and compensation, Law of 7 December 2016 modifying the law of 22 July 1985 on third party liability in the field of nuclear energy; 3 - Canada, Liability and compensation, Ratification by Canada of the Convention on Supplementary Compensation for Nuclear Damage; 4 - France, Radioactive waste management: Decree No. 2017-231 of 23 February 2017 implementing Article L. 542-1-2 of the French Environmental Code (Code de l'environnement) and setting out the provisions of the National Radioactive Material and Waste Management Plan; and Order of 23 February 2017 implementing Decree No. 2017-231 of 23 February 2017 implementing Article L. 542-1-2 of the French Environmental Code setting out the provisions of the National Radioactive Material and Waste Management Plan; Liability and compensation: Order of 10 November 2016 amending the Appendix to the Order of 19 August 2016, setting the list of reduced liability amount sites pursuant to Decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the Environmental Code and relating to third party liability in the nuclear energy field; International co-operation: Decree No. 2016-1225 of 16 September 2016 making public the Protocol to the Co-operation Agreement between the Government of the French Republic and the Government of the Hashemite Kingdom of Jordan for the Development of the Pacific Uses of Nuclear Energy, signed in Paris on 27 August 2008; 5 - Germany, Transport of radioactive materials: New Versions of Ordinances on the Transport of Dangerous Goods (2017); Radioactive Waste Management: Act on the Reorganisation of the Responsibility of Nuclear Waste Disposal (2017); 6 - Lithuania, Nuclear security: Cyber security; Nuclear installations: Free release criteria of buildings and site of nuclear

  4. Intracoronary stem cell infusion after acute myocardial infarction: a meta-analysis and update on clinical trials.

    Science.gov (United States)

    de Jong, Renate; Houtgraaf, Jaco H; Samiei, Sanaz; Boersma, Eric; Duckers, Henricus J

    2014-04-01

    Several cell-based therapies for adjunctive treatment of acute myocardial infarction have been investigated in multiple clinical trials, but the benefits still remain controversial. This meta-analysis aims to evaluate the efficacy of bone marrow-derived mononuclear cell (BMMNC) therapy in patients with acute myocardial infarction, but also explores the effect of newer generations of stem cells. A random-effects meta-analysis was performed on randomized controlled trials investigating the effects of stem cell therapy in patients with acute myocardial infarction that were published between January 2002 and September 2013. The defined end points were left ventricular (LV) ejection fraction, LV end-systolic and end-diastolic volumes, infarct size, and major adverse cardiac and cerebrovascular event rates. Also, several subgroup analyses were performed on BMMNC trials. Overall, combining the results of 22 randomized controlled trials (RCTs), LV ejection fraction increased by +2.10% (95% confidence interval [CI], 0.68-3.52; P=0.004) in the BMMNC group as compared with controls, evoked by a preservation of LV end-systolic volume (-4.05 mL; 95% CI, -6.91 to -1.18; P=0.006) and a reduction in infarct size (-2.69%; 95% CI, -4.83 to -0.56; P=0.01). However, there is no effect on cardiac function, volumes, or infarct size, when only RCTs (n=9) that used MRI-derived end points were analyzed. Moreover, no beneficial effect could be detected on major adverse cardiac and cerebrovascular event rates after BMMNC infusion after a median follow-up duration of 6 months. Intracoronary infusion of BMMNC is safe, but does not enhance cardiac function on MRI-derived parameters, nor does it improve clinical outcome. New and possibly more potent stem cells are emerging in the field, but their clinical efficacy still needs to be defined in future trials.

  5. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.

    Science.gov (United States)

    Pappas, Peter G; Kauffman, Carol A; Andes, David R; Clancy, Cornelius J; Marr, Kieren A; Ostrosky-Zeichner, Luis; Reboli, Annette C; Schuster, Mindy G; Vazquez, Jose A; Walsh, Thomas J; Zaoutis, Theoklis E; Sobel, Jack D

    2016-02-15

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  6. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications.

    Science.gov (United States)

    Torabinejad, M; Parirokh, M; Dummer, P M H

    2018-03-01

    Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite

  7. 1979 New Mexico legislative session: energy issues and legislation

    International Nuclear Information System (INIS)

    Barsumian, L.; Vandevender, S.G.

    1979-10-01

    This report is an account of the energy legislation and associated issues considered during the 1979 session of the 34th New Mexico Legislature. The session's major issue was the federal study of a proposed nuclear Waste Isolation Pilot Plant (WIPP) in New Mexico. A large proportion of time and effort was spent on resolving the state's formal position toward the federal project. However, other energy concerns were also significant even though they were neither as controversial nor as visible as the primary issue. The two most important laws enacted were the Radioactive Waste Consultation Act and the Radioactive Waste Transportation Act. The Legislature considered 47 other energy-related bills, of which 17 were enacted

  8. 1979 New Mexico legislative session: energy issues and legislation. [WIPP

    Energy Technology Data Exchange (ETDEWEB)

    Barsumian, L.; Vandevender, S.G.

    1979-10-01

    This report is an account of the energy legislation and associated issues considered during the 1979 session of the 34th New Mexico Legislature. The session's major issue was the federal study of a proposed nuclear Waste Isolation Pilot Plant (WIPP) in New Mexico. A large proportion of time and effort was spent on resolving the state's formal position toward the federal project. However, other energy concerns were also significant even though they were neither as controversial nor as visible as the primary issue. The two most important laws enacted were the Radioactive Waste Consultation Act and the Radioactive Waste Transportation Act. The Legislature considered 47 other energy-related bills, of which 17 were enacted.

  9. Recent advances in gastrointestinal oncology - updates and insights from the 2009 annual meeting of the American Society of Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Hsueh Chung-Tsen

    2010-03-01

    Full Text Available Abstract We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.

  10. Muscles, Ligaments and Tendons Journal – Basic principles and recommendations in clinical and field Science Research: 2016 Update

    Science.gov (United States)

    Padulo, Johnny; Oliva, Francesco; Frizziero, Antonio; Maffulli, Nicola

    2016-01-01

    Summary The proper design and implementation of a study as well as a balanced and well-supported evaluation and interpretation of its main findings are of crucial importance when reporting and disseminating research. Also accountability, funding acknowledgement and adequately declaring any conflict of interest play a major role in science. Since the Muscles, Ligaments and Tendons Journal (MLTJ) is committed to the highest scientific and ethical standards, we encourage all Authors to take into account and to comply, as much as possible, to the contents and issues discussed in this official editorial. This could be useful for improving the quality of the manuscripts, as well as to stimulate interest and debate and to promote constructive change, reflecting upon uses and misuses within our disciplines belonging to the field of “Clinical and Sport - Science Research”. PMID:27331026

  11. Muscles, Ligaments and Tendons Journal - Basic principles and recommendations in clinical and field Science Research: 2016 Update.

    Science.gov (United States)

    Padulo, Johnny; Oliva, Francesco; Frizziero, Antonio; Maffulli, Nicola

    2016-01-01

    The proper design and implementation of a study as well as a balanced and well-supported evaluation and interpretation of its main findings are of crucial importance when reporting and disseminating research. Also accountability, funding acknowledgement and adequately declaring any conflict of interest play a major role in science. Since the Muscles, Ligaments and Tendons Journal (MLTJ) is committed to the highest scientific and ethical standards, we encourage all Authors to take into account and to comply, as much as possible, to the contents and issues discussed in this official editorial. This could be useful for improving the quality of the manuscripts, as well as to stimulate interest and debate and to promote constructive change, reflecting upon uses and misuses within our disciplines belonging to the field of "Clinical and Sport - Science Research".

  12. Effect of resveratrol on lipid profile: An updated systematic review and meta-analysis on randomized clinical trials.

    Science.gov (United States)

    Haghighatdoost, Fahimeh; Hariri, Mitra

    2018-03-01

    Despite the notion that resveratrol can significantly reduce plasma lipids, the result of randomized clinical trials (RCTs) on resveratrol effect and the serum lipid profile are contradictory. Our objective was to conduct a systematic review and meta-analysis on randomized clinical trials (RCTs) and assess the effect of resveratrol on lipids. ISI web of science, Ovid, PubMed/Medline, SCOPUS, and Google Scholar data bases were searched up to Jun 2017. RCTs that assessed resveratrol effects on lipid profile among adult participants were chosen. Treatment effects were considered as weighted mean difference (WMD) and the corresponding standard error (SE) in concentrations of serum lipids. To estimate the overall summary effect, we used random-effects model. The protocol was registered with PROSPERO (No. CRD42017072365). This meta-analysis was performed on twenty-one trials. Our results indicated that resveratrol can't significantly change total cholesterol (TC) (WMD = -0.08 mmol/l, 95% CI: -0.23, 0.08; P = .349, I 2  = 87.8%), low-density lipoprotein (LDL-C) (WMD: -0.04 mmol/l, 95% CI: -0.21, 0.12; P = .620, I 2  = 93.4%), and high density lipoprotein (HDL-C) (WMD: -0.01 mmol/l, 95% CI: -0.04, 0.02; P = .269, I 2  = 88.6%). Its effect on triacylglycerol (TG) (WMD: 0.58 mmol/l, 95% CI: 0.34, 0.82; P resveratrol dosage, and intervention duration could not change the results. We conclude that resveratrol does not change lipid profile concentration. Confirmation of this conclusion will require more studies exclusively on dyslipidemic patients in which the intake of lipid lowering agents is among the exclusion criteria. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Critical Care Nurses' Knowledge of Confidentiality Legislation.

    Science.gov (United States)

    Newman, Angela B; Kjervik, Diane K

    2016-05-01

    Health care legislation can be difficult to understand and apply in critical situations where patients may not be physically capable of autonomous control of confidential health information. Nurses are often the first to encounter confidential information about patients. To explore critical care nurses' knowledge of federal and North Carolina state legislation regarding confidentiality. This descriptive, qualitative study included 12 critical care nurses who were asked to describe their knowledge of federal confidentiality legislation and specific knowledge of North Carolina's confidentiality legislation. Critical care nurses were knowledgeable about federal confidentiality laws but demonstrated a need for further education about state-specific legislation. Nurses' application of confidentiality legislation demonstrates their knowledge of confidentiality legislation. To continue the trusting relationship that nurses have traditionally held with patients and patients' families, it is imperative for nurses to remain current about confidentiality legislation. Through education both before and after licensure, correct application of legislation can be achieved. Further research can aid in exploring the intersection between health care legislation and ethics. ©2016 American Association of Critical-Care Nurses.

  14. Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials.

    Science.gov (United States)

    Vaduganathan, Muthiah; Qamar, Arman; Gupta, Ankur; Bajaj, Navkaranbir; Golwala, Harsh B; Pandey, Ambarish; Bhatt, Deepak L

    2017-12-08

    Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic stroke, but available trials have varied by size, device studied, and follow-up. We conducted a systematic search of published randomized clinical trials evaluating patent foramen ovale closure versus medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models. Of 480 studies screened, we included 5 randomized clinical trials in the meta-analysis in which 3440 patients were randomized to patent foramen ovale closure (n = 1829) or medical therapy (n = 1611) and followed for an average of 2.0 to 5.9 years. Index stroke/transient ischemic attack occurred within 6 to 9 months of randomization. The primary end point was composite stroke/transient ischemic attack and death (in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure reduced the primary end point (0.70 vs 1.48 events per 100 patient-years; risk ratio [RR], 0.52 [0.29-0.91]; I 2  = 55.0%) and stroke/transient ischemic attack (1.04 vs 2.00 events per 100 patient-years; RR, 0.55 [0.37-0.82]; I 2  = 42.2%) with modest heterogeneity compared with medical therapy. Procedural bleeding was not different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83]; I 2  = 29.2%), but new-onset atrial fibrillation/flutter was increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69 [2.17-10.12]; I 2  = 29.3%). In patients with recent cryptogenic stroke, patent foramen ovale closure reduces recurrent stroke/transient ischemic attack compared with medical therapy, but is associated with a higher risk of new-onset atrial fibrillation/flutter. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update.

    Science.gov (United States)

    Waltregny, David; de Leval, Jean

    2009-03-01

    Six years ago, the inside-out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates and low morbidity at short term. A recent analysis of medium-term results indicated that the TVT-O procedure is efficient, with maintenance, after a 3-year minimum follow-up, of cure rates comparing favorably with those reported for TVT. No late complications were observed. As of July 2008, more than 35 clinical papers, including ten randomized trials and two national registries, have been published on the outcome of the TVT-O surgery. Results from these studies have confirmed that the TVT-O procedure is safe and as efficient as the TVT procedure, at least in the short/medium term.

  16. Updates on breast cancer genetics: Clinical implications of detecting syndromes of inherited increased susceptibility to breast cancer.

    Science.gov (United States)

    Cobain, Erin F; Milliron, Kara J; Merajver, Sofia D

    2016-10-01

    Since the initial discovery that pathogenic germline alterations in BRCA 1/2 increase susceptibility to breast and ovarian cancer, many additional genes have now been discovered that also increase breast cancer risk. Given that several more genes have now been implicated in hereditary breast cancer syndromes, there is increased clinical use of multigene panel testing to evaluate patients with a suspected genetic predisposition to breast cancer. While this is most certainly a cost-effective approach, broader testing strategies have resulted in a higher likelihood of identifying moderate-penetrance genes, for which management guidelines regarding breast cancer risk reduction have not been firmly established. In addition, the testing of more genes has led to increased detection of variants of uncertain significance. We review the current knowledge regarding both high- and moderate-risk hereditary breast cancer syndromes, as well as additional genes implicated in hereditary breast cancer for which there is limited data. Furthermore, strategies for cancer risk reduction in mutation carriers as well as therapeutic implications for those patients who harbor pathogenic germline alterations are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Oncological Safety of Lipofilling in Patients with Breast Cancer: A Meta-analysis and Update on Clinical Practice.

    Science.gov (United States)

    Wazir, Umar; El Hage Chehade, Hiba; Headon, Hannah; Oteifa, Medhat; Kasem, Abdul; Mokbel, Kefah

    2016-09-01

    Lipofilling is an increasingly popular technique for breast reconstruction following both mastectomy and breast-conserving surgery (BCS). However, concerns remain over its oncological safety and its effect on cancer recurrence. A systematic literature review and meta-analysis was carried out. Patients who had undergone mastectomy or BCS were investigated separately in order to find out whether the addition of lipofilling had a significant effect on locoregional recurrence rate. Eleven studies were used in the analysis, yielding a total of 2,382 patients. For patients undergoing mastectomy (mean follow-up=36.2 months, range=12-90 months) or BCS (mean follow-up=30.2 months, range=12-60 months), the addition of lipofilling was not found to significantly affect the locoregional recurrence rate. This meta-analysis demonstrates that lipofilling is an oncologically safe procedure to be incorporated into breast reconstruction following either mastectomy or BCS for breast cancer. However, a careful oncological follow-up is recommended. In the future, more adequately powered controlled clinical trials are needed in order to fully understand long-term outcomes after lipofilling. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Clinical neuropathology practice news 3-2012: the "ABC" in AD-revised and updated guideline for the neuropathologic assessment of Alzheimer's disease.

    Science.gov (United States)

    Kovacs, Gabor G; Gelpi, Ellen

    2012-01-01

    The two major approaches for the neuropathological assessment of Alzheimer's disease (AD) related pathology have been based on the assessment of neuritic plaques (CERAD) and neurofibrillary pathology (Braak and Braak). In 1997 these two approaches were integrated in the criteria and recommendations of the National Institute on Aging and the Reagan Institute Working group. Recently a new guideline has been published by the National Institute on Aging-Alzheimer's Association. This new guideline recognizes the existence of a pre-clinical stage of AD as part of continuous neuropathological changes in the background of the disease process, and it fosters the assessment of amyloid-beta phases in addition to neurofibrillary degeneration and neuritic plaques following an "ABC" score. Further, it suggests protocols for the neuropathological assessment of additional/concomitant neurodegenerative and vascular pathologies. Altogether, the new guideline responds to the need for an update of the existing "1997 criteria" for AD. Continued studies will have to assess the added value of the new approach and the influence of interlaboratory and/or methodological differences on the implementation of these new recommendations.

  19. Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute.

    Science.gov (United States)

    Kahrilas, Peter J; Katzka, David; Richter, Joel E

    2017-11-01

    The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20-40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  20. Fragile X-Associated Tremor Ataxia Syndrome: The Expanding Clinical Picture, Pathophysiology, Epidemiology, and Update on Treatment

    Directory of Open Access Journals (Sweden)

    Deborah A. Hall

    2012-05-01

    Full Text Available Fragile X-associated tremor/ataxia syndrome (FXTAS is a progressive degenerative movement disorder characterized by kinetic tremor, cerebellar gait ataxia, parkinsonism, and cognitive decline. This disorder occurs in both males and females, frequently in families with children who have fragile X syndrome. The clinical features of this disorder, both classic and newly described, are summarized in this paper. In screening studies, fragile X mental retardation 1 (FMR1 gene premutation (55–200 CGG expansions are most frequently seen in men with ataxia who have tested negative for spinocerebellar ataxias. Since the original description, the classic FXTAS phenotype has now been reported in females and in carriers of smaller (45–54 CGG and larger (>200 CGG expansions in FMR1. Premutation carriers may present with a Parkinson disease phenotype or hypotension, rather than with tremor and/or ataxia. Parkinsonism and gait ataxia may also be seen in individuals with gray zone (41–54 CGG expansions. Studies regarding medication to treat the symptoms in FXTAS are few in number and suggest that medications targeted to specific symptoms, such as kinetic tremor or gait ataxia, may be most beneficial. Great progress has been made in regards to FXTAS research, likely given the readily available gene test and the screening of multiple family members, including parents and grandparents, of fragile X syndrome children. Expansion of genotypes and phenotypes in the disorder may suggest that a broader disease definition might be necessary in the future.

  1. Update on the pathological processes, molecular biology, and clinical utility of N-acetylcysteine in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Tse HN

    2014-08-01

    Full Text Available Hoi Nam Tse, Cee Zhung Steven TsengMedical and Geriatric Department, Kwong Wah Hospital, Hong Kong Special Administrative RegionAbstract: Chronic obstructive pulmonary disease (COPD is a common and morbid disease characterized by high oxidative stress. Its pathogenesis is complex, and involves excessive oxidative stress (redox imbalance, protease/antiprotease imbalance, inflammation, apoptosis, and autoimmunity. Among these, oxidative stress has a pivotal role in the pathogenesis of COPD by initiating and mediating various redox-sensitive signal transduction pathways and gene expression. The protective physiological mechanisms of the redox balance in the human body, their role in the pathogenesis of COPD, and the clinical correlation between oxidative stress and COPD are reviewed in this paper. N-acetylcysteine (NAC is a mucolytic agent with both antioxidant and anti-inflammatory properties. This paper also reviews the use of NAC in patients with COPD, especially the dose-dependent properties of NAC, eg, its effects on lung function and the exacerbation rate in patients with the disease. Earlier data from BRONCUS (the Bronchitis Randomized on NAC Cost-Utility Study did not suggest that NAC was beneficial in patients with COPD, only indicating that it reduced exacerbation in an "inhaled steroid-naïve" subgroup. With regard to the dose-dependent properties of NAC, two recent randomized controlled Chinese trials suggested that high-dose NAC (1,200 mg daily can reduce exacerbations in patients with COPD, especially in those with an earlier (moderately severe stage of disease, and also in those who are at high risk of exacerbations. However, there was no significant effect on symptoms or quality of life in patients receiving NAC. Further studies are warranted to investigate the effect of NAC at higher doses in non-Chinese patients with COPD.Keywords: N-acetylcysteine, antioxidant, anti-inflammatory, chronic obstructive pulmonary disease

  2. Pneumococcal Bacteremia Requiring Hospitalization in Rural Thailand: An Update on Incidence, Clinical Characteristics, Serotype Distribution, and Antimicrobial Susceptibility, 2005-2010.

    Directory of Open Access Journals (Sweden)

    Julia Rhodes

    Full Text Available Streptococcus pneumoniae is an important cause of morbidity and mortality in Southeast Asia, but regional data is limited. Updated burden estimates are critical as pneumococcal conjugate vaccine (PCV is highly effective, but not yet included in the Expanded Program on Immunization of Thailand or neighboring countries.We implemented automated blood culture systems in two rural Thailand provinces as part of population-based surveillance for bacteremia. Blood cultures were collected from hospitalized patients as clinically indicated.From May 2005- March 2010, 196 cases of pneumococcal bacteremia were confirmed in hospitalized patients. Of these, 57% had clinical pneumonia, 20% required mechanical ventilation, and 23% (n = 46 died. Antibiotic use before blood culture was confirmed in 25% of those with blood culture. Annual incidence of hospitalized pneumococcal bacteremia was 3.6 per 100,000 person-years; rates were higher among children aged <5 years at 11.7 and adults ≥65 years at 14.2, and highest among infants <1 year at 33.8. The median monthly case count was higher during December-March compared to the rest of the year 6.0 vs. 1.0 (p<0.001. The most common serotypes were 23F (16% and 14 (14%; 61% (74% in patients <5 years were serotypes in the 10-valent PCV (PCV 10 and 82% (92% in <5 years in PCV 13. All isolates were sensitive to penicillin, but non-susceptibility was high for co-trimoxazole (57%, erythromycin (30%, and clindamycin (20%.We demonstrated a high pneumococcal bacteremia burden, yet underestimated incidence because we captured only hospitalized cases, and because pre-culture antibiotics were frequently used. Our findings together with prior research indicate that PCV would likely have high serotype coverage in Thailand. These findings will complement ongoing cost effectiveness analyses and support vaccine policy evaluation in Thailand and the region.

  3. A Clinical Update of the Hb Siirt [β27(B9)Ala→Gly; HBB: c.83C>G] Hemoglobin Variant.

    Science.gov (United States)

    Cappabianca, Maria Pia; Colosimo, Alessia; Sabatucci, Annalaura; Dainese, Enrico; Di Biagio, Paola; Piscitelli, Roberta; Sarra, Ofelia; Zei, Daniela; Amato, Antonio

    2017-01-01

    We report a clinical update of the hemoglobin (Hb) variant [β27(B9)Ala→Gly; HBB: c.83C>G], named Hb Siirt, that was previously described as a silent variant in a 23-year-old Kurdish female. The patient was also a carrier of the codon 5 (-CT) (HBB: c.17_18delCT) frameshift mutation and of the ααα anti 3.7 triplication. Her initial moderate β-thalassemia intermedia (β-TI) phenotype worsened with time, causing the patient to become a transfusion-dependent subject at the age of ∼40 years. Subsequent molecular characterization of both parents revealed that the Hb Siirt variant was inherited by the mother, while the other two globin alterations (HBB: c.17_18delCT and ααα anti 3.7 triplication) were genetically transmitted by the father. The latter remained a carrier of a mild β-TI phenotype throughout his life, at least until the age of 65 years. We hypothesize that the worsened clinical conditions in the daughter were due to the additional, maternally inherited Hb Siirt variant. However, protein 3D conformational analysis did not seem to reveal substantial overall structural changes. Among the other three described variants [Hb Volga (HBB: c.83C>A), Hb Knossos (HBB: c.82 G>T), Hb Grange-Blanche (HBB: c.83C>T] that are due to nucleotide substitutions at codon 27 of the β-globin gene; only Hb Knossos causes a β + -thalassemia (β + -thal) phenotype.

  4. State legislative developments in radioactive materials transportation, July 1, 1994--June 30, 1995

    International Nuclear Information System (INIS)

    Goehring, J.B.; Reed, J.B.

    1995-08-01

    Each year, the National Conference of State Legislatures (NCSL) prepares an update on state developments in radioactive materials transportation. The 1995 Report on State Legislative Developments in Radioactive Materials Transportation describes activities between July 1, 1994 and June 30, 1995. Forty-six bills were introduced and are arranged in this report by state according to their status--enacted, pending or failed. The bills address nuclear materials transportation as well as the broader areas of hazardous materials transportation, waste storage and emergency responsiveness. Also included are state legislative resolutions and Federal Register notices and rule changes related to radioactive waste and hazardous materials transportation that affect states

  5. State legislative developments in radioactive materials transportation, July 1, 1996--June 6, 1997

    International Nuclear Information System (INIS)

    Kim, M.H.; Reed, J.B.

    1997-06-01

    The National Conference of State Legislatures (NCSL) prepares an update on state developments in radioactive materials transportation each year. The 1997 Report on State Legislative Developments in Radioactive Materials Transportation describes activities between July 1, 1996 and June 6, 1997. Fifty bills were introduced and are arranged in this report by state according to their status--enacted, pending or failed. The bills address nuclear materials transportation as well as the broader areas of hazardous materials transportation, waste, storage and emergency response. Also summarized are state legislative resolutions and Federal Register notices and rule changes related to radioactive waste and hazardous materials transportation that affect states

  6. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    Anon.

    2001-01-01

    These columns treat of the legislative and regulatory activities of different OECD countries: Australia (environment protection and biodiversity conservation act and regulations, 1999-2000); Bulgaria (basic standards for radiation protection, 2000); France (decree on the standard tax charged on polluting activities due from operators of installations classified for environmental protection purposes, 2000; amendment of the orders on the transport of dangerous goods by road and by rail, 2000); Georgia (law on nuclear and radiation safety, 1998); Germany (amendments to nuclear legislation implementing EURATOM directives, 2000; amendment to the nuclear third party liability provisions of the atomic energy act, 2001; amendment to the foreign trade ordinance, 2000; ordinance on the treatment of foodstuffs with radiation, 2000; general administrative regulations on radioactivity limits in food and feeds); Ireland (European communities regulations on foodstuffs treated with ionizing radiations, 2000); Japan (law for nuclear sitting area development, 2000; Republic of Korea (amendments to the act on compensation for nuclear damage, 2001); Latvia (act on radiation safety and nuclear safety, 2000); Lithuania (resolution approving the decommissioning program for Unit 1, Ignalina NPP, 2001); Luxembourg (grand-ducal regulations on the protection of the public against the risks resulting from ionizing radiation, 2000; grand-ducal regulations relating to foods and food ingredients treated with ionizing radiation, 2000); Mexico (norm regarding selection, qualification and training requirements for staff of a NPP, 2000; norm regarding solid residue as radioactive waste, 2000); Mongolia (law on nuclear weapons free status and its implementing resolution, 2000); Netherlands (amendment to the nuclear energy act, 2000); Norway (act on radiation and use of radiation, 2000); Pakistan (nuclear authority ordinance, 2001); Poland (atomic energy act, 2000); Spain (royal decree on activities

  7. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2016-01-01

    This section treats of the following National legislative and regulatory activities: 1 - Argentina: Organisation and structure; 2 - France: Radioactive waste management (Act No. 2016-1015 of 25 July 2016 specifying the procedures for creating a reversible deep geological repository for long-lived medium and high-level radioactive waste), Liability and compensation (Decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the French Environmental Code and relating to third party liability in the field of nuclear energy; Ministerial Order of 19 August 2016 listing the sites benefiting from a reduced amount of liability pursuant to decree No. 2016-333 of 21 March 2016 implementing Article L. 597-28 of the French Environmental Code and relating to third party liability in the field of nuclear energy), Nuclear facilities (Decree No. 2016-846 of 28 June 2016 related to the modification, final shutdown and decommissioning of basic nuclear installations, and to subcontracting); 3 - Germany: Nuclear trade - including non-proliferation (Amendments to the Foreign Trade Act and the Foreign Trade Ordinance (2015)), Radioactive waste management (Act on the Organisational Restructuring in the Field of Radioactive Waste Management (2016); Final report of the Commission to Review the Financing for the Phase-out of Nuclear Energy; Draft Bill of an Act on the Reorganisation of the Responsibility of Nuclear Waste Disposal (2016)); 4 - Lithuania: Nuclear safety and radiological protection (including nuclear emergency planning), Nuclear security (Physical security of sources of ionising radiation), Radioactive waste management, Licensing and regulatory infrastructure (Enforcement measures); 5 - Luxembourg: Radioactive waste management (Agreement between the Grand Duchy of Luxembourg and the Kingdom of Belgium on the Management and Final Disposal of the Radioactive Waste of the Grand Duchy of Luxembourg on the Territory of the Kingdom of Belgium, signed on 4 July 2016); 6

  8. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES - 2016 UPDATE

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R

    2016-01-01

    as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied...... to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules...... lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs...

  9. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee.

    Science.gov (United States)

    Rossini, P M; Burke, D; Chen, R; Cohen, L G; Daskalakis, Z; Di Iorio, R; Di Lazzaro, V; Ferreri, F; Fitzgerald, P B; George, M S; Hallett, M; Lefaucheur, J P; Langguth, B; Matsumoto, H; Miniussi, C; Nitsche, M A; Pascual-Leone, A; Paulus, W; Rossi, S; Rothwell, J C; Siebner, H R; Ugawa, Y; Walsh, V; Ziemann, U

    2015-06-01

    These guidelines provide an up-date of previous IFCN report on "Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application" (Rossini et al., 1994). A new Committee, composed of international experts, some of whom were in the panel of the 1994 "Report", was selected to produce a current state-of-the-art review of non-invasive stimulation both for clinical application and research in neuroscience. Since 1994, the international scientific community has seen a rapid increase in non-invasive brain stimulation in studying cognition, brain-behavior relationship and pathophysiology of various neurologic and psychiatric disorders. New paradigms of stimulation and new techniques have been developed. Furthermore, a large number of studies and clinical trials have demonstrated potential therapeutic applications of non-invasive brain stimulation, especially for TMS. Recent guidelines can be found in the literature covering specific aspects of non-invasive brain stimulation, such as safety (Rossi et al., 2009), methodology (Groppa et al., 2012) and therapeutic applications (Lefaucheur et al., 2014). This up-dated review covers theoretical, physiological and practical aspects of non-invasive stimulation of brain, spinal cord, nerve roots and peripheral nerves in the light of more updated knowledge, and include some recent extensions and developments. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Characteristics of radiation protection legislation

    International Nuclear Information System (INIS)

    Puig Cardozo, Diva E.

    2001-01-01

    The laws on radiological protection have special characteristics. They can exist laws that regulate dangerous activities that will be also applicable, if it corresponds to the activities that involve radioactive materials. But a law of radiological protection should exist. It foresees the existence of an appropriate regulatory body and specialized institutions, definitions, infractions and sanctions then the respective regulations will be elaborated for the different applications. The objective is to contribute to the development of the nuclear energy in the country and to provide the regulatory basis that assures a reasonable security for radioactive installations. The essential objectives of these laws are: 1. to establish the legislative framework for the development and employment of nuclear energy, without risks, according with treaties and conventions that the countries have approved. 2. To fix the fundamental principles and the conditions of their setting in practice allowing to a specific regulation determining application procedures. 3. To create a structure of regulation of enough authority to be able to control and to watch over in an effective way the authorized activities 4. To guarantee an appropriate financial protection against the derived damages of accidents or nuclear incidents. (author)

  11. Juvenile prison in parallel legislation

    Directory of Open Access Journals (Sweden)

    Lutovac Mitar

    2016-01-01

    Full Text Available The need for punishment of juveniles occurred from the time when there was no clear line separating them from the adult criminal population. At the same time, the evolution of the juvenile punishment is not in itself involve substantial changes to their criminal status. On the contrary, the status of minors in society did not show serious differences regarding the status of young adults, as well as the adult elderly. On the other hand, on the ground of their punishment is recorded deviations that go in the direction of application of mild corporal punishment. Closing the minor was performed in a physically separate parts of the general penal institutions with the use of a lower degree of restrictions while serving juvenile prison. Due to the different treatment of minors during the evolution of their criminal status leads to their different treatment in comparative law. That is why we are witnessing the existence of numerous differences in the juvenile punishment in some countries in the world. On the European continent there is a wide range of different legal solutions when it comes to punishing juveniles. There are considerable differences in the procedure pronouncing juvenile prison and in particular penal treatment of juveniles in penitentiary institutions. For these reasons, the author has decided to show the basic statutory provisions in the part that relates to the issue of punishment of minors in the legislation of individual countries.

  12. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome

    OpenAIRE

    Kirkpatrick, Andrew W; Roberts, Derek J; De Waele, Jan; Jaeschke, Roman; Malbrain, Manu LNG; De Keulenaer, Bart; Duchesne, Juan; Bjorck, Martin; Leppaniemi, Ari; Ejike, Janeth C; Sugrue, Michael; Cheatham, Michael; Ivatury, Rao; Ball, Chad G; Reintam Blaser, Annika

    2013-01-01

    Purpose To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). Methods We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, a...

  13. Development of Food Legislation Around the World

    NARCIS (Netherlands)

    Meulen, van der B.M.J.

    2010-01-01

    A variety of systems are presented in the perspective of the development of food legislation to give an impression of the features found in food law and the reasons they have taken certain forms. Legislation on food is not only widely distributed in time but also in space. The assurance of safe food

  14. 43 CFR 26.4 - Legislation.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Legislation. 26.4 Section 26.4 Public Lands: Interior Office of the Secretary of the Interior GRANTS TO STATES FOR ESTABLISHING YOUTH CONSERVATION CORPS PROGRAMS § 26.4 Legislation. State programs must meet all of the requirements of section 4...

  15. Special Education Legislation and Policy in Canada

    Science.gov (United States)

    McBride, Shirley R.

    2013-01-01

    This article reviews the historical context in which Canadian legislation and policy for children with special needs has evolved. The potential for the rights of students with special needs in light of the Canadian Charter of Rights and Freedoms is outlined. The role of the Federal and Provincial governments in legislation and policy vis-à-vis…

  16. Domestic hygienic legislation concerning population radiation protection

    International Nuclear Information System (INIS)

    Marej, A.N.

    1984-01-01

    Problems and principles of domestic sanitary legislation, concerning population radiation protection, are considered. The legislation envisages preventive measures, directed to contamination preventation of the main environmental objects, it regulates their content in the objects, their human intake and ionizing radiation doses, which might affect population. Existing domestic hygienic guides and safety standards for personnel and population are enumerated and characterized

  17. 28 CFR 61.7 - Legislative proposals.

    Science.gov (United States)

    2010-07-01

    ... on the environment, that subunit shall prepare a legislative environmental impact statement in... ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.7 Legislative proposals. (a) Each subunit of the... to Congress which may have an effect on the environment shall, in the early stages of development of...

  18. Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach.

    Science.gov (United States)

    Dan, Tu D; Raben, David; Schneider, Charles J; Hockstein, Neil G; Witt, Robert L; Dzeda, Michael; Cormier, Jennifer F; Raben, Adam

    2015-06-01

    To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated. Median follow up was 37.2months (range 4-121months). Freedom from contralateral nodal failure at 5years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5year disease-free survival (DFS) was 86.7%. This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Legislating for advocacy: The case of whistleblowing.

    Science.gov (United States)

    Watson, Chanel L; O'Connor, Tom

    2017-05-01

    The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway. This paper traces the development of legislation for advocacy. The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.

  20. Radon legislation and national guidelines

    International Nuclear Information System (INIS)

    Aakerblom, G.

    1999-07-01

    The International Commission on Radiological Protection (ICRP) and The Council of the European Union have recommended the Member States to take action against radon in homes and at workplaces. Within the EU project European Research into Radon in Construction Concerted Action, ERRICCA, the Topic Group on Legal and Building Code Impact was designated to study the current radon legislation and give advice regarding future enactment of laws and recommendations. On behalf of the Group, a questionnaire on radon legislation was sent out to nearly all European states and a selection of non-European states. Questions were asked regarding reference levels for dwellings, workplaces and drinking water, and about regulations or recommendations for building materials and city planning. All 15 EU Member States, 17 non-EU European countries and 10 non-European countries responded to the questionnaire. Their answers are considered current as of the end of 1998. Most European States and many non-European countries have recommended reference levels for dwellings and workplaces, and some have guidelines for measures against radon incorporated in their building codes and guidelines for construction techniques. However, only a few countries have enforced reference levels or regulations for planning and construction. The reference levels for indoor radon concentration in existing and new dwellings or workplaces are within the range 150-1000 Bq/m 3 . Sweden is the only country (Out of 15 EU member states) which has enforced limits for existing dwellings. Sweden and the UK have both enforced levels for new dwellings. 7 non-European countries (Out of 17 responding countries) have enforced levels for existing dwellings and 9 have them for new dwellings. At the end of 1998, only Finland, Sweden, the Czech Republic, Romania, Russia and the Slovak Republic had limits for radon in water, although 8 countries were planning to introduce such limits. The present limits are within the range for 50

  1. A systematic review of management strategies for children's mental health care in the emergency department: update on evidence and recommendations for clinical practice and research.

    Science.gov (United States)

    Newton, Amanda S; Hartling, Lisa; Soleimani, Amir; Kirkland, Scott; Dyson, Michele P; Cappelli, Mario

    2017-06-01

    Children with mental health crises require access to specialised resources and services which are not yet standard in general and paediatric EDs. In 2010, we published a systematic review that provided some evidence to support the use of specialised care models to reduce hospitalisation, return ED visits and length of ED stay. We perform a systematic review to update the evidence base and inform current policy statements. Twelve databases and the grey literature were searched up to January 2015. Seven studies were included in the review (four newly identified studies). These studies compared ED-based strategies designed to assess, treat and/or therapeutically support or manage a mental health presentation. The methodological quality of six studies was assessed using the Cochrane Effective Practice and Organization of Care Risk of Bias tool (one interrupted time series study) and a modified Newcastle-Ottawa Scale (three retrospective cohort and two before-after studies). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to rate overall evidence quality (high, moderate, low or very low) for individual outcomes from these six studies. An additional study evaluated the psychometric properties of a clinical instrument and was assessed using criteria developed by the Society of Pediatric Psychology Assessment Task Force (well-established, approaching well-established or promising assessment). There is low to very low overall evidence quality that: (1) use of screening laboratory tests to medically clear mental health patients increases length of ED stay and costs, but does not increase the risk of clinical management or disposition change if not conducted; and (2) specialised models of ED care reduce lengths of ED stay, security man-hours and restraint orders. One mental health assessment tool of promising quality, the home, education, activities and peers, drugs and alcohol, suicidality, emotions and behaviour, discharge

  2. Law, bioethics and practice in France: forging a new legislative pact.

    Science.gov (United States)

    Berthiau, Denis

    2013-02-01

    In France, bioethics norms have emerged in close interaction with medical practices. The first bioethics laws were adopted in 1994, with provisions for updates in 2004 and most recently, in 2011. As in other countries, bioethics laws indirectly refer to certain fundamental values. The purpose of this paper is threefold. First, I shall briefly describe the construction of the French bioethics laws and the values they are meant to protect. Secondly, I will show that the practice of clinical ethics, as reported in a few studies on ART, living organ donation and PGD, challenge the role attributed to doctors as "gatekeepers" of those fundamental values. Thirdly, I will suggest that the quality of medical practices would improve if the law focused on strengthening the tacit pact between doctors and patients, rather than putting doctors in charge of enforcing societal values. Doctors, for their part, would limit their role to what they can do best: provide sufficient patient support and safe care. Against those who argue that we should dispense with bioethics laws altogether, I hold that the laws are useful in order to limit the development of abusive practices. However, a new legislative approach should be adopted which would a positive presumption in favor of patients' requests.

  3. Hawaii state legislator views on e-cigarettes and likelihood of legislative action.

    Science.gov (United States)

    Juarez, Deborah Taira; Seto, Jason; Guimaraes, Alexander; Masterson, James; Davis, James; Seto, Todd B

    2015-01-01

    To examine perspectives on e-cigarette use and regulations in Hawaii through key informant interviews with state legislators. E-cigarette use is rapidly increasing, with sales in 2013 topping $1 billion in the United States, but e-cigarettes are still a largely unregulated industry. Although e-cigarettes are thought by most to be a healthier alternative to traditional cigarettes, long-term health effects are not yet known. Semistructured key informant interviews were conducted with Hawaii state legislators (n = 15). We found a lack of consensus among legislators, which suggests that substantial legislative action is unlikely in the upcoming session. However, most legislators believe that some type of incremental legislation will pass, such as enactment of a small tax, limitations on advertising to protect adolescents, or regulations concerning where people can use e-cigarettes. Legislators eagerly await further research to clarify the overall benefits and harms of e-cigarettes at both the individual and population levels.

  4. Effects of Mental Health Benefits Legislation

    Science.gov (United States)

    Sipe, Theresa Ann; Finnie, Ramona K.C.; Knopf, John A.; Qu, Shuli; Reynolds, Jeffrey A.; Thota, Anilkrishna B.; Hahn, Robert A.; Goetzel, Ron Z.; Hennessy, Kevin D.; McKnight-Eily, Lela R.; Chapman, Daniel P.; Anderson, Clinton W.; Azrin, Susan; Abraido-Lanza, Ana F.; Gelenberg, Alan J.; Vernon-Smiley, Mary E.; Nease, Donald E.

    2015-01-01

    Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes. PMID:25998926

  5. Points for Improvement in Mexican Legislation on Safeguards

    International Nuclear Information System (INIS)

    Maciel Sánchez, S.; Carreño Padilla, A. L.

    2015-01-01

    The main goal of this paper is to underline the specific points needed still to be improved on safeguards in the Mexican legal framework. The problem: Mexico proposed the Tlatelolco Treaty which was before the TNP. So the Mexican legislation on safeguards should to be one of the best around the world, but there are still points to be improved, such as a specific regulation on the topic. Justification: Remembering that the exact sciences need of the law in order to be applied in a desirable way. I mean, the safeguards could be well conceived and well worked from the physics and mathematics point of view, but in order to be followed in any country, it is necessary the right legal framework. Hypothesis: What has Mexico now in its legislation on safeguards and what remains to be done (what is pending in the Mexican legal scope of the safeguards)? Objectives: – To propose legal solutions to correct the weakness of the Mexican legal framework on Safeguards; taking into account my own experience drafting the Mexican regulation on safeguards from 2008 for the Mexican Government in my nuclear law firm “Martínez and Maciel”. – To propose a legal framework on safeguards for Mexico as it is understood by the IAEA. – To update the legal frame work on safeguards in Mexico linking it to the Back end of the spent fuel. (Considering that sooner or later the Mexican Government will have to define its politic on this topic). (author)

  6. Harmonisation of Slovenian nuclear legislation with EU

    International Nuclear Information System (INIS)

    Gregoric, M.

    1999-01-01

    Slovenia as a member of the first group of candidates countries which started the accession negotiations with the European Union. The extensive work started in 1998 to align the domestic legislation with the legislation of the European Union. The activities related to the accession of Slovenia to EU in the area of nuclear legislation are carried out in different national working groups. The main part of activities is in working groups: energy and environment, but there are some topics, which are covered in other groups, like control of dual-use materials in the group of External Relations, research in reactor physics, nuclear engineering and fusion in the group Science and Technology

  7. 10 CFR 51.88 - Proposals for legislation.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Proposals for legislation. 51.88 Section 51.88 Energy...) Legislative Environmental Impact Statements-Proposals for Legislation § 51.88 Proposals for legislation. The... proposals for legislation. final environmental impact statements—general requirements ...

  8. National legislative and regulatory activities

    International Nuclear Information System (INIS)

    2001-01-01

    These columns summarize the recent changes made in the nuclear legislation and regulation of OECD countries: Argentina: Reorganization of the National Atomic Energy Commission (2001); Canada: Order aiming to increase security at major nuclear installations (2001); France: Establishment of the French Agency for Environmental Health Safety and the Institute for the Protection of Nuclear Safety (2001). Amendment of the Decree on the Holding Company of the Atomic Energy Commission (2001). Decree on the Special Commission for Major Nuclear Installations Classified as Secret (2001).Ordinance on the Implementation of EU Directives in the Field of Protection against Ionising Radiation (2001). Decree on Information of the Public (2001). Decree governing the Safety and Radiation Protection of Nuclear Installations and Activities used for Defence Purposes (2001). Order on Postal Deliveries of Radioactive Materials (2001). Order on the Carriage of Dangerous Goods by Road ('ADR Order') (2001). Order on the Transport of Dangerous Goods by Rail ('RID Order') (2001). Germany: Agreement on the phase-out of nuclear energy (2001). Ordinance implementing Euratom Directives on Radiation Protection (2001). Greece: Radiation Protection Regulations (2001). Italy: Amendment of the Decree implementing the Euratom basic radiation protection standards (2001) Implementation of the European Directive on the Quality of Water Intended for Human Consumption (2001). JAPAN: Revision of the Nuclear Disaster Prevention Guidelines (2000). Republic of Korea: Amendments to the Act on Compensation for Nuclear Damage (2001). Lithuania: Regulations for the Classification of Legal Acts Regulating Nuclear Safety (2001); Hygiene Standard 'Radiation Safety in Nuclear Power Plants' (2001). Guidelines governing the Procedure on Radiological Monitoring and Limitation of Releases of Radionuclides into the Environment from Nuclear Facilities (2001). Law on the Decommissioning Fund for the Ignalina Nuclear Power

  9. Canadian parents' attitudes and beliefs about bicycle helmet legislation in provinces with and without legislation.

    Science.gov (United States)

    Parkin, P C; Degroot, J; Macpherson, A; Fuselli, P; Macarthur, C

    2014-02-01

    The objective of this study was to survey Canadian parents on their attitudes and beliefs about bicycle helmet legislation and to compare responses from parents living in provinces with and without legislation. A national survey of 1002 parents of children aged under 18 years was conducted. Chi-square tests were used to compare responses from the surveyed parents in the different jurisdictions. Responses from parents living in provinces with legislation (n = 640) and without legislation (n = 362) were as follows: concern for injury (63% vs. 68%, nonsignificant [NS]); believe helmets are effective (98% vs. 98%, NS); child always wears a helmet (74% vs. 69%, NS); support legislation for children (95% vs. 83%, p legislation for all ages (85% vs. 75%, p legislation decreases the amount of time their child bicycles (5% vs. 8%, NS). Parents are highly supportive of bicycle helmet legislation in Canada. They believe that bicycle helmets are effective and that legislation does not decrease the amount of time a child spends bicycling. There was also a high level of support for legislation across all ages, and for police enforcement.

  10. CDC STATE System Tobacco Legislation - Advertising

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2015. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Advertising. The STATE...

  11. CDC STATE System Tobacco Legislation - Preemption Summary

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation—Preemption. The STATE...

  12. CDC STATE System Tobacco Legislation - Smokefree Campus

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Smokefree Campuses. The...

  13. CDC STATE System Tobacco Legislation - Preemption

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation—Preemption. The STATE...

  14. CDC STATE System Tobacco Legislation - Licensure

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation—Licensure. The STATE...

  15. Radiation Protection Legislation in the Nordic Countries

    International Nuclear Information System (INIS)

    Person, Lars.

    1990-01-01

    Recent alterations in the radiation protection laws of the Nordic countries are presented. The report amends the previous SS-report 87-37 with the title Radiation Protection and Atomic Energy Legislation in the Nordic Countries. (au)

  16. CDC STATE System Tobacco Legislation - Youth Access

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2016. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation—Youth Access. The STATE...

  17. CDC STATE System Tobacco Legislation - Youth Access

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation—Youth Access. The STATE...

  18. CDC STATE System Tobacco Legislation - Fire Safety

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Fire-Safety. The STATE...

  19. CDC STATE System Tobacco Legislation - Fire Safety

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2018. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Fire-Safety. The STATE...

  20. CDC STATE System Tobacco Legislation - Smokefree Campus

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2016. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation – Smokefree Campuses. The...

  1. CDC STATE System Tobacco Legislation - Tax

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2017. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation-Tax. The STATE System...

  2. CDC STATE System Tobacco Legislation - Tax

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1995-2018. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Legislation-Tax. The STATE System...

  3. Legislation on treating animals in human care

    OpenAIRE

    Konečná, Petra

    2016-01-01

    1 Abstract This Master's thesis entitled Legislation on treating animals in human care compares Czech and Australian legislation in selected aspects of three categories of animals in human care - farm animals, companion animals and animals used for scientific and other research purposes. The thesis is composed of 5 main chapters. The first chapter describes sources of law regarding treating animals in human care from the perspectives of international law, European Union law, federal Czech law...

  4. Specific legislation on biobanks in Spain.

    Science.gov (United States)

    García-Merino, Isabel Ma; Consuegra, Irene; Jiménez, José Luís; Muñoz-Fernández, Ma Ángeles

    2015-06-01

    Spain has enacted specific legislation concerning biobanks. This legislation regulates how biobanks should be set up, how they should operate, and the requirements they need to comply with. The main objective of this legislation is to keep a good balance between scientific progress and respect for the rights and freedom of individuals participating in research. Therefore, this legislation lays down a series of basic principles, for instance, the principle to inform donors accurately i) on the deposit of samples in terms of the objectives and implications of their donation and on the need to obtain written consents; ii) on the obligation to establish consistent procedures to guarantee the confidentiality of personal data associated with and obtained from biological samples; iii) on the concept of free sample donation either by donors or by biobanks; iv) on the need for consistent procedures to deposit samples and data in biobanks; and v) for acts of donation and data for research projects to be performed correctly. Although this Spanish legislation fulfills its objectives, it has some drawbacks; mainly it overprotects research participants. This issue should be analyzed in future revisions of the legislation.

  5. Legislating Interprofessional Regulatory Collaboration in Nova Scotia

    Directory of Open Access Journals (Sweden)

    William Lahey

    2013-10-01

    Full Text Available To shift health professions regulation from traditional to ‘collaborative’ self-regulation, Nova Scotia has adopted legislation which will: make all self-regulating health professions members of the Regulated Health Professions Network; mandate the Network to facilitate voluntary collaboration among its members; and enable regulators to work together on investigations of patient complaints, to adjust scopes of practice on an ongoing basis and to adjudicate appeals of unsuccessful applicants for registration. The goals are to give health professions regulation the capacity to enable and support the functioning of interprofessional teams. The legislation was adopted primarily for two reasons: collaborative development and unanimous support by all of the province’s self-regulating professions; and alignment with the government’s health care reform agenda and its emphasis on collaborative team-based care. Contrary to the approach of several other provinces, the legislation will enable but not require regulators to collaborate on the premise that consensual collaboration is more likely to happen, to be meaningful and to yield tangible benefits. Support for this approach can be taken from the impressive collaborative work on which the legislation is based. Evaluation will be critical, and the five-year review required by the legislation will give Nova Scotia the opportunity to test not only the legislation but the ideas on which it is based. The extent of the legislation’s reliance on voluntary process will prove to be either its greatest strength or its greatest weakness.

  6. State legislators' beliefs about legislation that restricts youth access to tobacco products.

    Science.gov (United States)

    Gottlieb, Nell H; Goldstein, Adam O; Flynn, Brian S; Cohen, E Joanna E; Bauman, Karl E; Solomon, Laura J; Munger, Michael C; Dana, Greg S; McMorris, Laura E

    2003-04-01

    Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.

  7. Amblyopia update: new treatments.

    Science.gov (United States)

    Vagge, Aldo; Nelson, Leonard B

    2016-09-01

    This review article is an update on the current treatments for amblyopia. In particular, the authors focus on the concepts of brain plasticity and their implications for novel treatment strategies for both children and adults affected by amblyopia. A variety of strategies has been developed to treat amblyopia in children and adults. New evidence on the pathogenesis of amblyopia has been obtained both in animal models and in clinical trials. Mainly, these studies have challenged the classical concept that amblyopia becomes untreatable after the 'end' of the sensitive or critical period of visual development, because of a lack of sufficient plasticity in the adult brain. New treatments for amblyopia in children and adults are desirable and should be encouraged. However, further studies should be completed before such therapies are widely accepted into clinical practice.

  8. NB market update

    International Nuclear Information System (INIS)

    Marshall, W. K.

    2004-01-01

    The 2004 New Brunswick proclamation introduced several changes to the industry. This paper presents an update of the current New Brunswick electricity market from the perspective of the recently created New Brunswick System Operator (NBSO). A comparison was made between the modified industry and the previous industry structure. Significant changes included: corporate restructuring and market implementation; the formation of the independent system operator; and an increase in Public Utilities Board regulatory authority. The main objectives of the NBSO were reviewed, including its intention to reliably plan and operate the integrated power system as well as facilitating and operating the electricity market. Details of directors and officers were provided along with a list of legislated functions which included entering agreements with transmitters; provision and procurement of ancillary services; maintenance of integrated system; coordination of external activities; participation with standards authorities; planning and development of transmission; and the facilitation of a competitive market. An outline of the NBSO, Transco and Public Utilities Board relationships were presented. Details of the market advisory committee were outlined, with information concerning contracts, operations and services agreements. Transmission and ancillary services were also discussed, as well as issues concerning interruptible load agreements. A chart of the New Brunswick electricity market structure was presented, along with a market overview including details of capacity, ancillary services and suppliers. Market rules and amendments were presented, as well as market participation guides. Details of generation resource adequacy requirements and the imposition of penalties were outlined. Scheduling and dispatch issues were overviewed, as well as settlement processes, inputs and their sources, including settlements for variances. Future development possibilities included an expansion of

  9. Unintended consequences of health care legislation.

    Science.gov (United States)

    Thrall, James H

    2011-10-01

    Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. Legislations combating counterfeit drugs in Hong Kong.

    Science.gov (United States)

    Lai, C W; Chan, W K

    2013-08-01

    To understand legislation combating counterfeit drugs in Hong Kong. This study consisted of two parts. In part I, counterfeit drugs–related ordinances and court cases were reviewed. In part II, indepth interviews of the stakeholders were described. Hong Kong. All Hong Kong ordinances were screened manually to identify those combating counterfeit drugs. Court cases were searched for each of the identified cases. Then, the relevant judgement justifications were analysed to identify sentencing issues. Indepth interviews with the stakeholders were conducted to understand their perceptions about such legislation. Trade Marks Ordinance, Patents Ordinance, Trade Descriptions Ordinance, and Pharmacy and Poisons Ordinance were current legislative items combating counterfeit drugs. Sentencing criteria depended on: intention to deceive, quantity of seized drugs, presence of expected therapeutic effect or toxic ingredients, previous criminal records, cooperativeness with Customs officers, honest confessions, pleas of guilty, types of drugs, and precautionary measures to prevent sale of counterfeit drugs. Stakeholders’ perceptions were explored with respect to legislation regarding the scale and significance of the counterfeit drug problem, penalties and deterrents, drug-specific legislation and authority, and inspections and enforcement. To plug the loopholes, a specific law with heavy penalties should be adopted. This could be supplemented by non-legal measures like education of judges, lawyers, and the public; publishing the names of offending pharmacies; and emphasising the role of pharmacists to the public.

  11. Does State Legislation Improve Nursing Workforce Diversity?

    Science.gov (United States)

    Travers, Jasmine; Smaldone, Arlene; Cohn, Elizabeth Gross

    2015-08-01

    A health-care workforce representative of our nation's diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%-24.5%), California (3.3%-5.4%), and Michigan (8.0%-10.0%) significantly increased enrollment of Blacks, and Florida (11.8%-15.4%) and Texas (11.2%-13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation. © The Author(s) 2015.

  12. THE INFLUENCES OF CHANGES IN TAX LEGISLATION

    Directory of Open Access Journals (Sweden)

    MORAR IOAN DAN

    2013-07-01

    Full Text Available Taxation is a fairly important field in the relationship between taxpayers and tax authorities, especially given the frequent changes in specific legislation. Legislative changes affect the patrimonial position of the taxpayers, but also their behavior, therefore this phenomenon is important to advise those interested and also to analyze the changes resulting from changes in tax legislation. This paper aims to meaningfully present the latest legislative changes and to analyze their influences on taxpayers and on budget revenues from taxes subject to change. The research methodology is based on comparison and inference, based on previous analyzes for such studies on the tax system. In the literature there are known ways and methods of increasing the tax burden and, based on these variables, in the present paper we will highlight the particular influences on the taxpayer’s , loaded by weight imposed by the official distribution of the tax burden. The implications of legislative changes in tax matters should be sought in the innermost chord of taxpayers and also in the increasingly large and patched pockets of the modern state. In the first place, we will point out the implications on changing tax procedures, in terms of the workload for the taxpayer and the tax collectors. By accurately and relevantly analyzing the influences generated by such changes, the author aims to demonstrate the harmful influences of some changes in terms of discouraging investments and honest labor.

  13. An action research approach to practice, service and legislative change.

    Science.gov (United States)

    Sullivan, Elise; Hegney, Desley G; Francis, Karen

    2013-11-01

    To describe the action research approach taken to engage a multidisciplinary group of health professionals and managers from five rural health services with government officers in redesigning their emergency care services and informing legislative change. The diminishing size of the medical workforce across rural Victoria in Australia captured the Victorian state government's attention when this threatened the sustainability of emergency care services in rural and remote hospitals in 2006. The government funded the collaborative practice model pilot between 2006 and 2008 to develop and test an alternative model of emergency care service in which nurses practised at a more advanced and autonomous level. Data were sourced from a combination of interviews, focus groups and patient records. Qualitative data were analysed using convergent interview and thematic analysis. Quantitative data were analysed using frequencies and cross tabulations. The three critical success factors owing to action research are presented. It provided a politically safe approach to service, policy and legislative change, ensured collaboration permeated the endeavour and helped to shift the focus from a technical to an emancipatory approach to action research. Action research was key to the success achieved by the participants in changing clinical practice, service delivery and the Victorian Drugs Poisons and Controlled Substances Act (1981) to authorise registered nurses to supply medicines. This paper offers an approach that nurses in practice, management and government can take to drive changes at practice, service and legislative levels in advanced nursing practice.

  14. Examining hypnosis legislation: a survey of the practice in Israel.

    Science.gov (United States)

    Aviv, Alex; Dalia, Gilboa; Gaby, Golan; Kobi, Peleg

    2008-01-01

    Hypnosis as a therapeutic technique bears potential risks when carried out inexpertly. Because of this, Israel was the first to legislate hypnosis. This study examines the current state of clinical hypnosis practice in Israel. A questionnaire was sent to 470 licensed hypnotists and 1250 unlicensed professionals; 478 (25.7%) of the 1720 potential respondents returned the questionnaires. Of these, 249 (51.8%) were licensed hypnotists, and 232 (48.2%) were unlicensed. Of the unlicensed professionals, 45% reported practicing hypnosis; 50% of them practice hypnosis with adolescents and 41.2% with children. Many of them practice hypnosis in public clinics (71.6%). Of the licensed professionals, 94.4% reported practicing hypnosis in the course of their clinical work. The authors conclude that great number of unlicensed hypnotists carry on clinical practice of hypnosis and suggest steps to increase the efficiency of the law as part of a regulatory system.

  15. CFC legislation in the European Union

    Directory of Open Access Journals (Sweden)

    Cvjetković Cvjetana M.

    2015-01-01

    Full Text Available In this paper the author considers CFC legislation in the Member States of the European Union, and points to the official attitude of the institutions of the European Union toward CFC legislation. Special attention in this paper is focused on Judgment of the Court of Justice of the European Union in the case Cadbury Schweppes. The aim of the paper is to analyze CFC legislation in the Member States in order to determine its basic characteristics, as well as to determine its compatibility with freedoms guaranteed by the primary law of the European Union, i.e. with Judgment of the Court of Justice of the European Union in the Cadbury Schweppes case.

  16. LEGISLATIVE, ACCOUNTING AND FISCAL NON-CONFORMITIES

    Directory of Open Access Journals (Sweden)

    PALIU – POPA LUCIA

    2017-12-01

    Full Text Available In the context of the debate analysis from the last decades on the relationship between accounting and taxation, independence or dependence of the accounting rules from the tax ones and taking into consideration that the independence of the two leads to permanent and even significant differences between the accounting and tax profit, I found that certain terms are regulated differently in accounting legislation in our country compared to fiscal one or the legislation in the economic field. Taken from this perspective the main objective of this scientific approach is the identification of accounting and tax legislative nonconformities and the proposal of the ways to solve them so as to eliminate, where possible, differentiated professional interpretations.

  17. LEGISLATIVE, ACCOUNTING AND FISCAL NON-CONFORMITIES

    Directory of Open Access Journals (Sweden)

    PALIU – POPA LUCIA

    2016-12-01

    Full Text Available In the context of the debate analysis from the last decades on the relationship between accounting and taxation, independence or dependence of the accounting rules from the tax ones and taking into consideration that the independence of the two leads to permanent and even significant differences between the accounting and tax profit, I found that certain terms are regulated differently in accounting legislation in our country compared to fiscal one or the legislation in the economic field. Taken from this perspective the main objective of this scientific approach is the identification of accounting and tax legislative nonconformities and the proposal of the ways to solve them so as to eliminate, where possible, differentiated professional interpretations.

  18. [History of psychiatric legislation in Italy].

    Science.gov (United States)

    Stocco, Ester; Dario, Claudia; Piazzi, Gioia; Fiori Nastro, Paolo

    2009-01-01

    The different models of mental illness which have followed one another in Italian psychiatry have been linked to the history of psychiatric legislation and its various attempts at reform. The first law of the newly United State which unified legislations and former procedures, whose prevalent psychiatric theories were those that referred to degeneration, was the law 36/1904 that set up the asylums. Accordingly psychiatric praxis was focused on social protection and custody, given that the mentally ill was seen as incurable; Fascism added the inmate's obligation to be enrolled in the judicial register. Afterwards numerous attempts to reform the psychiatric legislation were made that eventually gave rise to law 431/1968 which paved the way to territorial psychiatry. Law 180/1978 changed the organization of Italian psychiatry abolishing asylums and the concept of dangerousness, including psychiatry in the National Health Service but adopting an idea of mental illness as simply social unease.

  19. Updating systematic reviews: an international survey.

    Directory of Open Access Journals (Sweden)

    Chantelle Garritty

    Full Text Available BACKGROUND: Systematic reviews (SRs should be up to date to maintain their importance in informing healthcare policy and practice. However, little guidance is available about when and how to update SRs. Moreover, the updating policies and practices of organizations that commission or produce SRs are unclear. METHODOLOGY/PRINCIPAL FINDINGS: The objective was to describe the updating practices and policies of agencies that sponsor or conduct SRs. An Internet-based survey was administered to a purposive non-random sample of 195 healthcare organizations within the international SR community. Survey results were analyzed using descriptive statistics. The completed response rate was 58% (n = 114 from across 26 countries with 70% (75/107 of participants identified as producers of SRs. Among responders, 79% (84/107 characterized the importance of updating as high or very-high and 57% (60/106 of organizations reported to have a formal policy for updating. However, only 29% (35/106 of organizations made reference to a written policy document. Several groups (62/105; 59% reported updating practices as irregular, and over half (53/103 of organizational respondents estimated that more than 50% of their respective SRs were likely out of date. Authors of the original SR (42/106; 40% were most often deemed responsible for ensuring SRs were current. Barriers to updating included resource constraints, reviewer motivation, lack of academic credit, and limited publishing formats. Most respondents (70/100; 70% indicated that they supported centralization of updating efforts across institutions or agencies. Furthermore, 84% (83/99 of respondents indicated they favoured the development of a central registry of SRs, analogous to efforts within the clinical trials community. CONCLUSIONS/SIGNIFICANCE: Most organizations that sponsor and/or carry out SRs consider updating important. Despite this recognition, updating practices are not regular, and many organizations lack

  20. Smoke-free legislation and child health.

    Science.gov (United States)

    Faber, Timor; Been, Jasper V; Reiss, Irwin K; Mackenbach, Johan P; Sheikh, Aziz

    2016-11-17

    In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world's population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike.

  1. Impact of the legislation on consumers

    International Nuclear Information System (INIS)

    Lee, D.O.

    1982-01-01

    Douglas Lee points out that the question of nuclear waste will not go away. Nuclear waste is with us and consumers should support legislation to deal with the problem once and for all. The spent fuel is growing, and twenty-nine nuclear plants will face onsite storage problems in this decade. If these plants shut down, consumers will face higher electric generating costs if a switch to a more expensive fuel is necssary, or if the utilities are forced to purchase power of the grid. The cost of waste disposal under this proposed legislation will amount to about 75 cents per month for those electric customers serviced by nuclear plants

  2. Legislation in the electricity economy 1980

    International Nuclear Information System (INIS)

    Antoni, W.; Haeusler, C.; Hermann, H.P.; Meyer-Woebse, G.; Schmidt, K.

    1981-01-01

    The authors survey substantial developments of legislation in the electricity economy in 1980. They deal with prominent, legal subjects of a political nature and discuss questions posed by the interpretation and application of laws with regard to supply concepts, to the 4th amendment to the anti-trust law, to legislation relating to the anti-trust law, to recommendations by the Investigation Committee, to rate approvals, general terms and conditions governing supplies, to atomic energy law, to the environmental protection law, to the law relating to the conservation of nature and preservation of rural amenities, to the law relating to roads and to developments of tax laws. (HSCH) [de

  3. Outdoor recreation in forest policy and legislation

    DEFF Research Database (Denmark)

    Mann, Carsten; Pouta, Eija; Gentin, Sandra

    2010-01-01

    The benefists of outdoor recreation and the need for recreation inventories and monitoring are described in various policy and legislation documents at the European level. The objective of this paper is to analyse how these recreational aspects are reflected at the national level in core forest...... indicates that a consistent forest recreation monitoring system, linked to sustainable forest management, as describes for example in the Helsinki process, should be better transferred into national policuy and legislation. Compareable data across Europe could then provide a sound base for making decisions...

  4. EU law revisions and legislative drift

    DEFF Research Database (Denmark)

    Borghetto, Enrico; Mäder, Lars Kai

    2014-01-01

    European Union research has made great strides in understanding the dynamics of the European Union decision-making process. In contrast to this progress, the dynamics unfolding after the enactment of a European Union secondary legislative act has largely been ignored. Some of these acts remain...... revisions of European Union legislative acts are more likely to occur. Based on an analysis of the revision histories of 158 major European Union acts in the time period between 1958 and 2003, we find significant support for this hypothesis....

  5. Norway's ICT Accessibility Legislation, Methods and Indicators.

    Science.gov (United States)

    Rygg, Malin; Rømen, Dagfinn; Sterri, Brynhild Runa

    2016-01-01

    This paper gives an overview of the Norwegian legislation on Universal Design of information and communication technology (ICT) and how the Norwegian Authority for Universal Design of ICT works to enforce and achieve the goals behind the legislation. The Authority uses indicators to check websites for compliance with the regulations. This paper describes the rationale and intended use for the indicators and how they are used for both supervision and benchmarks as well as a way of gathering data to give an overview of the current state of Universal Design of websites in Norway.

  6. The congressional viewpoint: Deficit reduction and risk legislation

    Energy Technology Data Exchange (ETDEWEB)

    Chakoff, H.E.

    1995-12-31

    This presentation will provide a current congressional status of legislation related to low-level waste and DOE cleanup. Key legislation discussed will include S. 755 for Privatization of the Uranium Enrichment Corporation and the markup of H.R. 1020, the Nuclear Waste Legislation. In addition, the session will include a discussion of legislation related to the approval of the Texas compact.

  7. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Kjærsgaard, Annette; Hansen, Tina

    2017-01-01

    to three critical outcomes (aspiration, pneumonia and death) and seven important outcomes (dehydration, weight loss, mealtime performance, patient preferences, intervention adherence and quality of life). METHODS: Three steps were used. First: An updated systematic literature search. Second: An assessment......: The body of evidence consisted of two RCTs for review question 1 both using nectar thickened liquids or honey-thickened liquids. No evidence was found for two important outcomes, mealtime performance and quality of life. With regard to risk of pneumonia, death, aspiration, dehydration, weight loss...

  8. Tendances Carbone no. 104. Towards a re-calibrated EU ETS for 2030: assessment of the legislative proposal to revise the EU ETS Directive

    International Nuclear Information System (INIS)

    Jalard, Matthieu; Alberola, Emilie

    2015-07-01

    Among the publications of CDC Climat Research, 'Tendances Carbone' bulletin specifically studies the developments of the European market for CO 2 allowances. Beside some statistical figures about energy production/consumption and carbon markets, this issue specifically addresses the following points: - EU ETS -Directive: On July 15, the EU Commission released a legislative proposal to revise the EU ETS Directive post-2020, translating into legislation the October 2014 Council Conclusions. - EU ETS carbon leakages provisions: The legislative proposal includes a 43% share of free allocation from 2021 to 2030, a new Carbon leakage list representing 93% of industrial emissions, an update of production levels and benchmarks every five years

  9. Recommendations for the clinical practice: Standards, options and recommendations 2003 for the use of recombinant erythropoietin (alpha and beta epoetine, alpha darbepoetine, EPO) in the taking charge of anemia in oncology for the patients treated by radiotherapy, update

    International Nuclear Information System (INIS)

    Marchal, Ch.; Spaeth, C.; Casadevall, N.; Daouphars, M.; Marec-Berard, P.; Fabre, N.; Haugh, M.

    2004-01-01

    Standards, Options and Recommendations for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy - UPDATE 2003. Context. - 'The Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the twenty French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives. - To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy. Methods. - The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomized clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002. Results. - There is no standard attitude for use of rHuEPO in patients undergoing radiotherapy. There is no evidence to support use of rHuEPO in patients with ENT cancer receiving radiotherapy alone. In patients undergoing curative radiotherapy, it is recommended to correct anaemia under 10 g/dL using transfusion rather than rHuEPO. When the haemoglobin concentration is between 12 g/dL and 14 g/dL initial use of rHuEPO can be an option under certain conditions for radio-chemotherapy if the risk of anaemia is

  10. Legislation on university technology transfer and research management 2012

    International Nuclear Information System (INIS)

    2012-02-01

    This book deals with legislation on university technology transfer in 2012, which includes invention promotion act, legislation on technology transfer and promotion of industrialization, legislation on industrial education and industrial cooperation, and special legislation on venture business. It lists the legislation related research and development by government department : fundamental law of scientific technique, law on evaluation and management of domestic research development business, national science and technology council and the patent office.

  11. Updates in ophthalmic pathology.

    Science.gov (United States)

    Mendoza, Pia R; Grossniklaus, Hans E

    2017-05-01

    Ophthalmic pathology has a long history and rich heritage in the field of ophthalmology. This review article highlights updates in ophthalmic pathology that have developed significantly through the years because of the efforts of committed individuals and the confluence of technology such as molecular biology and digital pathology. This is an exciting period in the history of ocular pathology, with cutting-edge techniques paving the way for new developments in diagnostics, therapeutics, and research. Collaborations between ocular oncologists and pathologists allow for improved and comprehensive patient care. Ophthalmic pathology continues to be a relevant specialty that is important in the understanding and clinical management of ocular disease, education of eye care providers, and overall advancement of the field.

  12. Updates in ophthalmic pathology

    Directory of Open Access Journals (Sweden)

    Pia R Mendoza

    2017-01-01

    Full Text Available Ophthalmic pathology has a long history and rich heritage in the field of ophthalmology. This review article highlights updates in ophthalmic pathology that have developed significantly through the years because of the efforts of committed individuals and the confluence of technology such as molecular biology and digital pathology. This is an exciting period in the history of ocular pathology, with cutting-edge techniques paving the way for new developments in diagnostics, therapeutics, and research. Collaborations between ocular oncologists and pathologists allow for improved and comprehensive patient care. Ophthalmic pathology continues to be a relevant specialty that is important in the understanding and clinical management of ocular disease, education of eye care providers, and overall advancement of the field.

  13. [Update Chagas disease].

    Science.gov (United States)

    Molina, Israel; Salvador, Fernando; Sánchez-Montalvá, Adrián

    2016-02-01

    The constant migration flows have favored the presence of people with Chagas disease in regions traditionally regarded as non-endemic, such as North America, Europe, Asia and Oceania. This has forced both health authorities and professionals to be updated in order to respond to such a demand for assistance. Recent years have led to significant progress in the field of diagnosis and treatment of Chagas disease, one of the most neglected tropical diseases. Recent clinical trials are providing new evidence that makes the management of these patients, a constant challenge for the professionals involved. Innovative diagnostic tools and therapeutic regimens, allow us to face the future of Chagas disease with optimism. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  14. Update on equine allergies.

    Science.gov (United States)

    Fadok, Valerie A

    2013-12-01

    Horses develop many skin and respiratory disorders that have been attributed to allergy. These disorders include pruritic skin diseases, recurrent urticaria, allergic rhinoconjunctivitis, and reactive airway disease. Allergen-specific IgE has been detected in these horses, and allergen-specific immunotherapy is used to ameliorate clinical signs. The best understood atopic disease in horses is insect hypersensitivity, but the goal of effective treatment with allergen-specific immunotherapy remains elusive. In this review, updates in pathogenesis of allergic states and a brief mention of the new data on what is known in humans and dogs and how that relates to equine allergic disorders are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Road tunnels safety according to European legislation

    Directory of Open Access Journals (Sweden)

    Fedor KÁLLAY

    2008-01-01

    Full Text Available The article deals with safety of European road tunnels in accordance with actual European legislation. Standards and recommendations of European Commission, PIARC and other professional bodies of the European Union define minimal technological requirements for equipment and operation of the tunnels in scope of Trans-European Road Network.

  16. Institutional independence and the constitutionality of legislation ...

    African Journals Online (AJOL)

    The test for determining whether judicial independence is safeguarded is an objective one based on public confidence in the structure of the court and the ... in the analysis of the application of the principles of judicial independence to specific legislative schemes where the structure of the tribunal thereby established had ...

  17. Legislation, Empirical Research and Juridical Law

    NARCIS (Netherlands)

    Schotel, B.

    2013-01-01

    This article looks at the incorporation of empirical research into legislation from a juridical law perspective. Juridical law is characterized by four elements: autonomous and artificial reasoning; making statements to authorize factual actions; mobilizing helpers of the proponent and de-mobilizing

  18. Buffalo City learners' knowledge of abortion legislation

    African Journals Online (AJOL)

    Background: The Choice on Termination of Pregnancy (CTOP) Act legalised abortion on request in South Africa until up to 12 weeks of gestation and thereafter under specified conditions. Within the context of liberal legislation, accurate information is a necessary (although not sufficient) requirement for women to exercise ...

  19. Legislation hampers medical research in acute situations

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John

    2015-01-01

    INTRODUCTION: Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation...

  20. Parental Perceptions of the 2014 SEND Legislation

    Science.gov (United States)

    Holland, John; Pell, Gabrielle

    2017-01-01

    The study researched parent's experiences of The Children and Families Act 2014 in Hull and the East Riding of Yorkshire. A sample of parents using KIDS Services in the area were surveyed by questionnaire, both before and after the legislation came into force. Nearly half of the parents were aware of a change in Special Educational Needs and…

  1. Networking Concepts and Cooperation among Legislative Libraries ...

    African Journals Online (AJOL)

    This paper argues that military rule does not provide the appropriate environment for the growth and development of legislative libraries. Cooperation and not competition is stated as the driving philosophy for library networks and cooperation. Resource sharing is the premise for participation in library network. Network ...

  2. The need for hate crime legislation

    African Journals Online (AJOL)

    the Consortium for Refugees and Migrants in South. Africa and convener of ... risk for developing a variety of mental health problems including ..... organisation has expressed an interest in support- ing South Africa by providing experts for related training.57. Regardless of whether hate crime legislation is adopted in South ...

  3. Federal/State Radiation Control Legislation, 1974

    International Nuclear Information System (INIS)

    Miller, L.A.

    1975-07-01

    A review is presented of Federal and State radiation control legislation for calendar year 1974, in Federal-State, subject, and status order. A brief description of each bill introduced in 1974 is included, plus existing laws or statutes governing radiation control. (auth)

  4. Quality legislation: lessons for Ontario from abroad

    NARCIS (Netherlands)

    Veillard, Jérémy; Tipper, Brenda; Klazinga, Niek

    2012-01-01

    While the Excellent Care for All Act, 2010 (ECFA Act) provides a comprehensive approach to stimulating quality improvement in healthcare, there are other examples of legislations articulating strategies aimed at the same goal but proposing different approaches. This paper reviews quality of care

  5. Analysis of cosmetics with regard to legislation

    NARCIS (Netherlands)

    Liem, D.H.

    1976-01-01

    A general picture of toxicological approach and practical aspects of cosmetic safety is described in this thesis. Such considerations are the basis for introducing negative and positive lists of cosmetic ingredients into cosmetic legislation. The first Dutch Cosmetic Act of 1968 already has several

  6. The European legislative framework for audit committees

    NARCIS (Netherlands)

    van der Elst, C.F.

    In 2014 the European Union reformed the regulatory framework of statutory audits in Directive 2014/56/EC and Regulation (EU) Nr. 537/2014. Part of the new legislation addresses the composition and responsibilities of the audit committee of public-interest entities. This contribution studies the

  7. Industrial Relations Legislation: A Creative Contribution

    Science.gov (United States)

    Leary, Malcolm

    1976-01-01

    One specific area of industrial relations training is considered--that of meeting the implications of change as a result of the current theme of joint involvement in proposed industrial relations legislation. This will demand new approaches for industry in England. (Author/BP)

  8. Wole Soyinka's Glocal Cultural Legislation | Awosanmi | Ibadan ...

    African Journals Online (AJOL)

    The Nobel Foundation‟s citation on Soyinka in 1986 as a writer “who in a wide cultural perspective and with poetic overtones, fashions the drama of existence” marks the zenith of recognition accorded his humanistic legislative mission. Implied here is a profound cultural intelligence which authenticates his ...

  9. North Carolina Sexual Offender Legislation: Policy Placebo?

    Science.gov (United States)

    Page, Amy Dellinger; Hill, Julie Sprinkle; Gilbert, Griff

    2012-01-01

    Current legislation at the state and federal level is largely based on the premise that we can best protect children by prohibiting sexual offenders' access to children through the use of residency restrictions, employment sanctions, and community notification. While well intentioned, these policies are short sighted and based more on public…

  10. 133 LEGISLATIVE APPROVAL OF EXECUTIVE APPOINTMENTS ...

    African Journals Online (AJOL)

    Fr. Ikenga

    that peace, order and good governance shall be promoted both at the Federal and State levels. Keywords: Executive appointments, Legislative approval, National Assembly, Constitutional duty. 1. Introduction. The National Assembly is the highest law making and representative body in Nigeria. It is the. Constitutional ...

  11. Herbal products: Marketing strategies and legislation

    NARCIS (Netherlands)

    Hooyenga, P.A.; Witkamp, R.F.; Groen, K.P.

    2009-01-01

    Marketing of herbal products in the European Union (EU) has been regulated under national legislation for years, leading to differences in legal status of these herbal products. In one member state, a product may be regulated as a food supplement, while in the other member state the same product is

  12. Legislating interprofessional collaboration: A policy analysis of health professions regulatory legislation in Ontario, Canada.

    Science.gov (United States)

    Regan, Sandra; Orchard, Carole; Khalili, Hossein; Brunton, Laura; Leslie, Kate

    2015-01-01

    Changes to Ontario's health professions regulatory system were initiated through various legislative amendments. These amendments introduced a legislative obligation for health regulatory colleges to support interprofessional collaboration (IPC), collaborate where they share controlled acts, and incorporate IPC into their quality assurance programs. The purpose of this policy analysis was to identify activities, strategies, and collaborations taking place within health professions regulatory colleges pertaining to legislative changes related to IPC. A qualitative content analysis of (1) college documents pertaining to IPC (n = 355) and (2) interviews with representatives from 14 colleges. Three themes were identified: ideal versus reality; barriers to the ideal; and legislating IPC. Commitment to the ideal of IPC was evident in college documents and interviews. Colleges expressed concern about the lack of clarity regarding the intent of legislation. In addition, barriers stemming from long-standing issues in practice including scope of practice protection, conflicting legislation, and lack of knowledge about the roles of other health professionals impede IPC. Government legislation and health professional regulation have important roles in supporting IPC; however, broader collaboration may be required to achieve policy objectives.

  13. Concordance of the Indian Mental Healthcare Act 2017 with the World Health Organization's Checklist on Mental Health Legislation.

    Science.gov (United States)

    Duffy, Richard M; Kelly, Brendan D

    2017-01-01

    areas; this may represent arrangement-focused rather than realisation-focused legislation, and lead to inadvertent limitation of certain rights. Finally, the WHO-RB checklist is an extremely useful tool for this kind of analysis; we recommend it is updated to reflect the CRPD and other relevant developments.

  14. State legislative developments in radioactive materials transportation, July 1, 1995--June 30, 1996

    International Nuclear Information System (INIS)

    Goehring, J.B.; Reed, J.B.

    1996-09-01

    The National Conference of State Legislatures (NCSL) prepares an update on state developments in radioactive materials transportation each year. The 1996 Report on State Legislative Developments in Radioactive Materials Transportation describes activities between July 1, 1995, and June 30, 1996. Thirteen bills were introduced and are arranged in this report by state according to their status--enacted, pending or failed. The report also includes 10 New York bills introduced in 1995 that remained pending during this review period. The bills address nuclear materials transportation as well as the broader areas of hazardous materials transportation, waste storage and emergency response. Also summarized are a state legislative resolution and Federal Register notices and rule changes related to radioactive waste and hazardous materials transportation that affect states

  15. PSYCHOACTIVE SUBSTANCES: ISSUE, ANALYSIS OF THE CURRENT LEGISLATION AND ITS APPROPRIATENESS TO THE REALITY

    Directory of Open Access Journals (Sweden)

    André Jacinto

    2015-04-01

    Full Text Available The consumption of psychoactive substances has followed Humanity since the primordial of the civilization, not only by their medicinal proprieties as well as for religious and recreational purposes, however, its usage creates dependence and, subsequently, illicit traffic. Since the beginning of the previous century, many nations and international organisms have worked, without success, in the development of elimination strategies to this problem. Part of this failure is due to the current legal forms, because, when a new psychoactive substance is created, it occupies a legal void, in which its’ distribution and consumption are free, being recurrent updates to the legislation needed. An example of this situation was the one verified in the establishments commonly called smartshops. We purpose to compile the psychoactive substances’ legislation, analyse its’, advantages and disadvantages and to suggest a new legal form, based in new scientific facts, that allows to contour this situation.

  16. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines.

    Science.gov (United States)

    van der Molen, Aart J; Reimer, Peter; Dekkers, Ilona A; Bongartz, Georg; Bellin, Marie-France; Bertolotto, Michele; Clement, Olivier; Heinz-Peer, Gertraud; Stacul, Fulvio; Webb, Judith A W; Thomsen, Henrik S

    2018-02-09

    The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. AREAS COVERED IN PART 1: Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.

  17. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy.

    Science.gov (United States)

    Neuss, Michael N; Polovich, Martha; McNiff, Kristen; Esper, Peg; Gilmore, Terry R; LeFebvre, Kristine B; Schulmeister, Lisa; Jacobson, Joseph O

    2013-03-01

    In 2009, ASCO and the Oncology Nursing Society (ONS) published standards for the safe use of parenteral chemotherapy in the outpatient setting, including issues of practitioner orders, preparation, and administration of medication. In 2011, these were updated to include inpatient facilities. In December 2011, a multistakeholder workgroup met to address the issues associated with orally administered antineoplastics, under the leadership of ASCO and ONS. The workgroup participants developed recommended standards, which were presented for public comment. Public comments informed final edits, and the final standards were reviewed and approved by the ASCO and ONS Boards of Directors. Significant newly identified recommendations include those associated with drug prescription and the necessity of ascertaining that prescriptions are filled. In addition, the importance of patient and family education regarding administration schedules, exception procedures, disposal of unused oral medication, and aspects of continuity of care across settings were identified. This article presents the newly developed standards.

  18. Achieving fire-safe cigarette legislation through coalition-based legislative advocacy.

    Science.gov (United States)

    Goldstein, Adam O; Grant, Ernest; McCullough, Anna; Cairns, Bruce; Kurian, Ann

    2010-02-01

    Advocates who work for tobacco control legislation through coalition-based policy advocacy have access to a broad base of support and resources that are critical to overcoming the tobacco industry lobby. This article provides an example of how a coalition-based advocacy strategy that engaged a diverse group of stakeholders and was supported by a national coordinating movement achieved state level fire-safe cigarette legislation in a tobacco-producing and manufacturing state.

  19. Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys Clinical Management Tool

    Directory of Open Access Journals (Sweden)

    Sander JO Veldhuyzen van Zanten

    2005-01-01

    Full Text Available The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD. The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

  20. Market, Legislation Make Wind an Attractive Investment in Texas

    Energy Technology Data Exchange (ETDEWEB)

    2001-06-01

    This brochure, part of the SEP Stellar Projects series, covers development of wind energy in Texas due to favorable legislation and public policy and favorable market forces. Those odd shaped structures popping up out in West Texas aren't funny looking oil rigs and they're not genetically altered cotton plants. They're wind turbines, an old technology with a 21st century update. Once too expensive for commercial production, the addition of computers to wind turbines and the rise in fossil fuel prices has brought the cost of wind-generated electricity in line with other power sources. A push by the 1999 Legislature to restructure the retail electric power market put in place rules that encourage wind generation. One rule requires Texas utilities to get an additional 2,000 megawatts of their power from renewable resources such as wind and solar power by 2009. Rules easing the cost of transmitting electricity from remote areas also aid the development of wind farms in West Texas.

  1. Recommendations for reporting of secondary findings in clinical exome and genome sequencing, 2016 update (ACMG SF v2.0): a policy statement of the American College of Medical Genetics and Genomics.

    Science.gov (United States)

    Kalia, Sarah S; Adelman, Kathy; Bale, Sherri J; Chung, Wendy K; Eng, Christine; Evans, James P; Herman, Gail E; Hufnagel, Sophia B; Klein, Teri E; Korf, Bruce R; McKelvey, Kent D; Ormond, Kelly E; Richards, C Sue; Vlangos, Christopher N; Watson, Michael; Martin, Christa L; Miller, David T

    2017-02-01

    Disclaimer: These recommendations are designed primarily as an educational resource for medical geneticists and other healthcare providers to help them provide quality medical services. Adherence to these recommendations is completely voluntary and does not necessarily assure a successful medical outcome. These recommendations should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed toward obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. Clinicians are encouraged to document the reasons for the use of a particular procedure or test, whether or not it is in conformance with this statement. Clinicians also are advised to take notice of the date this statement was adopted and to consider other medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.To promote standardized reporting of actionable information from clinical genomic sequencing, in 2013, the American College of Medical Genetics and Genomics (ACMG) published a minimum list of genes to be reported as incidental or secondary findings. The goal was to identify and manage risks for selected highly penetrant genetic disorders through established interventions aimed at preventing or significantly reducing morbidity and mortality. The ACMG subsequently established the Secondary Findings Maintenance Working Group to develop a process for curating and updating the list over time. We describe here the new process for accepting and evaluating nominations for updates to the secondary findings list. We also report outcomes from six nominations received in the initial 15 months after

  2. Occupational radiation protection legislation in Israel

    International Nuclear Information System (INIS)

    Tadmor, J.; Schlesinger, T.; Lemesch, C.

    1980-01-01

    Various governmental agencies, including the Ministry of Health, the Ministry of Labor and the Israel AEC are responsible for the control of the use of radioactive materials and medical X-ray machines in Israel. Present legislation deals mainly with the legal aspects of the purchase, transport and possession of radioactive materials and the purchase and operation of medical X-ray machines. No legislation refers explicitly to the protection of the worker from ionizing (and non-ionizing) radiation. A special group of experts appointed by the Minister of Labor recently worked out a comprehensive draft law concerning all legal aspects of occupational radiation protection in Israel. Among the main chapters of the draft are: general radiation protection principles, national radiation protection standards, medical supervision of radiation workers, personal monitoring requirements. The present situation with regard to radiation hazard control in Israel and details of the proposed radiation protection law is discussed. (Author)

  3. Functional foods: traditional use and European legislation.

    Science.gov (United States)

    Serafini, Mauro; Stanzione, Alessandra; Foddai, Sebastiano

    2012-03-01

    The concept of functional foods was born in Japan in the 1980s. They are foods that were developed specifically to promote health or reduce the risk of disease. Functional foods have not already been defined by the legislation in Europe. Generally, they are considered as those foods which are intended to be consumed as part of the normal diet and which contain biologically active components which offer the potential of enhanced health or reduced risk of disease. Attention concerning this category of foods has grown, new products have appeared in the European market and interest has turned to define the standards and guidelines for the development and promotion of this kind of foods. In the European Union, there is harmonised legislation on health claims, while compounds, ingredients, plants are still regulated only at national level. The question of traditional use and the role of European Food Safety Authority as European Authority for Food Safety will be examined.

  4. Critical analysis of the Colombian mining legislation

    International Nuclear Information System (INIS)

    Vargas P, Elkin; Gonzalez S, Carmen Lucia

    2003-01-01

    The document analyses the Colombian mining legislation, Act 685 of 2001, based on the reasons expressed by the government and the miners for its conceit and approval. The document tries to determine the developments achieved by this new Mining Code considering international mining competitiveness and its adaptation to the constitutional rules about environment, indigenous communities, decentralization and sustainable development. The analysis formulates general and specific hypothesis about the proposed objectives of the reform, which are confronted with the arguments and critical evaluations of the results. Most hypothesis are not verified, thus demonstrating that the Colombian mining legislation is far from being the necessary instrument to promote mining activities, making it competitive according to international standards and adapted to the principles of sustainable development, healthy environment, community participation, ethnic minorities and regional autonomy

  5. Legislative Framework for Landscape Planning in Latvia

    Science.gov (United States)

    Nitavska, Natalija; Zigmunde, Daiga

    2017-10-01

    With the adoption and the ratification of the European Landscape Convention a legally justified need for a clear landscape policy was grounded in the European countries. It includes the elaboration of the new and the improvement of the existing legislative documents on landscape planning, protection and management. The aim of the particular study is to analyse the existing legislative documents in Latvia influencing landscape planning on different scales / and the implementation of the European Landscape Convention. The study emphasizes the complex structure of the Latvian legislative framework affected by the distribution of the normative documents under the various ministries. Therefore, the main problem is unclear responsibility levels and organizational system for solving the issues regarding landscape planning, protection and management. Thus the various discussions between the involved disciplines and responsible institutions are arising. Two groups of the legislative documents influencing the implementation of the landscape policy in Latvia are detected within the study. The first group is strategic documents determining main landscape planning principles and directions at European, national, regional and professional or sectoral level. The second group is operational documents providing a set of actions for the landscape planning, protection and management at the local or the municipality level. The study concludes that operational documents developed by the municipalities are in high importance because of their direct influence on the landscape planning in Latvia. This often leads to the different landscape planning requirements included in the normative documents of the neighbouring municipalities, although the spatial and ecological borders of the visual landscape do not fit with the formal borders of the municipalities. Thus, it is essential to develop the common principles and actions that would be incumbent on all municipalities to provide the

  6. State Firearm Legislation and Nonfatal Firearm Injuries

    Science.gov (United States)

    Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P.

    2015-01-01

    Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department–treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3–36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department–treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. PMID:26066935

  7. French legislation on food irradiation - Licensing procedure

    International Nuclear Information System (INIS)

    Souverain, R.

    1977-01-01

    French legislation on food irradiation subjects marketing of such foodstuffs to a prior licence granted by an interministerial order on the type of goodstuff concerned. The basic text on the licensing procedure is the Decree of 8 May 1970 whose purpose is to ensure the health and safety of the consumer by laying down instructions for the operations, surveillance and labelling, which must set out clearly the type of treatment. (NEA) [fr

  8. Nuclear safety legislation and supervision in China

    International Nuclear Information System (INIS)

    Zhang Shiguan

    1991-02-01

    The cause for the urgent need of nuclear safety legislation and supervision in China is firstly described, and then a brief introduction to the basic principle and guideline of nuclear safety is presented. Finally the elaboration on the establishment of nuclear safety regulatory system, the enactment of a series of regulations and safety guides, and the implementation of licencing, nuclear safety supervision and research for ensuring the safety of nuclear energy, since the founding of the National Nuclear Safety Administration, are introduced

  9. Sexting: Current Research Gaps and Legislative Issues

    OpenAIRE

    Ngo, Fawn; Jaishankar, K; Agustina, Jose R.

    2017-01-01

    'Sexting, the portmanteau of Sex and Texting, has become a hot topic of debate between the legislators, researchers, educators, parents and teens' (Jaishankar, 2009, para 1). In spite of the considerable and growing body of literature on sexting, there are significant gaps in the current research. A review of research to date also reveals a dearth of cross-national and cross-cultural research on the topic of sexting. Notably, legal and ethical issues abound with the current method for punishi...

  10. Fifty years of German nuclear legislation

    International Nuclear Information System (INIS)

    Heller, W.

    2006-01-01

    The political situation and the state of legislation after World War II make it difficult to pinpoint a precise date of origin of German nuclear legislation. The restrictions imposed by the Allied High Commission (AHC) without any exception put a ban on the production of uranium and thorium metal as well as the construction of nuclear reactors. These restrictions were lifted expressly when the German Atomic Energy Act (AtG) entered into force on January 1, 1960, i.e. much later than the formal step of gaining sovereignty, which was marked by the protocol of May 5, 1955 terminating the Occupation Statute. In October 1955, the German federal government established the then Federal Ministry for Atomic Matters also in an attempt to reconnect to developments in nuclear fission in other parts of the Western world. To supersede the AHC law, the German federal government in December 1956 publicized a draft Atomic Energy Act. It is safe, therefore, to consider that year the starting point of German atomic legislation. This step was followed by deliberations preparatory to the adoption of the Atomic Energy Act. In 1957, however, adoption failed because no two-thirds majority was reached to amend the Basic Law, i.e. the Constitution. As a consequence, some federal states saw the need to adopt state legislation to regulate this area. On December 3, 1959, a new draft Atomic Energy Act was adopted by the German federal parliament after the second and third readings - coupled with an amendment to the Basic Law on that same day - with the votes of the opposition and with one abstention. (orig.)

  11. Dense Breast Legislation in the United States: State of the States.

    Science.gov (United States)

    Dehkordy, Soudabeh Fazeli; Carlos, Ruth C

    2016-11-01

    Limitations of screening mammography in patients with dense breasts combined with the significant increased risk for breast cancer have made the issue of dense breasts a matter of great concern in recent years, leading to advocacy for policy change and legislation. Dense breast notification legislation requires direct patient notification of mammographic results indicating the presence of dense breast tissue. The aim of this study was to summarize the state of dense breast notification legislation across the country. The general intent of dense breast notification legislation is to increase awareness of dense breasts and encourage patients to discuss the clinical issues with their physicians. It was first enacted in Connecticut in 2009, and since then, 27 other states have passed, rejected, or considered dense breast notification legislation. At the federal level, a bill was introduced in October 2011, but it was not enacted. There are significant differences in the language of the laws from state to state that complicate implementation. Furthermore, legislated recommendations for possible additional testing are often unaccompanied by legal provisions for insurance coverage, which potentially results in unequal access. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Generic legislation of new psychoactive drugs.

    Science.gov (United States)

    van Amsterdam, Jan; Nutt, David; van den Brink, Wim

    2013-03-01

    New psychoactive drugs (NPDs, new psychoactive substances) enter the market all the time. However, it takes several months to ban these NPDs and immediate action is generally not possible. Several European countries and drug enforcement officers insist on a faster procedure to ban NPDs. Introduction of generic legislation, in which clusters of psychotropic drugs are banned in advance, has been mentioned as a possible solution. Here we discuss the pros and cons of such an approach. First, generic legislation could unintentionally increase the expenditures of enforcement, black market practices, administrative burden and health risks for users. Second, it may have a negative impact on research and the development of new treatments. Third, due to the complexity of generic legislation, problems in the enforcement are anticipated due to lack of knowledge about the chemical nomenclature. Finally, various legal options are already available to ban the use, sale and trade of NPDs. We therefore conclude that the currently used scientific benefit-risk evaluation should be continued to limit the adverse health effects of NPDs. Only in emergency cases, where fatal incidents (may) occur, should this approach be overruled.

  13. ROUNDTABLE - SESSION 2 EXPLOITATION, CONSERVATION AND LEGISLATION

    Directory of Open Access Journals (Sweden)

    EDSMAN L.

    2004-01-01

    Full Text Available The link between socioeconomics and conservation and the role of legislation in conservation work was discussed in the group with participants from nine European countries. Interest and knowledge among the general public, stakeholders and managers is the key to successful conservation of native crayfish species. Exploitation and conservation do not necessarily exclude each other. A controlled fishery, where it can be sustained, may be an essential tool for conservation by increasing the general awareness and involving more people in the task of protecting the native crayfish species. This strategy is mainly possible for the noble crayfish in the northern part of its distribution, where strong traditions connected to crayfish also exist. A balance between utilisation and overexploitation has to be found and local guidelines for sustainable exploitation produced. Media, the Internet and educational material aimed at schools and stakeholders are excellent ways of reaching a wide audience with information. Universal objectives, rules and regulations at the European level are desirable and the noble crayfish and the stone crayfish should be included in Annex II of the Habitat Directive. Based on this framework detailed regulations are best worked out at the national level, considering the specific crayfish situation in the country. Information about the legislation, the purpose of the legislation and the consequences when not obeying it should be distributed. Stricter regulation of the trade with live alien crayfish is vital because of the associated risk of introducing new diseases and species.

  14. LEGISLATIVE ASPECTS CONCERNING THE LEATHER WASTES

    Directory of Open Access Journals (Sweden)

    TIMOFTE Claudia Simona

    2017-05-01

    Full Text Available This paper underlines the current legislation and compliance issues leather waste in different waste groups according to relevant legislation and shows that, although seemingly harmless waste of skin sometimes contain dangerous compounds. As presented risks to human health were some restricted substances in leather. Since 2001 Romania had preoccupation in national legislation on waste management, but some categories, such as leather waste are not framed to this category. Also, another goal is implementing the EU management/storage strategy of industrial waste. Unfortunately, Romania imports huge quantities of used clothing and shoes. Transport, storage and use of them are poor, and many of these are subsequently stored waste by the fact that it is even sometimes improperly discarded. The paper also shows the statistics on waste management in the Bihor County by activity of national economy and by activity of industry at level of CANE REV.2 Section. Analyzing the postings on Internet regarding the sale and purchase of leather wastes in Romania, it was found that there are the following 'categories' of wastes: leather goods, leather from coats, leather from footwear industry, suede, leather, leather resulting from the production of upholstery. It was found that most car buyers use waste leather upholstery. It is recommended that production companies to highlight more transparent their inventory textile and leather waste on types for those interested (including online can access/capitalize them.

  15. State Labor Legislation Enacted in 1973

    Science.gov (United States)

    Levy, David A.

    1974-01-01

    The primary areas considered by State legislatures in 1973 included higher minimum wage rates and broader coverage of minimum wage laws, improved occupational safety, collective bargaining procedures for public employees, elimination of discrimination in employment, and updating of child labor standards. (Author)

  16. Update on the molecular pathogenesis and clinical treatment of mantle cell lymphoma : report of the 10th annual conference of the European Mantle Cell Lymphoma Network

    NARCIS (Netherlands)

    Dreyling, Martin; Kluin-Nelemans, Hanneke C.; Bea, Silvia; Hartmann, Elena; Salaverria, Itziar; Hutter, Grit; Perez-Galan, Patricia; Roue, Gael; Pott, Christiane; Le Gouill, Steven; Cortelazzo, Sergio; Rule, Simon; Hess, Georg; Zaja, Francesco; Vitolo, Umberto; Szymczyk, Michal; Walewski, Jan; Ribrag, Vincent; Unterhalt, Michael; Hermine, Olivier; Hoster, Eva

    2011-01-01

    Mantle cell lymphoma (MCL) is a distinct subtype of malignant lymphoma characterized by the chromosomal translocation t(11;14)(q13;q32), resulting in constitutional overexpression of cyclin D1 and cell cycle dysregulation in virtually all cases. Clinically, MCL shows an aggressive clinical course

  17. Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study

    Science.gov (United States)

    Been, Jasper V; Mackay, Daniel F; Millett, Christopher; Pell, Jill P; van Schayck, Onno CP; Sheikh, Aziz

    2015-01-01

    Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes. PMID:26268789

  18. The constitutionality of mandatory seat belt use legislation.

    Science.gov (United States)

    1972-12-01

    A number of trends indicate that mandatory seat belt use legislation is to be expected within the near future. The constitutionality of such self-protective legislation has been the subject of recent speculation. Constitutional challenges may be expe...

  19. [The public health legislation in conditions of globalization].

    Science.gov (United States)

    Yefremov, D V; Jyliyaeva, E P

    2013-01-01

    The article demonstrates the impact of globalization on development of public health legislation at the international level and in particular countries. The legislation is considered as a tool to decrease the globalization health risks for population

  20. Legislative Framework Required for Africa's M-Economy

    DEFF Research Database (Denmark)

    Williams, Idongesit

    2014-01-01

    This article discusses the importance of developing legislative frameworks for the development of an m - economy in Africa......This article discusses the importance of developing legislative frameworks for the development of an m - economy in Africa...

  1. The relationship between administrative court control and legislative control

    International Nuclear Information System (INIS)

    Beckmann, M.

    1986-01-01

    The legislator can determine the extent of control of administrative courts by reduction of substantive conditions. The author has the opinion that the judicial control cannot be stricter than the legislative control. For the range of the control of administrative courts is decisive, to what extent the legislator is forced to proper legislative settlements. In this context the author discusses the Kalkar-decision of the Federal Constitutional Court of 1978. (CW) [de

  2. Selected Developments in South African Labour Legislation related to Persons with Disabilities

    Directory of Open Access Journals (Sweden)

    Yvette Basson

    2017-04-01

    Full Text Available In South Africa marginalised groups have historically been afforded legislative protection in order to ensure that the rights of these groups are respected, protected, promoted and fulfilled. Examples of two such groups are older persons, whose rights are provided for in terms of the Older Persons Act 13 of 2006 and children, whose rights are provided for in terms of the Children's Act 38 of 2005. Persons with disabilities have, however, not yet been the subject of dedicated legislation outlining the content of the rights to which they are entitled. As a result of this lack of dedicated legislation, the rights of persons with disabilities are dealt with in a piecemeal fashion, often in disparate pieces of legislation. In addition to this focus on the rights of persons with disabilities, South African labour law has recently undergone extensive amendments. These amendments have led to the rights of persons with disabilities in the workplace being affected substantially. Since these amendments are as yet untested, little scrutiny of these provisions and the effect they may have on persons with disabilities has been undertaken. This article will thus discuss selected amendments of the labour legislation, and interrogate the practical effect these amendments may have on the rights of such persons. Of particular importance for the purposes of this article is the updating of an existing institution known as Sheltered Employment Factories, as well as the introduction of harsher penalties for employers who remain non-compliant with certain provisions of the Employment Equity Act 55 of 1998.

  3. Politics is local: State legislator voting on restrictive voter identification legislation

    Directory of Open Access Journals (Sweden)

    Seth C McKee

    2015-07-01

    Full Text Available The marked increase in restrictive voter identification (ID laws since the 2010 elections reveals the extreme partisan polarization in those state legislatures advancing this reform. Unlike previous studies that examine state-level factors expected to influence passage of restrictive voter ID bills, this study is the first to investigate the question using the state legislator as the unit of analysis. Multivariate analysis of the voting behavior of state legislators shows which kinds of district-level factors increase or decrease their likelihood of supporting stricter voter ID laws. Given the differentiable coalitions favoring Democratic and Republican candidates, certain partisan-aligned district demographics influence state lawmaker support for restrictive voter ID legislation. Race in particular is a major cleavage conditioning support for restrictive voter ID laws. Unlike the mixed findings generated by macro-level studies, this article provides convincing evidence that the size of the black district population negatively influences the likelihood that a Democratic legislator votes in favor of a restrictive voter ID bill, but positively affects the probability that a Republican lawmaker votes yes. The findings in this study illuminate the contextual factors that influence legislator voting on this salient election reform.

  4. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

    NARCIS (Netherlands)

    Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der

    2016-01-01

    AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and

  5. A Clinical Practice Update on the Latest AAOS/ADA Guideline (December 2012) on Prevention of Orthopaedic Implant Infection in Dental Patients

    OpenAIRE

    Hamedani, Sh

    2013-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA), along with 10 other academic associations and societies recently (December 2012) published their mutual clinical practice guideline “Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.” This evidence-based guideline ,detailed in 325 pages, has three recommendations and substitutes the previous AAOS guideline. The new published clinical guideline is a protocol to pre...

  6. Revenge Pornography: Mental Health Implications and Related Legislation.

    Science.gov (United States)

    Kamal, Mudasir; Newman, William J

    2016-09-01

    Revenge pornography, also known as nonconsensual pornography, is a subtype of cyberharassment/cyberstalking, and a serious problem facing society in the Internet age. Revenge pornography can result in lifelong mental health consequences for victims, damaged relationships, and social isolation. Recently, a growing number of states have recognized the importance of this phenomenon and have enacted legislation that criminalizes it. The technology industry has also taken steps to assist victims of revenge pornography by creating web forms to request removal of links leading to the explicit content. The Cyber Civil Rights Initiative (CCRI) has been instrumental in promoting public awareness of this often overlooked problem and in providing services for victims. Although important steps have been made, greater recognition of the gravity of this problem and the mental health implications of revenge pornography is needed to expand legislation criminalizing such acts. A federal criminal law, in particular, is much overdue. Mental health professionals must understand the dimensions of revenge pornography to be able to identify and address the consequences in both forensic and clinical settings. © 2016 American Academy of Psychiatry and the Law.

  7. Five-grass pollen immunotherapy tablet: an update on the latest findings from clinical trials: an interview with Olivier de Beaumont.

    Science.gov (United States)

    de Beaumont, Olivier; Wilkinson, Jonathan

    2014-01-01

    Interview by Jonathan Wilkinson (Managing Commissioning Editor, Future Science Group). Olivier de Beaumont became Doctor of Medicine at the University of Paris Descartes in 1993. In the same year, he also took a Master of Health Economics degree at Paris Dauphine University. He is also a Master of Business Administration, ESCP Paris, 1999. At Stallergenes, he has been serving as Vice President/Head of Corporate Clinical Development since 2005, responsible for the clinical development plan, clinical operations, biometry and pharmacovigilance. In 2011, he took the responsibility of Senior Vice President Global Medical Affairs responsible for medical information and education, medical communication and nonregistration clinical studies. In 2014 he became Senior Vice President Global Scientific and Medical Affairs. From 2002 to 2005 he led the European business development of the world's leading clinical research organization Quintiles, developing Phase I-IV clinical trial programs for pharmaceutical companies. Previous roles included: Chief Scientific Officer and cofounder of Direct Medica (2000-2002), product champion and lifecycle management at Aventis (1998-2000), medical affairs manager in oncology and respiratory diseases at corporate Rhone-Poulenc Rorer (1993-1998).

  8. 40 CFR 1506.8 - Proposals for legislation.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Proposals for legislation. 1506.8 Section 1506.8 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OTHER REQUIREMENTS OF NEPA § 1506.8 Proposals for legislation. (a) The NEPA process for proposals for legislation (§ 1508.17...

  9. 31 CFR 0.212 - Influencing legislation or petitioning Congress.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Influencing legislation or... DEPARTMENT OF THE TREASURY EMPLOYEE RULES OF CONDUCT Rules of Conduct § 0.212 Influencing legislation or... Congress to favor or oppose any legislation. This prohibition does not apply to the official handling...

  10. Canadian Firearms Legislation and Effects on Homicide 1974 to 2008

    Science.gov (United States)

    Langmann, Caillin

    2012-01-01

    Canada has implemented legislation covering all firearms since 1977 and presents a model to examine incremental firearms control. The effect of legislation on homicide by firearm and the subcategory, spousal homicide, is controversial and has not been well studied to date. Legislative effects on homicide and spousal homicide were analyzed using…

  11. 29 CFR 783.28 - General legislative history.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false General legislative history. 783.28 Section 783.28 Labor... TO EMPLOYEES EMPLOYED AS SEAMEN Legislative History and Judicial Construction of the Exemptions § 783.28 General legislative history. As originally enacted in 1938, section 13(a)(3) of the Fair Labor...

  12. 29 CFR 784.102 - General legislative history.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false General legislative history. 784.102 Section 784.102 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL... Aquatic Products Legislative History of Exemptions § 784.102 General legislative history. (a) As orginally...

  13. A Critique of the Key Legislative Framework Guiding Civil Liberties ...

    African Journals Online (AJOL)

    Key legislative framework presented in this paper is within the areas of media and access to information, individual rights and freedoms, as well as legislation pertaining to the conduct of elections. In some cases, colonial legislation that politicians claimed to have repealed was reincarnated, as the post-colonial dispensation ...

  14. An Update on Memory Reconsolidation Updating.

    Science.gov (United States)

    Lee, Jonathan L C; Nader, Karim; Schiller, Daniela

    2017-07-01

    The reactivation of a stored memory in the brain can make the memory transiently labile. During the time it takes for the memory to restabilize (reconsolidate) the memory can either be reduced by an amnesic agent or enhanced by memory enhancers. The change in memory expression is related to changes in the brain correlates of long-term memory. Many have suggested that such retrieval-induced plasticity is ideally placed to enable memories to be updated with new information. This hypothesis has been tested experimentally, with a translational perspective, by attempts to update maladaptive memories to reduce their problematic impact. We review here progress on reconsolidation updating studies, highlighting their translational exploitation and addressing recent challenges to the reconsolidation field. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Malaysia water services reform: legislative issues

    Directory of Open Access Journals (Sweden)

    Nabsiah Abdul Wahid

    2014-08-01

    Full Text Available The latest attempt by the Malaysian government to restructure its water sector has managed to promulgate two important acts, the Suruhanjaya Perkhidmatan Air Negara (SPAN Act (Act 654 and the Water Services Industry Act (WSIA/Act 655; these also complicate the governing of water services and water resources in the country as they affect the sovereignty of a state’s land and water issues. In Malaysia’s federated system of governance, water resources are placed fully within the purview of each State’s government, as stated in the Waters Act 1920 (Revised 1989, while water services are straddled across the purview of both the State and Federal government (Water Supply Enactment 1955. Any reforms will remain problematic unless further analysis is carried out on the available legislation that directly impacts said reform, particularly the Waters Act and Water Supply Enactment. For example, when the Waters Act stipulates “the entire property in and control of all rivers in any State is vested solely in the Ruler of that State”, it is clear that the Federal Government has no authority whatsoever over water resources of any states. The Water Supply Enactment 1955 (adopted by several States further empowers the state’s water supply authorities to supply water to domestic and commercial consumers. Other legislation that has been enacted to govern land and water issues in the country include the Geological Act 1974 on groundwater abstraction and the Environmental Quality Act 1974 (incorporating all amendments up to 1st January 2006 on some aspects of the environmental impact of groundwater abstraction. While these legislations seemed to provide adequate coverage on the governance of groundwater abstraction; treatment, distribution and wastewater management, which form the water supply value chain in the country, are not covered. Similarly, the Sewerage Services Act 1993 covers only wastewater governance issues rather than the whole value chain

  16. Politeness Indicators in Nigeria Legislative Discourse

    Directory of Open Access Journals (Sweden)

    Clara Unoalegie Bola Agbara

    2018-02-01

    Full Text Available In every human interaction, interlocutors strive to maintain appropriate decorum and politeness in order to avoid undue feeling of not being ‘nice’ or being insensitive to co-participant’s self-esteem or image. This culture of being ‘nice’ is expressed not only through verbal codes, but also through non-verbal cues such as pitch, tone, voice modulation, facial expression and other forms of body language. Nigeria legislative House reflects the uniqueness of Nigeria as a multicultural nation with about two hundred and fifty ethnic groups. Each tribe has a unique way of expressing ‘nice’ (politeness. This paper examines how Nigerian legislators from different ethnic groups acknowledge the self-esteem of other legislators during senate debates. The study used Scollon and Scollon’s politeness principle which states that in every interaction there is a continuous ‘face’ (self-image negotiation and this ‘face’ which is made up of two aspects - involvement and independent- must be balanced during interactions because ‘face’ is a paradoxical concept. The interest of this study is to identify and to explain how politicians, who though are in opposition, acknowledge the self-esteem of others. Six hansards were sampled from 2009 to 2010, one bill from each quarter of the year. It was discovered that speakers almost always punctuate their contributions to debate with different types of politeness indicators as a means of acknowledging both the involvement and dependent face wants of participants. The politeness indicators often used by senators include address forms which are used not only as vocative (to the presiding senator but also as designative (for reference to a third person mentioned in the speech, first person plural pronouns, rhetorical (speech politeness markers and ritualized utterances.

  17. Legislating tolerance: Spain's national public smoking law.

    Science.gov (United States)

    Muggli, Monique E; Lockhart, Nikki J; Ebbert, Jon O; Jiménez-Ruiz, Carlos A; Riesco Miranda, Juan Antonio; Hurt, Richard D

    2010-02-01

    While Spain's national tobacco control legislation prohibits smoking in many indoor public places, the law provides for an exception to the prohibition of smoking by allowing separate seating sections and ventilation options in certain public places such as bars and restaurants, hotels and airports. Accordingly, Spain's law is not aligned with Article 8 Guidelines of the World Health Organization's Framework Convention on Tobacco Control, which requires parties to ensure universal protection against secondhand smoke exposure in all enclosed public places, workplaces and on all means of public transport. Spain's law is currently being promoted by the tobacco companies in other countries as a model for smoke-free legislation. In order to prevent weakening of smoke-free laws in other countries through industry-supported exceptions, we investigated the tactics used by the tobacco companies before the implementation of the new law and assessed the consequences of these actions in the hospitality sector. Internal tobacco industry documents made public through US litigation settlements dating back to the 1980s were searched in 2008-9. Documents show that tobacco companies sought to protect hospitality venues from smoking restrictions by promoting separate seating for smokers and ineffective ventilation technologies, supporting an unenforceable voluntary agreement between the Madrid local government and the hospitality industry, influencing ventilation standards setting and manipulating Spanish media. The Spanish National Assembly should adopt comprehensive smoke-free legislation that does not accommodate the interests of the tobacco industry. In doing so, Spain's smoke-free public places law would be better aligned with the Framework Convention on Tobacco Control.

  18. Legislative and technical aspects of mutagenicity testing.

    Science.gov (United States)

    Mayer, V W; Flamm, W G

    1975-08-01

    A brief account is given of the history of the legislative acts that give responsibility to the U.S. Food and Drug Administration (FDA) for ensuring the safety of foods, drugs, and cosmetics. Within the present legislative framework the FDA has the authority to impose regulations which are designed to ensure the safety of all foods, drugs, and cosmetics. The existing legislative authority is adequate for this purpose; however, the difficulty lies instead with technology and the inadequacy of scientific perspective in the emerging area of mutagenicity testing. Earlier efforts in development of mutagenicity screening systems culminated only a few years ago in the proposal to use the host-mediated assay, somatic cell cytogenetics, and dominant lethal tests collectively. Subsequent research efforts indicated that there were serious practical and scientific deficiencies in using this approach. More recently a new proposal, the tier system, has been suggested as an alternative measure. The proposed tier system at FDA consists of three testing levels of increasing complexity. The first tier is an initial screening effort using techniques having maximum sensitivity that are also useful for large-scale, rapid testing. The second tier is designed to identify and confirm that the presumptive mutagens detected in the first tier are truly mutagenic for higher organisms, most especially, for mammals. The third tier would be devoted to explicit genetic tests in mammals designed to ascertain the imposed risk to man by the introduction of a mutagen in our environment. The FDA is currently involved in a number of research activities in the area of mutagenicity safety screening which will explore the adequacies and possible deficiencies of the tier system approach. These efforts are described for our in-house activities, our contract activities, and our cooperative and collaborative activities with other government agencies and institutions.

  19. New protein sources and food legislation

    DEFF Research Database (Denmark)

    Belluco, Simone; Halloran, Afton Marina Szasz; Ricci, Antonia

    2017-01-01

    Growing global food demand has generated a greater interest in the consumption of new and diversified protein sources. Novel foodstuffs represent a challenge for food law as they need proper safety assessments before obtaining market permission. The case of edible insects and European law is a good...... framework for a novel food in a regulatory context. Once admitted, edible insects require proper rules to assure consumers and stakeholders of their benefits and safety. This overview highlights the need to develop clearer legislation to govern the future production and consumption of new food in Europe...

  20. [International trends in laboral risk legislation].

    Science.gov (United States)

    García-Vigil, José Luis

    2010-01-01

    It had been established that labor damage are: laboral injuries, professional diseases and others diseases related with laboral conditions. All of them are referred to as diseases or damages suffered as a consequence of a laboral relations. It is implicated that the damage occurs in the place or during a laboral scheduled time with a causal direct relation. There is a trend in the Spanish laboral legislation, which is controversial in laboral medicine, because it includes a Law for the Prevention of Laboral Risks that consider also to the chronic diseases as a cause no traumatic of a laboral risk to conditioned a damage during the laboral journey.