A treatment planning comparison of four target volume contouring guidelines for locally advanced pancreatic cancer radiotherapy

International Nuclear Information System (INIS)

Fokas, Emmanouil; Eccles, Cynthia; Patel, Neel; Chu, Kwun-Ye; Warren, Samantha; McKenna, W. Gillies; Brunner, Thomas B.

2013-01-01

Background and purpose: Contouring of target volumes varies significantly in radiotherapy of pancreatic ductal adenocarcinoma (PDAC). There is a lack of consensus as to whether elective lymph nodes (eLN’s) should be included or not in the planning target volume (PTV). In the present study we analyzed the dosimetric coverage of the eLN’s and organs at risk (OAR) by comparing four different contouring guidelines. Methods and materials: PTVs were delineated with (Oxford and RTOG guidelines) or without (Michigan and SCALOP guidelines) including the eLNs in eleven patients with PDAC. eLNs included the peripancreatic, paraaortic, paracaval, celiac trunk, superior mesenteric and portal vein clinical target volumes (CTVs). A 3D-CRT plan (50.40 Gy in 28 fractions) was performed to analyze and compare the dosimetric coverage of all eLNs and OAR between the 4 contouring guidelines. Results: The size of Oxford and RTOG PTVs was comparable and significantly larger than the SCALOP and Michigan PTVs. Interestingly the eLNs received a significant amount of incidental dose irradiation by PTV-based plans that only aimed to treat the tumor without the eLNs. The dosimetric coverage of eLN presented a large variability according to the respective contouring methods. The difference in the size of the 4 PTVs was reflected to the dose distribution at the OAR. Conclusions: Our study provides important information regarding the impact of different contouring guidelines on the dose distribution to the eLNs and the OAR in patients with locally advanced PDAC treated with radiotherapy

Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 2. Special test cases

International Nuclear Information System (INIS)

Simmons, C.S.; Cole, C.R.

1985-08-01

This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. Volume 1, titled ''Guideline Approach,'' consists of Chapters 1 through 5 and a glossary. Chapters 2 through 5 provide the more detailed discussions about the code selection approach. This volume, Volume 2, consists of four appendices reporting on the technical evaluation test cases designed to help verify the accuracy of ground-water transport codes. 20 refs

A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer

International Nuclear Information System (INIS)

Toita, Takafumi; Ohno, Tatsuya; Kaneyasu, Yuko

2011-01-01

The objective of this study was to develop a consensus-based guideline to define clinical target volume for primary disease (clinical target volume primary) in external beam radiotherapy for intact uterine cervical cancer. The working subgroup of the Japan Clinical Oncology Group (JCOG) Radiation Therapy Study Group began developing a guideline for primary clinical target volume in November 2009. The group consisted of 10 radiation oncologists and 2 gynecologic oncologists. The process started with comparing the contouring on computed tomographic images of actual cervical cancer cases among the members. This was followed by a comprehensive literature review that included primary research articles and textbooks as well as information on surgical procedures. Extensive discussion occurred in face-to-face meetings (three occasions) and frequent e-mail communications until a consensus was reached. The working subgroup reached a consensus on the definition for the clinical target volume primary. The clinical target volume primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, vagina and ovaries. Definitions for these component structures were determined. Anatomical boundaries in all directions were defined for the parametrium. Examples delineating these boundaries were prepared for the posterior border of the parametrium for various clinical situations (id est (i.e.) central tumor bulk, degree of parametrial involvement). A consensus-based guideline defining the clinical target volume primary was developed for external beam radiotherapy for intact uterine cervical cancer. This guideline will serve as a template for radiotherapy protocols in future clinical trials. It may also be used in actual clinical practice in the setting of highly precise external beam radiotherapy, including intensity-modulated radiotherapy. (author)

Guidelines for the verification and validation of expert system software and conventional software: Rationale and description of V ampersand V guideline packages and procedures. Volume 5

International Nuclear Information System (INIS)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A.

1995-03-01

This report is the fifth volume in a series of reports describing the results of the Expert System Verification C, and Validation (V ampersand V) project which is jointly funded by the U.S. Nuclear Regulatory Commission and the Electric Power Research Institute toward the objective of formulating Guidelines for the V ampersand V of expert systems for use in nuclear power applications. This report provides the rationale for and description of those guidelines. The actual guidelines themselves are presented in Volume 7, open-quotes User's Manual.close quotes Three factors determine what V ampersand V is needed: (1) the stage of the development life cycle (requirements, design, or implementation); (2) whether the overall system or a specialized component needs to be tested (knowledge base component, inference engine or other highly reusable element, or a component involving conventional software); and (3) the stringency of V ampersand V that is needed (as judged from an assessment of the system's complexity and the requirement for its integrity to form three Classes). A V ampersand V Guideline package is provided for each of the combinations of these three variables. The package specifies the V ampersand V methods recommended and the order in which they should be administered, the assurances each method provides, the qualifications needed by the V ampersand V team to employ each particular method, the degree to which the methods should be applied, the performance measures that should be taken, and the decision criteria for accepting, conditionally accepting, or rejecting an evaluated system. In addition to the Guideline packages, highly detailed step-by-step procedures are provided for 11 of the more important methods, to ensure that they can be implemented correctly. The Guidelines can apply to conventional procedural software systems as well as all kinds of Al systems

Radiologic measurement of extraocular muscle volumes in patients with Graves' orbitopathy: a review and guideline.

Science.gov (United States)

Bijlsma, Ward R; Mourits, Maarten Ph

2006-06-01

To evaluate and compare techniques for extraocular muscle (EOM) volume measurement and to provide guidelines for future measurements. Systematic review. Existing techniques used to measure extraocular muscle volumes on radiologic scans can be divided into manual outlining, computer assisted and automated segmentation. Both computed tomography (CT) and magnetic resonance (MR) image datasets can be used. On CT scans, one best measures muscle volume using region grow segmentation, accepting an overestimation of true volume by inevitable inclusion of non-muscular tissue. On high resolution MRI scans, single muscles can be outlined manually, but measurements include only part of the muscle due to poor tissue contrast at the orbital apex. Measurement errors can be reduced 3.5% by exact horizontal repositioning. A measured volume change of at least 6-17% is required to demonstrate a significant difference. Currently the best choice for EOM volume measurements on CT images is computer assisted grey value segmentation and on MRI images is manual outlining of individual muscles. Because of the time required and the complexity of the measurements, present EOM volume measurement is as yet only suitable for research purposes.

A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer

International Nuclear Information System (INIS)

Toita, Takafumi; Ohno, Tatsuya; Kaneyasu, Yuko

2010-01-01

The objective of this study was to develop a consensus-based guideline as well as an atlas defining pelvic nodal clinical target volumes in external beam radiotherapy for uterine cervical cancer. A working subgroup to establish the consensus-based guideline on clinical target volumes for uterine cervical cancer was formulated by the Radiation Therapy Study Group of the Japan Clinical Oncology Group in July 2008. The working subgroup consisted of seven radiation oncologists. The process resulting in the consensus included a comparison of contouring on CT images among the members, reviewing of published textbooks and the relevant literature and a distribution analysis of metastatic nodes on computed tomography/magnetic resonance imaging of actual patients. The working subgroup defined the pelvic nodal clinical target volumes for cervical cancer and developed an associated atlas. As a basic criterion, the lymph node clinical target volume was defined as the area encompassed by a 7 mm margin around the applicable pelvic vessels. Modifications were made in each nodal area to cover adjacent adipose tissues at risk of microscopic nodal metastases. Although the bones and muscles were excluded, the bowel was not routinely excluded in the definition. Each of the following pelvic node regions was defined: common iliac, external iliac, internal iliac, obturator and presacral. Anatomical structures bordering each lymph node region were defined for six directions; anterior, posterior, lateral, medial, cranial and caudal. Drafts of the definition and the atlas were reviewed by members of the JCOG Gynecologic Cancer Study Group (GCSG). We developed a consensus-based guideline defining the pelvic node clinical target volumes that included an atlas. The guideline will be continuously updated to reflect the ongoing changes in the field. (author)

Guidelines for the verification and validation of expert system software and conventional software: Volume 5, Rationale and description of verification and validation guideline packages and procedures. Final report

International Nuclear Information System (INIS)

Miller, L.A.; Hayes, J.E.; Mirsky, S.M.

1995-05-01

This report is the fifth volume in a series of reports describing the results of the Expert System Verification and Validation (V ampersand V) project which is jointly funded by US NRC and EPRI toward formulating guidelines for V ampersand V of expert systems for use in nuclear power applications. This report provides the rationale for and description of those guidelines. The actual guidelines themselves (and the accompanying 11 step by step Procedures) are presented in Volume 7, User's Manual. Three factors determine what V ampersand V is needed: (1) the stage, of the development life cycle (requirements, design, or implementation), (2) whether the overall system or a specialized component needs be tested (knowledge base component, inference engine or other highly reusable element, or a component involving conventional software), and (3) the stringency of V ampersand V that is needed (as judged from an assessment of the system's complexity and the requirement for its integrity to form three Classes). A V ampersand V guideline package is provided for each of the combinations of these three variables. The package specifies the V ampersand V methods recommended and the order in which they should be administered, the assurances each method provides, the qualifications needed by the V ampersand V team to employ each Particular method, the degree to which the methods should be applied, the performance measures that should be taken, and the decision criteria for accepting, conditionally accepting, or rejecting an evaluated system. In addition to the guideline packages, highly detailed step-by-step procedures are provided for 11 of the more important methods, to ensure that they Can be implemented correctly. The guidelines can apply to conventional procedural software systems as well as all kinds of AI systems

Impact of target volume coverage with Radiation Therapy Oncology Group (RTOG) 98-05 guidelines for transrectal ultrasound guided permanent Iodine-125 prostate implants

International Nuclear Information System (INIS)

Horwitz, Eric M.; Mitra, Raj K.; Uzzo, Robert G.; Das, Indra J.; Pinover, Wayne H.; Hanlon, Alexandra L.; McNeeley, Shawn W.; Hanks, Gerald E.

2003-01-01

Purpose: Despite the wide use of permanent prostate implants for the treatment of early stage prostate cancer, there is no consensus for optimal pre-implant planning guidelines that results in maximal post-implant target coverage. The purpose of this study was to compare post-implant target volume coverage and dosimetry between patients treated before and after Radiation Therapy Oncology Group (RTOG) 98-05 guidelines were adopted using several dosimetric endpoints. Materials and methods: Ten consecutively treated patients before the adoption of the RTOG 98-05 planning guidelines were compared with ten consecutively treated patients after implementation of the guidelines. Pre-implant planning for patients treated pre-RTOG was based on the clinical target volume (CTV) defined by the pre-implant TRUS definition of the prostate. The CTV was expanded in each dimension according to RTOG 98-05 and defined as the planning target volume. The evaluation target volume was defined as the post-implant computed tomography definition of the prostate based on RTOG 98-05 protocol recommendations. Implant quality indicators included V 100 , V 90 , V 100 , and Coverage Index (CI). Results: The pre-RTOG median V 100 , V 90 , D 90 , and CI values were 82.8, 88.9%, 126.5 Gy, and 17.1, respectively. The median post-RTOG V 100 , V 90 , D 90 , and CI values were 96.0, 97.8%, 169.2 Gy, and 4.0, respectively. These differences were all statistically significant. Conclusions: Implementation of the RTOG 98-05 implant planning guidelines has increased coverage of the prostate by the prescription isodose lines compared with our previous technique, as indicated by post-implant dosimetry indices such as V 100 , V 90 , D 90 . The CI was also improved significantly with the protocol guidelines. Our data confirms the validity of the RTOG 98-05 implant guidelines for pre-implant planning as it relates to enlargement of the CTV to ensure adequate margin between the CTV and the prescription isodose

Factors controlling volume errors through 2D gully erosion assessment: guidelines for optimal survey design

Science.gov (United States)

Castillo, Carlos; Pérez, Rafael

2017-04-01

The assessment of gully erosion volumes is essential for the quantification of soil losses derived from this relevant degradation process. Traditionally, 2D and 3D approaches has been applied for this purpose (Casalí et al., 2006). Although innovative 3D approaches have recently been proposed for gully volume quantification, a renewed interest can be found in literature regarding the useful information that cross-section analysis still provides in gully erosion research. Moreover, the application of methods based on 2D approaches can be the most cost-effective approach in many situations such as preliminary studies with low accuracy requirements or surveys under time or budget constraints. The main aim of this work is to examine the key factors controlling volume error variability in 2D gully assessment by means of a stochastic experiment involving a Monte Carlo analysis over synthetic gully profiles in order to 1) contribute to a better understanding of the drivers and magnitude of gully erosion 2D-surveys uncertainty and 2) provide guidelines for optimal survey designs. Owing to the stochastic properties of error generation in 2D volume assessment, a statistical approach was followed to generate a large and significant set of gully reach configurations to evaluate quantitatively the influence of the main factors controlling the uncertainty of the volume assessment. For this purpose, a simulation algorithm in Matlab® code was written, involving the following stages: - Generation of synthetic gully area profiles with different degrees of complexity (characterized by the cross-section variability) - Simulation of field measurements characterised by a survey intensity and the precision of the measurement method - Quantification of the volume error uncertainty as a function of the key factors In this communication we will present the relationships between volume error and the studied factors and propose guidelines for 2D field surveys based on the minimal survey

RELAP/MOD3 code manual: User's guidelines. Volume 5, Revision 1

International Nuclear Information System (INIS)

Fletcher, C.D.; Schultz, R.R.

1995-08-01

The RELAP5 code has been developed for best estimate transient simulation of light water reactor coolant systems during postulated accidents. The code models the coupled behavior of the reactor coolant system and the core for loss-of-coolant accidents, and operational transients, such as anticipated transient without scram, loss of offsite power, loss of feedwater, and loss of flow. A generic modeling approach is used that permits simulating a variety of thermal hydraulic systems. Control system and secondary system components are included to permit modeling of plant controls, turbines, condensers, and secondary feedwater systems. Volume V contains guidelines that have solved over the past several years through the use of the RELAP5 code

SU-F-BRA-14: Optimization of Dosimetric Guidelines for Accelerated Partial Breast Irradiation (APBI) Using the Strut-Adjusted Volume Implant (SAVI)

International Nuclear Information System (INIS)

Mooney, K; Altman, M; Garcia-Ramirez, J; Thomas, M; Zoberi, I; Mullen, D; DeWees, T; Esthappan, J

2015-01-01

Purpose: Treatment planning guidelines for accelerated partial breast irradiation (ABPI) using the strut-adjusted volume implant (SAVI) are inconsistent between the manufacturer and NSABP B-39/RTOG 0413 protocol. Furthermore neither set of guidelines accounts for different applicator sizes. The purpose of this work is to establish guidelines specific to the SAVI that are based on clinically achievable dose distributions. Methods: Sixty-two consecutive patients were implanted with a SAVI and prescribed to receive 34 Gy in 10 fractions twice daily using high dose-rate (HDR) Ir-192 brachytherapy. The target (PTV-EVAL) was defined per NSABP. The treatments were planned and evaluated using a combination of dosimetric planning goals provided by the NSABP, the manufacturer, and our prior clinical experience. Parameters evaluated included maximum doses to skin and ribs, and volumes of PTV-EVAL receiving 90%, 95%, 100%, 150%, and 200% of the prescription (V90, etc). All target parameters were evaluated for correlation with device size using the Pearson correlation coefficient. Revised dosimetric guidelines for target coverage and heterogeneity were determined from this population. Results: Revised guidelines for minimum target coverage (ideal in parentheses): V90≥95%(97%), V95≥90%(95%), V100≥88%(91%). The only dosimetric parameters that were significantly correlated (p<0.05) with device size were V150 and V200. Heterogeneity criteria were revised for the 6–1 Mini/6-1 applicators to V150≤30cc and V200≤15cc, and unchanged for the other sizes. Re-evaluation of patient plans showed 90% (56/62) met the revised minimum guidelines and 76% (47/62) met the ideal guidelines. All and 56/62 patients met our institutional guidelines for maximum skin and rib dose, respectively. Conclusions: We have optimized dosimetric guidelines for the SAVI applicators, and found that implementation of these revised guidelines for SAVI treatment planning yielded target coverage exceeding

Main-coolant-pump shaft-seal guidelines. Volume 2. Operational guidelines. Final report

International Nuclear Information System (INIS)

Fair, C.E.; Greer, A.O.

1983-03-01

This report presents a set of guidelines and criteria for improving main coolant pump shaft seal operational reliability. The noted guidelines are developed from EPRI sponsored nuclear power plant seal operating experience studies. Usage procedures/practices and operational environment influence on seal life and reliability from the most recent such survey are summarized. The shaft seal and its auxiliary supporting systems are discussed both from technical and operational related viewpoints

Main-coolant-pump shaft-seal guidelines. Volume 3. Specification guidelines. Final report

International Nuclear Information System (INIS)

Fair, C.E.; Greer, A.O.

1983-03-01

This report presents a set of guidelines and criteria to aid in the generation of procurement specifications for Main Coolant Pump Shaft Seals. The noted guidelines are developed from EPRI sponsored nuclear power plant seal operating experience studies, a review of pump and shaft seal literature and discussions with pump and seal designers. This report is preliminary in nature and could be expanded and finalized subsequent to completion of further design, test and evaluation efforts

ESTRO ACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer.

Science.gov (United States)

Nestle, Ursula; De Ruysscher, Dirk; Ricardi, Umberto; Geets, Xavier; Belderbos, Jose; Pöttgen, Christoph; Dziadiuszko, Rafal; Peeters, Stephanie; Lievens, Yolande; Hurkmans, Coen; Slotman, Ben; Ramella, Sara; Faivre-Finn, Corinne; McDonald, Fiona; Manapov, Farkhad; Putora, Paul Martin; LePéchoux, Cécile; Van Houtte, Paul

2018-04-01

Radiotherapy (RT) plays a major role in the curative treatment of locally advanced non-small cell lung cancer (NSCLC). Therefore, the ACROP committee was asked by the ESTRO to provide recommendations on target volume delineation for standard clinical scenarios in definitive (chemo)radiotherapy (RT) and adjuvant RT for locally advanced NSCLC. The guidelines given here are a result of the evaluation of a structured questionnaire followed by a consensus discussion, voting and writing procedure within the committee. Hence, we provide advice for methods and time-points of diagnostics and imaging before the start of treatment planning and for the mandatory and optional imaging to be used for planning itself. Concerning target volumes, recommendations are given for GTV delineation of primary tumour and lymph nodes followed by issues related to the delineation of CTVs for definitive and adjuvant radiotherapy. In the context of PTV delineation, recommendations about the management of geometric uncertainties and target motion are given. We further provide our opinions on normal tissue delineation and organisational and responsibility questions in the process of target volume delineation. This guideline intends to contribute to the standardisation and optimisation of the process of RT treatment planning for clinical practice and prospective studies. Copyright © 2018 Elsevier B.V. All rights reserved.

23 CFR 650.211 - Guidelines.

Science.gov (United States)

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Guidelines. 650.211 Section 650.211 Highways FEDERAL..., STRUCTURES, AND HYDRAULICS Erosion and Sediment Control on Highway Construction Projects § 650.211 Guidelines. (a) The FHWA adopts the AASHTO Highway Drainage Guidelines, Volume III, “Erosion and Sediment Control...

RELAP/MOD3 code manual: User`s guidelines. Volume 5, Revision 1

Energy Technology Data Exchange (ETDEWEB)

Fletcher, C.D.; Schultz, R.R. [Lockheed Idaho Technologies Co., Idaho Falls, ID (United States)

1995-08-01

The RELAP5 code has been developed for best estimate transient simulation of light water reactor coolant systems during postulated accidents. The code models the coupled behavior of the reactor coolant system and the core for loss-of-coolant accidents, and operational transients, such as anticipated transient without scram, loss of offsite power, loss of feedwater, and loss of flow. A generic modeling approach is used that permits simulating a variety of thermal hydraulic systems. Control system and secondary system components are included to permit modeling of plant controls, turbines, condensers, and secondary feedwater systems. Volume V contains guidelines that have solved over the past several years through the use of the RELAP5 code.

Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy for the Definitive Treatment of Cervix Cancer

International Nuclear Information System (INIS)

Lim, Karen; Small, William; Portelance, Lorraine; Creutzberg, Carien; Juergenliemk-Schulz, Ina M.; Mundt, Arno; Mell, Loren K.; Mayr, Nina; Viswanathan, Akila; Jhingran, Anuja; Erickson, Beth; De Los Santos, Jennifer; Gaffney, David; Yashar, Catheryn; Beriwal, Sushil; Wolfson, Aaron

2011-01-01

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.

Human-system interface design review guideline -- Review software and user's guide: Final report. Revision 1, Volume 3

International Nuclear Information System (INIS)

1996-06-01

NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant's HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 3 contains an interactive software application of the NUREG-0700, Revision 1 guidance and a user's guide for this software. The software supports reviewers during review preparation, evaluation design using the human factors engineering guidelines, and in report preparation. The user's guide provides system requirements and installation instructions, detailed explanations of the software's functions and features, and a tutorial on using the software

Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines

International Nuclear Information System (INIS)

Croke, Jennifer; Maclean, Jillian; Nyiri, Balazs; Li, Yan; Malone, Kyle; Avruch, Leonard; Kayser, Cathleen; Malone, Shawn

2014-01-01

Recurrence rates following radiotherapy for prostate cancer in the post-operative adjuvant or salvage setting remain substantial. Previous work from our institution demonstrated that published prostate bed CTV guidelines frequently do not cover the pre-operative MRI defined prostate. Inadequate target delineation may contribute to the high recurrence rates, but increasing target volumes may increase dose to organs at risk. We propose guidelines for delineating post-prostatectomy target volumes based upon an individual’s co-registered pre-operative MRI. MRI-based CTVs and PTVs were compared to those created using the RTOG guidelines in 30 patients. Contours were analysed in terms of absolute volume, intersection volume (Jaccard Index) and the ability to meet the RADICALS and QUANTEC rectal and bladder constraints (tomotherapy IMRT plans with PTV coverage of V98% ≥98%). CTV MRI was a mean of 18.6% larger than CTV RTOG: CTV MRI mean 138 cc (range 72.3 - 222.2 cc), CTV RTOG mean 116.3 cc (range 62.1 - 176.6 cc), (p < 0.0001). The difference in mean PTV was only 4.6%: PTV MRI mean 386.9 cc (range 254.4 – 551.2), PTV RTOG mean 370 cc (range 232.3 - 501.6) (p = 0.05). The mean Jaccard Index representing intersection volume between CTVs was 0.72 and 0.84 for PTVs. Both criteria had a similar ability to meet rectal and bladder constraints. Rectal DVH: 77% of CTV RTOG cases passed all RADICALS criteria and 37% all QUANTEC criteria; versus 73% and 40% for CTV MRI (p = 1.0 for both). Bladder DVH; 47% of CTV RTOG cases passed all RADICALS criteria and 67% all QUANTEC criteria, versus 57% and 60% for CTV MRI (p = 0.61for RADICALS, p = 0.79 for QUANTEC). CTV MRI spares more of the lower anterior bladder wall than CTV RTOG but increases coverage of the superior lateral bladder walls. CTV contours based upon the patient’s co-registered pre-operative MRI in the post-prostatectomy setting may improve coverage of the individual’s prostate bed without substantially increasing

Main-coolant-pump shaft-seal guidelines. Volume 1. Maintenance-manual guidelines. Final report

International Nuclear Information System (INIS)

Fair, C.E.; Greer, A.O.

1983-03-01

This report presents a set of guidelines and a listing of information and data which should be included in maintenance manuals and procedures for Main Coolant Pump Shaft Seals. The noted guidelines and data listing are developed from EPRI sponsored nuclear plant seal operating experience studies. The maintenance oriented results of the most recent such study is summarized. The shaft seal and its auxiliary supporting systems are discussed from both technical and maintenance related viewpoints

Best-practices guidelines for L2PSA development and applications. Volume 2 - Best practices for the Gen II PWR, Gen II BWR L2PSAs. Extension to Gen III reactors

International Nuclear Information System (INIS)

Raimond, E.; Durin, T.; Rahni, N.; Meignen, R.; Cranga, M.; Pichereau, F.; Bentaib, A.; Guigueno, Y.; Loeffler, H.; Mildenberger, O.; Lajtha, G.; Santamaria, C.S.; Dienstbier, J.; Rydl, A.; Holmberg, J.E.; Lindholm, I.; Maennistoe, I.; Pauli, E.M.; Dirksen, G.; Grindon, L.; Peers, K.; Hulqvist, G.; Parozzi, F.; Polidoro, F.; Cazzoli, E.; Vitazkova, J.; Burgazzi, L.; Oury, L.; Ngatchou, C.; Siltanen, S.; Niemela, I.; Routamo, T.; Helstroem, P.; Bassi, C.; Brinkman, H.; Seidel, A.; Schubert, B.; Wohlstein, R.; Guentay, S.; Vincon, L.

2010-01-01

The objective of this coordinated action was to develop best practice guidelines for the performance of Level 2 PSA methodologies with a view of harmonisation at EU level and to allow meaningful and practical uncertainty evaluations in a Level 2 PSA. Specific relationships with community in charge of nuclear reactor safety (utilities, safety authorities, vendors, and research or services companies) have been established in order to define the current needs in terms of guidelines for level 2 PSA development and applications. An international workshop was organised in Hamburg, with the support of VATTENFALL, in November 2008. The level 2 PSA experts from the ASAMPSA2 project partners have proposed some guidelines for the development and application of L2PSA based on their experience and on information available from international cooperation (EC Severe Accident network of Excellence - SARNET, IAEA standards, OECD-NEA publications and workshop) or open literature. The number of technical issues addressed in the guideline is very large and all are not covered with the same relevancy in the first version of the guideline. This version is submitted for external review in November 2010 by severe accident experts and PSA, especially, from SARNET and OECD-NEA members. The feedback of the external review will be dis cussed during an international open works hop planned in March 2011 and all outcomes will be taken into consideration in the final version of this guideline (June 2011). The guideline includes 3 volumes: - Volume 1 - General considerations on L2PSA. - Volume 2 - Technical recommendations for Gen II and III reactors. - Volume 3 - Specific considerations for future reactor (Gen IV). The recommendations formulated in the guideline should not be considered as 'mandatory' but should help the L2PSA developers to achieve high quality studies with limited time and resources. It may also help the L2PSA reviewers by positioning one specific study in comparison with some

Advanced human-system interface design review guideline. General evaluation model, technical development, and guideline description

International Nuclear Information System (INIS)

O'Hara, J.M.

1994-07-01

Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator's overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use

Advanced human-system interface design review guideline. General evaluation model, technical development, and guideline description

Energy Technology Data Exchange (ETDEWEB)

O`Hara, J.M.

1994-07-01

Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator`s overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use.

Advanced human-system interface design review guideline. Evaluation procedures and guidelines for human factors engineering reviews

Energy Technology Data Exchange (ETDEWEB)

O`Hara, J.M.; Brown, W.S. [Brookhaven National Lab., Upton, NY (United States); Baker, C.C.; Welch, D.L.; Granda, T.M.; Vingelis, P.J. [Carlow International Inc., Falls Church, VA (United States)

1994-07-01

Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator`s overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support. NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use.

Advanced human-system interface design review guideline. Evaluation procedures and guidelines for human factors engineering reviews

International Nuclear Information System (INIS)

O'Hara, J.M.; Brown, W.S.; Baker, C.C.; Welch, D.L.; Granda, T.M.; Vingelis, P.J.

1994-07-01

Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator's overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support. NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use

Guidelines and workbook for assessment of organization and administration of utilities seeking operating license for a nuclear power plant. Guidelines for utility organization and administration plan. Volume 1, Revision 1

International Nuclear Information System (INIS)

Thurber, J.A.; Olson, J.; Osborn, R.N.; Sommers, P.; Widrig, R.D.

1986-09-01

Volumes 1 and 2 of this report are a partial response to the requirements of Item I.B.1.1 of the ''NRC Action Plan Developed as a Result of the TMI-2 Accident,'' NUREG-0660, and are designed to serve as a basis for replacing the earlier NUREG-0731, ''Guidelines for Utility Management Structure and Technical Resources.'' These Guidelines are intended to provide guidance to the user in preparing a written plan for a proposed nuclear organization and administration. The purpose of the Workbook (Vol. 2) is to guide the NRC reviewer through a systematic review and assessment of a proposed organization and administration. It is the NRC's intention to incorporate these Guidelines and Workbook into a future revision of the Standard Review Plan (SRP), NUREG-0800. However, at this time the report is being published so that the material may be used on a voluntary basis by industry to systematically prepare or evaluate their organization or administration plans. Use of the report by the NRC would not occur until after it has been incorpoarted in the SRP

Health economics and outcomes methods in risk-based decision-making for blood safety.

Science.gov (United States)

Custer, Brian; Janssen, Mart P

2015-08-01

Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing interventions. The objective of this review is to address key considerations and limitations of current methods as they apply to blood safety. Because a voluntary blood supply is an example of a public good, analyses should be conducted from the societal perspective when possible. Two primary study designs are recommended for most blood safety intervention assessments: budget impact analysis (BIA), which measures the cost to implement an intervention both to the blood operator but also in a broader context, and cost-utility analysis (CUA), which measures the ratio between costs and health gain achieved, in terms of reduced morbidity and mortality, by use of an intervention. These analyses often have important limitations because data that reflect specific aspects, for example, blood recipient population characteristics or complication rates, are not available. Sensitivity analyses play an important role. The impact of various uncertain factors can be studied conjointly in probabilistic sensitivity analyses. The use of BIA and CUA together provides a comprehensive assessment of the costs and benefits from implementing (or not) specific interventions. RBDM is multifaceted and impacts a broad spectrum of stakeholders. Gathering and analyzing health economic evidence as part of the RBDM process enhances the quality, completeness, and transparency of decision-making. © 2015 AABB.

Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group

International Nuclear Information System (INIS)

Poortmans, Philip; Bossi, Alberto; Vandeputte, Katia; Bosset, Mathieu; Miralbell, Raymond; Maingon, Philippe; Boehmer, Dirk; Budiharto, Tom; Symon, Zvi; Bergh, Alfons C.M. van den; Scrase, Christopher; Poppel, Hendrik van; Bolla, Michel

2007-01-01

The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing post-operative radiotherapy for prostate cancer requires a standardisation of the target volume definition and delineation as well as standardisation of the clinical quality assurance procedures. Recommendations for this are presented on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group and in addition to the already published guidelines for radiotherapy as the primary treatment

Health economics and outcomes methods in risk-based decision-making for blood safety

NARCIS (Netherlands)

Custer, Brian; Janssen, Mart P.

2015-01-01

Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation.

Science.gov (United States)

Nehme, Ziad; Boyle, Malcolm J

2009-02-20

Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045). Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

Sandia software guidelines: Software quality planning

Energy Technology Data Exchange (ETDEWEB)

1987-08-01

This volume is one in a series of Sandia Software Guidelines intended for use in producing quality software within Sandia National Laboratories. In consonance with the IEEE Standard for Software Quality Assurance Plans, this volume identifies procedures to follow in producing a Software Quality Assurance Plan for an organization or a project, and provides an example project SQA plan. 2 figs., 4 tabs.

ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

International Nuclear Information System (INIS)

Offersen, Birgitte V.; Boersma, Liesbeth J.; Kirkove, Carine; Hol, Sandra; Aznar, Marianne C.; Biete Sola, Albert; Kirova, Youlia M.; Pignol, Jean-Philippe; Remouchamps, Vincent; Verhoeven, Karolien; Weltens, Caroline; Arenas, Meritxell; Gabrys, Dorota; Kopek, Neil; Krause, Mechthild; Lundstedt, Dan; Marinko, Tanja

2015-01-01

Background and purpose: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results: Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency

Guidelines for wireless technology in nuclear power plants

International Nuclear Information System (INIS)

Shankar, Ramesh

2003-01-01

As a result of technological breakthroughs, increased demand for the use of wireless technology is common in all industries today, and the electric power industry is no exception. Already, wireless technology has many applications in our industry, including - but not limited to - cellular phone systems, paging systems, two-way radio communication systems, dose management and tracking systems, and operator logs. EPRI has prepared a comprehensive guidelines document to support evaluation of wireless technologies in power plants for integrated (voice/data/video) communication, remote equipment and system monitoring, and to complement an electronic procedures support system (EPSS). The guidelines effort focuses on the development of a rules structure to support the deployment of wireless devices in a plant without compromising continuous, safe, and reliable operation. The guidelines document consists of two volumes. The first volume is introductory in nature and lays out the business case for applying wireless technologies. The intended audience is senior plant management personnel and utility industry executives. This volume contains background information, templates, worksheets, processes, and presentations that will allow internal sponsors to create business cases for piloting wireless projects. The second volume includes guidance on implementation and regulatory issues relevant to plant implementation. It covers the following application areas: implementation of integrated communication capability, equipment monitoring, work quality control, time and knowledge management, and business process automation. It details regulatory issues relevant to the adoption of wireless technology within nuclear power plants and offers guidance on preparing for and executing pilot and implementations of wireless technologies. The paper will cover important aspects on the guidelines. (author)

Sector-specific issues and reporting methodologies supporting the General Guidelines for the voluntary reporting of greenhouse gases under Section 1605(b) of the Energy Policy Act of 1992. Volume 2: Part 4, Transportation sector; Part 5, Forestry sector; Part 6, Agricultural sector

International Nuclear Information System (INIS)

1994-10-01

This volume, the second of two such volumes, contains sector-specific guidance in support of the General Guidelines for the voluntary reporting of greenhouse gas emissions and carbon sequestration. This voluntary reporting program was authorized by Congress in Section 1605(b) of the Energy Policy Act of 1992. The General Guidelines, bound separately from this volume, provide the overall rationale for the program, discuss in general how to analyze emissions and emission reduction/carbon sequestration projects, and address programmatic issues such as minimum reporting requirements, time parameters, international projects, confidentiality, and certification. Together, the General Guidelines and the guidance in these supporting documents will provide concepts and approaches needed to prepare the reporting forms. This second volume of sector-specific guidance covers the transportation sector, the forestry sector, and the agricultural sector

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

Directory of Open Access Journals (Sweden)

Boyle Malcolm J

2009-02-01

Full Text Available Abstract Background Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. Methods An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Results Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015 and 23% reduction in suboptimal minute volumes (p = 0.045. Conclusion Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

Understanding standard drinks and drinking guidelines.

Science.gov (United States)

Kerr, William C; Stockwell, Tim

2012-03-01

For consumers to follow drinking guidelines and limit their risk of negative consequences they need to track their ethanol consumption. This paper reviews published research on the ability of consumers to utilise information about the alcohol content of beverages when expressed in different forms, for example in standard drinks or units versus percentage alcohol content. A review of the literature on standard drink definitions and consumer understanding of these, actual drink pouring, use of standard drinks in guidelines and consumer understanding and use of these. Standard drink definitions vary across countries and typically contain less alcohol than actual drinks. Drinkers have difficulty defining and pouring standard drinks with over-pouring being the norm such that intake volume is typically underestimated. Drinkers have difficulty using percentage alcohol by volume and pour size information in calculating intake but can effectively utilise standard drink labelling to track intake. Standard drink labelling is an effective but little used strategy for enabling drinkers to track their alcohol intake and potentially conform to safe or low-risk drinking guidelines. © 2011 Australasian Professional Society on Alcohol and other Drugs.

Reinforced soil structures. Volume I, Design and construction guidelines

Science.gov (United States)

1990-11-01

This report presents comprehensive guidelines for evaluating and using soil reinforcement techniques in the construction of retaining walls, embankment slopes, and natural or cut slopes. A variety of available systems for reinforced soil including in...

Space Guidelines for Libraries.

Science.gov (United States)

Wisconsin Coordinating Committee for Higher Education, Madison.

The following guidelines are recommended: stack space--for each 10 volumes, one square foot of space; reading room--25 square feet per station x 20% of the total undergraduate population; carrel space--25% of the graduate enrollment x 45 square feet; office and auxilliary space--135 square feet x full time equivalent staff. (NI)

Guidelines for the design and operation of makeup water treatment systems

International Nuclear Information System (INIS)

Lee, Y.H.; Planek, M.A.; Sopocy, D.M.; Tomaga, C.M.; Abrams, I.M.; Anderson, C.C.; Balazs, M.K.; Houskava, J.; Williams, R.

1989-06-01

These guidelines present the industry with a standardized program to ensure the optimum design and operation of their individual makeup water treatment systems. These guidelines present, in a non-technical and non-proprietary format, the makeup water treatment system design and operating topics that are discussed in detail in Volumes 1 and 2 of NP-6377-SL. The individual guidelines contained in Volumes 1 and 2 are presented as separate imperative statements, followed by a technical justification discussion, which provides further explanations. In addition and when applicable, the guidelines relate pertinent operational in regard to monitoring parameters for operation, alternative actions, troubleshooting, management responsibilities and shutdown practices. Design considerations are also addressed, when applicable, in regard to equipment cost and advantages and disadvantages for the design recommendations. Appendices provide background information for performance criteria, component description, economic evaluation procedures and definitions. 4 refs

Prefabricated vertical drains, vol. I : engineering guidelines.

Science.gov (United States)

1986-09-01

This volume presents procedures and guidelines applicable to the design and instal : tion of prefabricated vertical drains to accelerate consolidation of soils. The : contents represent the Consultant's interpretation of the state-of-the-art as of : ...

Bone mineral density across a range of physical activity volumes: NHANES 2007-2010.

Science.gov (United States)

Whitfield, Geoffrey P; Kohrt, Wendy M; Pettee Gabriel, Kelley K; Rahbar, Mohammad H; Kohl, Harold W

2015-02-01

The association between aerobic physical activity volume and bone mineral density (BMD) is not completely understood. The purpose of this study was to clarify the association between BMD and aerobic activity across a broad range of activity volumes, particularly volumes between those recommended in the 2008 Physical Activity Guidelines for Americans and those of trained endurance athletes. Data from the 2007-2010 National Health and Nutrition Examination Survey were used to quantify the association between reported physical activity and BMD at the lumbar spine and proximal femur across the entire range of activity volumes reported by US adults. Participants were categorized into multiples of the minimum guideline-recommended volume based on reported moderate- and vigorous-intensity leisure activity. Lumbar and proximal femur BMD were assessed with dual-energy x-ray absorptiometry. Among women, multivariable-adjusted linear regression analyses revealed no significant differences in lumbar BMD across activity categories, whereas proximal femur BMD was significantly higher among those who exceeded the guidelines by 2-4 times than those who reported no activity. Among men, multivariable-adjusted BMD at both sites neared its highest values among those who exceeded the guidelines by at least 4 times and was not progressively higher with additional activity. Logistic regression estimating the odds of low BMD generally echoed the linear regression results. The association between physical activity volume and BMD is complex. Among women, exceeding guidelines by 2-4 times may be important for maximizing BMD at the proximal femur, whereas among men, exceeding guidelines by ≥4 times may be beneficial for lumbar and proximal femur BMD.

Technical guideline technology according to the X-ray regulations

International Nuclear Information System (INIS)

2011-01-01

The guideline covers the required technical knowledge concerning radiation protection and knowledge concerning for the operation of X-ray devices for technical purposes and stray radiation sources requiring licensing, and requirements for the qualification of officially authorized inspectors. The guidelines includes the following chapters: (1) introductory regulations; (2) Volume of the required technical knowledge; (3) Acquirement and certification of the technical knowledge; (4) Actualization of the technical knowledge; (5)Approval of courses and other training measures; (6) Combination of courses and training measures according to the guideline; (7) Requirements for qualification of officially authorized inspectors; (8) Interim regulations.

Factors influencing adherence to dietary guidelines: a qualitative ...

African Journals Online (AJOL)

2014-01-17

Jan 17, 2014 ... Original Research: Factors influencing adherence to dietary guidelines. 76. 2014 Volume ..... eat, because they dik (tired) of giving you special food. Then they go .... patients in this study were satisfied with the advice received ...

Right-Turn Traffic Volume Adjustments in Traffic Signal Warrant Analysis

Science.gov (United States)

2015-01-01

To accomplish this research, a comprehensive literature review of existing guidelines and findings based on national and local studies was conducted. Ultimately, guidelines for consistent application for adjusting right-turn traffic volumes were deve...

Anatomic guidelines defined by reformatting images on MRI for volume measurement of amygdala and hippocampus

International Nuclear Information System (INIS)

Hoshida, Tohru; Sakaki, Toshisuke; Uematsu, Sumio.

1995-01-01

Twelve patients with intractable partial epilepsy underwent MR scans at the Epilepsy Center of the Johns Hopkins Hospital. There were five women and seven men, ranging in age from five to 51 years (mean age: 26 years). Coronal images were obtained using a 3-D SPGR. The coronal images were transferred to an Allegro 5.1 workstation, and reformatted along the cardinal axes (axial and sagittal) in multiple view points. The anterior end of the amygdala was measured at the level just posterior to the disappearance of the temporal stem. The semilunar gyrus of the amygdala was separated from the ambient gyrus by the semianular sulcus that forms the boundary between the amygdala and the entorhinal cortex. The delineation of the hippocampal formation included the subicular complex, hippocampal proper, dentate gyrus, alveus, and fimbria. The uncal cleft separated the uncus above from the parahippocampal gyrus below. The roof of this cleft was formed by the hippocampus and the dentate gyrus, and the floor, by the presubiculum and subiculum. Although using some guidelines, strictly separating the hippocampal head from the posterior part of the amygdala was not feasible as was previously reported, because of the isointensity on MRI between the cortex of the amygdala and the hippocampus. The most posterior portion of the hippocampus was measured at the level of the subsplenial gyri, just below the splenium of the corpus callosum, to measure the hippocampal volume in its near totality. Therefore, it is reliable, and clinically useful, to measure the combined total volume of the amygdala and the hippocampus when comparing results with those of other centers. (S.Y.)

Guidelines for the content of records to support nuclear power plant operation, maintenance, and modification (NCIG-08): Volume 1, Guidelines: Final report

International Nuclear Information System (INIS)

Reedy, R.F.; Hegglin, D.P.

1988-11-01

The record systems at many nuclear power plant sites are becoming overloaded with unnecessary and superfluous records. The reason for this overload is that although the Codes and Standards list the record types to be retained, there is no definition for the contents of the records. This encourages varied interpretations which often lead to the approach of ''save everything''. This document provides guidelines for the content of records to support nuclear power plant operation, maintenance and modification. These Guidelines are based on an engineering approach to identify which data in the records are of ''significant value'' in (1) demonstrating capability for safe operation; (2) maintaining, reworking, repairing, replacing, or modifying an item; (3) determining the cause of an accident or malfunction of an item; and (4) providing required baseline data for in-service inspection. Particular topical issues affecting record retention needs, such as plant life extension activities, may require additional evaluation of data or records. By identifying the data to be retained in the records, it is possible to modify the record management system to substantially reduce the amount of unnecessary information being retained in the records. These Guidelines will provide for more uniform interpretation of requirements. The Guidelines are meant as an interpretation of current Codes, Standards and Regulatory Guides, and not as new requirements. Should any conflict exist between these Guidelines and the specified requirements of the NRC Regulations, the regulations govern. 4 tabs

Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

International Nuclear Information System (INIS)

Ng, Michael; Leong, Trevor; Chander, Sarat; Chu, Julie; Kneebone, Andrew; Carroll, Susan; Wiltshire, Kirsty; Ngan, Samuel; Kachnic, Lisa

2012-01-01

Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

EPRI BWR Water Chemistry Guidelines Revision

International Nuclear Information System (INIS)

Garcia, Susan E.; Giannelli, Joseph F.

2014-01-01

BWRVIP-190: BWR Water Chemistry Guidelines – 2008 Revision has been revised. The revision committee consisted of U.S. and non-U.S. utilities (members of the BWR Vessel and Internals Protection (BWRVIP) Mitigation Committee), reactor system manufacturers, fuel suppliers, and EPRI and industry experts. The revised document, BWRVIP-190 Revision 1, was completely reformatted into two volumes, with a simplified presentation of water chemistry control, diagnostic and good practice parameters in Volume 1 and the technical bases in Volume 2, to facilitate use. The revision was developed in parallel and in coordination with preparation of the Fuel Reliability Guidelines Revision 1: BWR Fuel Cladding Crud and Corrosion. Guidance is included for plants operating under normal water chemistry (NWC), moderate hydrogen water chemistry (HWC-M), and noble metal application (GE-Hitachi NobleChem™) plus hydrogen injection. Volume 1 includes significant changes to BWR feedwater and reactor water chemistry control parameters to provide increased assurance of intergranular stress corrosion cracking (IGSCC) mitigation of reactor materials and fuel reliability during all plant conditions, including cold shutdown (≤200°F (93°C)), startup/hot standby (>200°F (93°C) and ≤ 10%) and power operation (>10% power). Action Level values for chloride and sulfate have been tightened to minimize environmentally assisted cracking (EAC) of all wetted surfaces, including those not protected by hydrogen injection, with or without noble metals. Chemistry control guidance has been enhanced to minimize shutdown radiation fields by clarifying targets for depleted zinc oxide (DZO) injection while meeting requirements for fuel reliability. Improved tabular presentations of parameter values explicitly indicate levels at which actions are to be taken and required sampling frequencies. Volume 2 provides the technical bases for BWR water chemistry control for control of EAC, flow accelerated corrosion

46 CFR Appendix B to Subpart C to... - Substance Technical Guidelines, Benzene

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Substance Technical Guidelines, Benzene B Appendix B to... Subpart C to Part 197—Substance Technical Guidelines, Benzene I. Physical and Chemical Data (a) Substance... temperature: 580 °C (1076 °F). (3) Flammable limits in air, % by volume: Lower: 1.3%, Upper: 7.5%. (4...

Procedure guideline for radioiodine test (version 3)

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.; Eschner, W.; Deutsche Gesellschaft fuer Medizinische Physik; Koeln Univ.; Lassmann, M.; Deutsche Gesellschaft fuer Medizinische Physik; Wuerzburg Univ.; Leisner, B.; Allgemeines Krankenhaus St. Georg, Hamburg; Reiners, C.; Wuerzburg Univ.

2007-01-01

The version 3 of the procedure guideline for radioiodine test is an update of the guideline previously published in 2003. The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium-iodine crystal, alternatively or additionally the gamma camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered. (orig.)

Inpatient Volume and Quality of Mental Health Care Among Patients With Unipolar Depression

DEFF Research Database (Denmark)

Rasmussen, Line Ryberg; Mainz, Jan; Jørgensen, Mette

2018-01-01

OBJECTIVE: The relationship between inpatient volume and the quality of mental health care remains unclear. This study examined the association between inpatient volume in psychiatric hospital wards and quality of mental health care among patients with depression admitted to wards in Denmark...... was assessed by receipt of process performance measures reflecting national clinical guidelines for care of depression. RESULTS: Compared with patients admitted to low-volume psychiatric hospital wards, patients admitted to very-high-volume wards were more likely to receive a high overall quality of mental...... wards was associated with a greater chance of receiving guideline-recommended process performance measures for care of depression....

Postoperative Radiotherapy for Prostate Cancer: A Comparison of Four Consensus Guidelines and Dosimetric Evaluation of 3D-CRT Versus Tomotherapy IMRT

International Nuclear Information System (INIS)

Malone, Shawn; Croke, Jennifer; Roustan-Delatour, Nicolas; Belanger, Eric; Avruch, Leonard; Malone, Colin; Morash, Christopher; Kayser, Cathleen; Underhill, Kathryn; Li Yan; Malone, Kyle; Nyiri, Balazs; Spaans, Johanna

2012-01-01

Purpose: Despite the benefits of adjuvant radiotherapy after radical prostatectomy, approximately one-half of patients relapse. Four consensus guidelines have been published (European Organization for Research and Treatment of Cancer, Faculty of Radiation Oncology Genito-Urinary Group, Princess Margaret Hospital, Radiation Therapy Oncology Group) with the aim of standardizing the clinical target volume (CTV) delineation and improve outcomes. To date, no attempt has been made to compare these guidelines in terms of treatment volumes or organ at risk (OAR) irradiation. The extent to which the guideline-derived plans meet the dosimetric constraints of present trials or of the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) trial is also unknown. Our study also explored the dosimetric benefits of intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 20 patients treated with postoperative RT were included. The three-dimensional conformal radiotherapy (3D-CRT) plans were applied to cover the guideline-generated planning target volumes (66 Gy in 33 fractions). Dose–volume histograms (DVHs) were analyzed for CTV/planning target volume coverage and to evaluate OAR irradiation. The OAR DVHs were compared with the constraints proposed in the QUANTEC and Radiotherapy and Androgen Deprivation In Combination After Local Surgery (RADICALS) trials. 3D-CRT plans were compared with the tomotherapy plans for the Radiation Therapy Oncology Group planning target volume to evaluate the advantages of IMRT. Results: The CTV differed significantly between guidelines (p < 0.001). The European Organization for Research and Treatment of Cancer-CTVs were significantly smaller than the other CTVs (p < 0.001). Differences in prostate bed coverage superiorly accounted for the major volumetric differences between the guidelines. Using 3D-CRT, the DVHs rarely met the QUANTEC or RADICALS rectal constraints, independent of the guideline used. The RADICALS

Guidelines for optimization of planar HDR implants

International Nuclear Information System (INIS)

Zwicker, R.D.; Schmidt-Ullrich, R.

1996-01-01

Purpose: Conventional low dose rate (LDR) planar Ir-192 implants are typically carried out using at most a few different source strengths. Remote afterloading offers a much higher degree of flexibility with individually programmable dwell times. Dedicated software is available to generate individual dwell times producing isodose surfaces which contour as closely as possible the target volume. The success of these algorithms in enclosing the target volume while sparing normal tissues is dependent on the positioning of the source guides which constrain the dwell points. In this work we provide source placement guidelines for optimal coverage and dose uniformity in planar high dose rate (HDR) implants. The resulting distributions are compared with LDR treatments in terms of dose uniformity and early and late tissue effects. Materials and methods: Computer studies were undertaken to determine source positions and dwell times for optimal dose uniformity in planar HDR implants, and the results were compared to those obtained using corresponding LDR implant geometries. The improvements in the dose distributions achieved with the remote after loader are expected to help offset the increased late tissue effects which can occur when LDR irradiation is replaced with a few large HDR fractions. Equivalent differential volume-dose (DVD) curves for early and late effects were calculated for different numbers of HDR fractions using a linear-quadratic model and compared to the corresponding curves for the LDR regime. Results: Tables of source placement parameters were generated as guidelines for achieving highly homogeneous planar HDR dose distributions. Differential volume-dose data generated inside the target volume provide a quantitative measure of the improvement in real dose homogeneity obtained with remote afterloading. The net result is a shift of the peak in the DVD curve toward lower doses relative to the LDR implant. The equivalent DVD curves for late effects obtained

Verification and validation guidelines for high integrity systems. Volume 1

Energy Technology Data Exchange (ETDEWEB)

Hecht, H.; Hecht, M.; Dinsmore, G.; Hecht, S.; Tang, D. [SoHaR, Inc., Beverly Hills, CA (United States)

1995-03-01

High integrity systems include all protective (safety and mitigation) systems for nuclear power plants, and also systems for which comparable reliability requirements exist in other fields, such as in the process industries, in air traffic control, and in patient monitoring and other medical systems. Verification aims at determining that each stage in the software development completely and correctly implements requirements that were established in a preceding phase, while validation determines that the overall performance of a computer system completely and correctly meets system requirements. Volume I of the report reviews existing classifications for high integrity systems and for the types of errors that may be encountered, and makes recommendations for verification and validation procedures, based on assumptions about the environment in which these procedures will be conducted. The final chapter of Volume I deals with a framework for standards in this field. Volume II contains appendices dealing with specific methodologies for system classification, for dependability evaluation, and for two software tools that can automate otherwise very labor intensive verification and validation activities.

Verification and validation guidelines for high integrity systems. Volume 1

International Nuclear Information System (INIS)

Hecht, H.; Hecht, M.; Dinsmore, G.; Hecht, S.; Tang, D.

1995-03-01

High integrity systems include all protective (safety and mitigation) systems for nuclear power plants, and also systems for which comparable reliability requirements exist in other fields, such as in the process industries, in air traffic control, and in patient monitoring and other medical systems. Verification aims at determining that each stage in the software development completely and correctly implements requirements that were established in a preceding phase, while validation determines that the overall performance of a computer system completely and correctly meets system requirements. Volume I of the report reviews existing classifications for high integrity systems and for the types of errors that may be encountered, and makes recommendations for verification and validation procedures, based on assumptions about the environment in which these procedures will be conducted. The final chapter of Volume I deals with a framework for standards in this field. Volume II contains appendices dealing with specific methodologies for system classification, for dependability evaluation, and for two software tools that can automate otherwise very labor intensive verification and validation activities

Guideline for radiotherapy of liver cancer

International Nuclear Information System (INIS)

Kishi, Kazushi; Shirai, Shintaro; Satou, Morio; Ueda, Hiroki; Wigg, D.R

2007-01-01

This paper describes bases of radiotherapy (RT) of liver cancer for its application, efficacy, clinical target volume (CTV) and characteristics, dose fractionation and its theory, 2D/3D irradiation, evaluation, and safety. The description here is leading to execute the Guideline 200X to be issued in a near future by the Japanese College of Radiology, and is supplementary to the Guideline in nature. The Guideline is to incorporate the recent progresses of the therapy to complement the previous Guideline 2004. Thus here are described the application of RT to unresectable hepatoma in relation to intervention; characteristics of RT including dose-effect relationships, morphological characteristics of intravascular tumor thrombi (ITT) and CTV, dose fractionation and a/b ratio (liver 2.5 vs hepatoma 7.4), focal lesion in parenchyma, ITT and RT, lymph metastasis, arteriovenous shunt and dissemination, and desensitization in bone and adrenal metastases; prediction of radiation liver damage; and adverse effect by radiation and its control. The evidenced bases of RT are still poor in this field, but the fact that hepatoma, highly sensitive to radiation, exhibits clear dose-response ensures its efficacy if the problems of low tolerance and of breathing movement at irradiation can be solved. (R.T.)

Guidelines for the verification and validation of expert system software and conventional software: Project summary. Volume 1

International Nuclear Information System (INIS)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A.

1995-03-01

This eight-volume report presents guidelines for performing verification and validation (V ampersand V) on Artificial Intelligence (Al) systems with nuclear applications. The guidelines have much broader application than just expert systems; they are also applicable to object-oriented programming systems, rule-based systems, frame-based systems, model-based systems, neural nets, genetic algorithms, and conventional software systems. This is because many of the components of AI systems are implemented in conventional procedural programming languages, so there is no real distinction. The report examines the state of the art in verifying and validating expert systems. V ampersand V methods traditionally applied to conventional software systems are evaluated for their applicability to expert systems. One hundred fifty-three conventional techniques are identified and evaluated. These methods are found to be useful for at least some of the components of expert systems, frame-based systems, and object-oriented systems. A taxonomy of 52 defect types and their delectability by the 153 methods is presented. With specific regard to expert systems, conventional V ampersand V methods were found to apply well to all the components of the expert system with the exception of the knowledge base. The knowledge base requires extension of the existing methods. Several innovative static verification and validation methods for expert systems have been identified and are described here, including a method for checking the knowledge base open-quotes semanticsclose quotes and a method for generating validation scenarios. Evaluation of some of these methods was performed both analytically and experimentally. A V ampersand V methodology for expert systems is presented based on three factors: (1) a system's judged need for V ampersand V (based in turn on its complexity and degree of required integrity); (2) the life-cycle phase; and (3) the system component being tested

Guidelines for the verification and validation of expert system software and conventional software: Project summary. Volume 1

Energy Technology Data Exchange (ETDEWEB)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A. [Science Applications International Corp., McLean, VA (United States)

1995-03-01

This eight-volume report presents guidelines for performing verification and validation (V&V) on Artificial Intelligence (Al) systems with nuclear applications. The guidelines have much broader application than just expert systems; they are also applicable to object-oriented programming systems, rule-based systems, frame-based systems, model-based systems, neural nets, genetic algorithms, and conventional software systems. This is because many of the components of AI systems are implemented in conventional procedural programming languages, so there is no real distinction. The report examines the state of the art in verifying and validating expert systems. V&V methods traditionally applied to conventional software systems are evaluated for their applicability to expert systems. One hundred fifty-three conventional techniques are identified and evaluated. These methods are found to be useful for at least some of the components of expert systems, frame-based systems, and object-oriented systems. A taxonomy of 52 defect types and their delectability by the 153 methods is presented. With specific regard to expert systems, conventional V&V methods were found to apply well to all the components of the expert system with the exception of the knowledge base. The knowledge base requires extension of the existing methods. Several innovative static verification and validation methods for expert systems have been identified and are described here, including a method for checking the knowledge base {open_quotes}semantics{close_quotes} and a method for generating validation scenarios. Evaluation of some of these methods was performed both analytically and experimentally. A V&V methodology for expert systems is presented based on three factors: (1) a system`s judged need for V&V (based in turn on its complexity and degree of required integrity); (2) the life-cycle phase; and (3) the system component being tested.

Computer-Based CPR Simulation Towards Validation of AHA/ERC Guidelines.

Science.gov (United States)

John, Alka Rachel; Manivannan, M; Ramakrishnan, T V

2017-06-01

As per the AHA 2015 and ERC 2015 guidelines for resuscitation, chest compression depth should be between 5 and 6 cm with a rate of 100-120 compressions per minute. Theoretical validation of these guidelines is still elusive. We developed a computer model of the cardiopulmonary resuscitation (CPR) system to validate these guidelines. A lumped element computer model of the cardiovascular system was developed to simulate cardiac arrest and CPR. Cardiac output was compared for a range of compression pressures and frequencies. It was observed from our investigation that there is an optimum compression pressure and rate. The maximum cardiac output occurred at 100 mmHg, which is approximately 5.7 cm, and in the range of 100 to 120 compressions per minute with an optimum value at 110 compressions per minute, validating the guidelines. Increasing the pressure or the depth of compression beyond the optimum, limits the blood flow by depleting the volume in the cardiac chambers and not allowing for an effective stroke volume. Similarly increasing the compression rate beyond the optimum degrades the ability of the chambers to pump blood. The results also bring out the importance of complete recoil of the chest after each compression with more than 400% increase in cardiac output from 90% recoil to 100% recoil. Our simulation predicts that the recommendation to compress harder and faster is not the best counsel as there is an optimum compression pressure and rate for high-quality CPR.

Guidelines for the verification and validation of expert system software and conventional software. Volume 1: Project summary. Final report

International Nuclear Information System (INIS)

Miller, L.A.; Hayes, J.E.; Mirsky, S.M.

1995-05-01

This eight-volume report presents guidelines for performing verification and validation (V ampersand V) on Artificial Intelligence (AI) systems with nuclear applications. The guidelines have much broader application than just expert systems; they are also applicable to object-oriented programming systems, rule-based systems, frame-based systems, model-based systems, neural nets, genetic algorithms, and conventional software systems. This is because many of the components of AI systems are implemented in conventional procedural programming languages, so there is no real distinction. The report examines the state of the art in verifying and validating expert systems. V ampersand V methods traditionally applied to conventional software systems are evaluated for their applicability to expert systems. One hundred fifty-three conventional techniques are identified and evaluated. These methods are found to be useful for at least some of the components of expert systems, frame-based systems, and object-oriented systems. A taxonomy of 52 defect types and their delectability by the 153 methods is presented. With specific regard to expert systems, conventional V ampersand V methods were found to apply well to all the components of the expert system with the exception of the knowledge base. The knowledge base requires extension of the existing methods. Several innovative static verification and validation methods for expert systems have been identified and are described here, including a method for checking the knowledge base open-quotes semanticsclose quotes and a method for generating validation scenarios. Evaluation of some of these methods was performed both analytically and experimentally

SPORT AND EXERCISE PHYSIOLOGY TESTING Volume one: Sport Testing Volume two: Exercise and Clinical Testing

Directory of Open Access Journals (Sweden)

Edward M. Winter

2007-03-01

Full Text Available DESCRIPTION The objective of the book is to discuss the theoretical and practical aspects of physiological testing in exercise and sports which is essential to evaluate and monitor developing exercise performance for athletes and public health, and improving quality of life for patients.A board of leading sport and exercise physiologists and scientists are gathered to discuss physiological assessments that have proven validity and reliability, both in sport and health relevant issues. Incidentally, it updates the reader about the current subjects of physiological exertion testing in both research and clinical procedures. Both volumes individually cover the increasing number of available research and review publications, and theoretical explanations are supported by practical examples. A step-by-step and/or checklist method is used in appropriate sections which make the guides more user-friendly than most. PURPOSE The first volume is designed to help readers develop an understanding of the essential concepts of sport specific testing whereas the second volume aims at making the exercise and clinical specific testing comprehensible, dealing with both technical terms and the theories underlying the importance of these tests. AUDIENCE As Guidelines books of the British Association of Sport and Exercise Sciences, it will be of interest to a wide range of students, researchers and practitioners in the sport and exercise disciplines whether they work in the laboratory or in the field. FEATURES The first volume features immediate practical requirements particularly in sport testing. It is composed of five parts with detailed sub-sections in all of them. The topics of the parts are: i general principles, ii methodological issues, iii general procedures, iv sport specific procedures, v special populations.The second volume is also presented in five parts, again with sub-sections in all of them, but considering the requirements in clinical and exercise

Volume-constrained optimization of magnetorheological and electrorheological valves and dampers

Science.gov (United States)

Rosenfeld, Nicholas C.; Wereley, Norman M.

2004-12-01

This paper presents a case study of magnetorheological (MR) and electrorheological (ER) valve design within a constrained cylindrical volume. The primary purpose of this study is to establish general design guidelines for volume-constrained MR valves. Additionally, this study compares the performance of volume-constrained MR valves against similarly constrained ER valves. Starting from basic design guidelines for an MR valve, a method for constructing candidate volume-constrained valve geometries is presented. A magnetic FEM program is then used to evaluate the magnetic properties of the candidate valves. An optimized MR valve is chosen by evaluating non-dimensional parameters describing the candidate valves' damping performance. A derivation of the non-dimensional damping coefficient for valves with both active and passive volumes is presented to allow comparison of valves with differing proportions of active and passive volumes. The performance of the optimized MR valve is then compared to that of a geometrically similar ER valve using both analytical and numerical techniques. An analytical equation relating the damping performances of geometrically similar MR and ER valves in as a function of fluid yield stresses and relative active fluid volume, and numerical calculations are provided to calculate each valve's damping performance and to validate the analytical calculations.

2013 AAHA/AAFP fluid therapy guidelines for dogs and cats.

Science.gov (United States)

Davis, Harold; Jensen, Tracey; Johnson, Anthony; Knowles, Pamela; Meyer, Robert; Rucinsky, Renee; Shafford, Heidi

2013-01-01

Fluid therapy is important for many medical conditions in veterinary patients. The assessment of patient history, chief complaint, physical exam findings, and indicated additional testing will determine the need for fluid therapy. Fluid selection is dictated by the patient's needs, including volume, rate, fluid composition required, and location the fluid is needed (e.g., interstitial versus intravascular). Therapy must be individualized, tailored to each patient, and constantly re-evaluated and reformulated according to changes in status. Needs may vary according to the existence of either acute or chronic conditions, patient pathology (e.g., acid-base, oncotic, electrolyte abnormalities), and comorbid conditions. All patients should be assessed for three types of fluid disturbances: changes in volume, changes in content, and/or changes in distribution. The goals of these guidelines are to assist the clinician in prioritizing goals, selecting appropriate fluids and rates of administration, and assessing patient response to therapy. These guidelines provide recommendations for fluid administration for anesthetized patients and patients with fluid disturbances.

Computerization of guidelines: towards a "guideline markup language".

Science.gov (United States)

Dart, T; Xu, Y; Chatellier, G; Degoulet, P

2001-01-01

Medical decision making is one of the most difficult daily tasks for physicians. Guidelines have been designed to reduce variance between physicians in daily practice, to improve patient outcomes and to control costs. In fact, few physicians use guidelines in daily practice. A way to ease the use of guidelines is to implement computerised guidelines (computer reminders). We present in this paper a method of computerising guidelines. Our objectives were: 1) to propose a generic model that can be instantiated for any specific guidelines; 2) to use eXtensible Markup Language (XML) as a guideline representation language to instantiate the generic model for a specific guideline. Our model is an object representation of a clinical algorithm, it has been validated by running two different guidelines issued by a French official Agency. In spite of some limitations, we found that this model is expressive enough to represent complex guidelines devoted to diabetes and hypertension management. We conclude that XML can be used as a description format to structure guidelines and as an interface between paper-based guidelines and computer applications.

How can we improve guideline use? A conceptual framework of implementability

Directory of Open Access Journals (Sweden)

Lemieux-Charles Louise

2011-03-01

Full Text Available Abstract Background Guidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines. Methods A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team. Results The final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic. Conclusions Numerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed

Design Guidelines and Criteria for User/Operator Transactions with Battlefield Automated Systems. Volume III-A. Human Factors Analyses of User/ Operator Transactions with TACFIRE - The Tactical Fire Direction System

Science.gov (United States)

1981-02-01

7. Reseaarch Product 81-26 - DESIGN GUIDELINES AND CRITERIA FOR USER/ I;. I’OPERATOR TRANSACTIONS WITH BATTLEFIELD AUTOMIATED SYSTEMS I’ /HVtAN...FACTORS XWLYSES :’F K~R/ OPERATOR TRANSACTIONS WTHT TACFIRE - THE TACTICAL FIRE DiRECTION SY2T3EM A HUMAN FACTORS TECHNICAL AREA L~h~h K L-J 1’ U~~i~ ll...Battlefield Auto- Inter : Oct 1979-Feb 1981 mated Systems Volume III-A: Human Factors 4t C/ Analyses of User/Operator Transactions with 6. PERFORMING

Large-volume injection in gas chromatographic trace analysis using temperature-programmable (PTV) injectors

NARCIS (Netherlands)

Mol, J.G.J.; Janssen, J.G.M.; Cramers, C.A.M.G.; Brinkman, U.A.T.

1996-01-01

The use of programmed-temperature vaporising (PTV) injectors for large-volume injection in capillary gas chromatography is briefly reviewed. The principles and optimisation of large-volume PTV injection are discussed. Guidelines are given for selection of the PTV conditions and injection mode for

Target volume delineation variation in radiotherapy for early stage rectal cancer in the Netherlands

International Nuclear Information System (INIS)

Nijkamp, Jasper; Haas-Kock, Danielle F.M. de; Beukema, Jannet C.; Neelis, Karen J.; Woutersen, Dankert; Ceha, Heleen; Rozema, Tom; Slot, Annerie; Vos-Westerman, Hanneke; Intven, Martijn; Spruit, Patty H.; Linden, Yvette van der; Geijsen, Debby; Verschueren, Karijn; Herk, Marcel B. van; Marijnen, Corrie A.M.

2012-01-01

Purpose: The aim of this study was to measure and improve the quality of target volume delineation by means of national consensus on target volume definition in early-stage rectal cancer. Methods and materials: The CTV’s for eight patients were delineated by 11 radiation oncologists in 10 institutes according to local guidelines (phase 1). After observer variation analysis a workshop was organized to establish delineation guidelines and a digital atlas, with which the same observers re-delineated the dataset (phase 2). Variation in volume, most caudal and cranial slice and local surface distance variation were analyzed. Results: The average delineated CTV volume decreased from 620 to 460 cc (p < 0.001) in phase 2. Variation in the caudal CTV border was reduced significantly from 1.8 to 1.2 cm SD (p = 0.01), while it remained 0.7 cm SD for the cranial border. The local surface distance variation (cm SD) reduced from 1.02 to 0.74 for anterior, 0.63 to 0.54 for lateral, 0.33 to 0.25 for posterior and 1.22 to 0.46 for the sphincter region, respectively. Conclusions: The large variation in target volume delineation could significantly be reduced by use of consensus guidelines and a digital delineation atlas. Despite the significant reduction there is still a need for further improvement.

Site locality identification study: Hanford Site. Volume I. Methodology, guidelines, and screening

International Nuclear Information System (INIS)

1980-07-01

Presented in this report are the results of the site locality identification study for the Hanford Site using a screening process. To enable evaluation of the entire Hanford Site, the screening process was applied to a somewhat larger area; i.e., the Pasco Basin. The study consisted of a series of screening steps that progressively focused on smaller areas which are within the Hanford Site and which had a higher potential for containing suitable repository sites for nuclear waste than the areas not included for further study. Five site localities, designated H-1, H-2, H-3, H-4, H-5 (Figure A), varying in size from approximately 10 to 50 square miles, were identified on the Hanford Site. It is anticipated that each site locality may contain one or more candidate sites suitable for a nuclear waste repository. The site locality identification study began with definition of objectives and the development of guidelines for screening. Three objectives were defined: (1) maximize public health and safety; (2) minimize adverse environmental and socioeconomic impacts; and (3) minimize system costs. The screening guidelines have numerical values that provided the basis for the successive reduction of the area under study and to focus on smaller areas that had a higher likelihood of containing suitable sites

S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

Directory of Open Access Journals (Sweden)

Schmitt, D. V.

2010-01-01

Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the

Guidelines for the verification and validation of expert system software and conventional software: Validation scenarios. Volume 6

International Nuclear Information System (INIS)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A.

1995-03-01

This report is the sixth volume in a series of reports describing the results of the Expert System Verification and Validation (V ampersand V) project which is jointly funded by the US Nuclear Regulatory Commission and the Electric Power Research Institute. The ultimate objective is the formulation of guidelines for the V ampersand V of expert systems for use in nuclear power applications. This activity was concerned with the development of a methodology for selecting validation scenarios and subsequently applying it to two expert systems used for nuclear utility applications. Validation scenarios were defined and classified into five categories: PLANT, TEST, BASICS, CODE, and LICENSING. A sixth type, REGRESSION, is a composite of the others and refers to the practice of using trusted scenarios to ensure that modifications to software did not change unmodified functions. Rationale was developed for preferring scenarios selected from the categories in the order listed and for determining under what conditions to select scenarios from other types. A procedure incorporating all of the recommendations was developed as a generalized method for generating validation scenarios. The procedure was subsequently applied to two expert systems used in the nuclear industry and was found to be effective, given that an experienced nuclear engineer made the final scenario selections. A method for generating scenarios directly from the knowledge base component was suggested

Guidelines for the verification and validation of expert system software and conventional software: Validation scenarios. Volume 6

Energy Technology Data Exchange (ETDEWEB)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A. [Science Applications International Corp., McLean, VA (United States)

1995-03-01

This report is the sixth volume in a series of reports describing the results of the Expert System Verification and Validation (V&V) project which is jointly funded by the US Nuclear Regulatory Commission and the Electric Power Research Institute. The ultimate objective is the formulation of guidelines for the V&V of expert systems for use in nuclear power applications. This activity was concerned with the development of a methodology for selecting validation scenarios and subsequently applying it to two expert systems used for nuclear utility applications. Validation scenarios were defined and classified into five categories: PLANT, TEST, BASICS, CODE, and LICENSING. A sixth type, REGRESSION, is a composite of the others and refers to the practice of using trusted scenarios to ensure that modifications to software did not change unmodified functions. Rationale was developed for preferring scenarios selected from the categories in the order listed and for determining under what conditions to select scenarios from other types. A procedure incorporating all of the recommendations was developed as a generalized method for generating validation scenarios. The procedure was subsequently applied to two expert systems used in the nuclear industry and was found to be effective, given that an experienced nuclear engineer made the final scenario selections. A method for generating scenarios directly from the knowledge base component was suggested.

Computer-generated display system guidelines. Volume 2. Developing an evaluation plan

International Nuclear Information System (INIS)

1984-09-01

Volume 1 of this report provides guidance to utilities on the design of displays and the selection and retrofit of a computer-generated display system in the control room of an operating nuclear power plant. Volume 2 provides guidance on planning and managing empirical evaluation of computer-generated display systems, particularly when these displays are primary elements of computer-based operator aids. The guidance provided is in terms of a multilevel evaluation methodology that enables sequential consideration of three primary issues: (1) compatibility; (2) understandability; and (3) effectiveness. The evaluation process approaches these three issues with a top-down review of system objectives, functions, tasks, and information requirements. The process then moves bottom-up from lower-level to higher-level issues, employing different evaluation methods at each level in order to maximize the efficiency and effectiveness of the evaluation process

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

Science.gov (United States)

Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

2012-07-04

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

Guideline of guidelines: asymptomatic microscopic haematuria.

Science.gov (United States)

Linder, Brian J; Bass, Edward J; Mostafid, Hugh; Boorjian, Stephen A

2018-02-01

The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Diabetes guidelines and clinical practice: is there a gap? The South ...

African Journals Online (AJOL)

2012-01-03

Jan 3, 2012 ... Original Research: Diabetes guidelines and clinical practice. 85. 2012 Volume 17 No 2 ... endorsed by The Society of Endocrinology Metabolism and Diabetes of ... do not reach the target HbA1c value of < 7%.8-10 In striving to achieve ..... reflected the worst glycaemic control, as assessed by HbA1c levels.

Guidelines for Guidelines: Are They Up to the Task? A Comparative Assessment of Clinical Practice Guideline Development Handbooks

Science.gov (United States)

Ansari, Shabnam; Rashidian, Arash

2012-01-01

Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings

Procedure guideline for radioiodine test (version 3); Verfahrensanweisung zum Radioiodtest (Version 3)

Energy Technology Data Exchange (ETDEWEB)

Dietlein, M.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Nuklearmedizinische Klinik der Henriettenstiftung, Hannover (Germany); Eschner, W. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Allgemeines Krankenhaus St. Georg, Hamburg (Germany). Abt. fuer Nuklearmedizin; Reiners, C. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2007-07-01

The version 3 of the procedure guideline for radioiodine test is an update of the guideline previously published in 2003. The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium-iodine crystal, alternatively or additionally the gamma camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered. (orig.)

A Handbook for Public Playground Safety. Volume II: Technical Guidelines for Equipment and Surfacing.

Science.gov (United States)

Consumer Product Safety Commission, Washington, DC.

This handbook suggests safety guidelines for public playground equipment and describes various surfaces used under the equipment and possible injuries resulting from falls. The handbook is intended for use mainly by manufacturers, installers, school and park officials, and others interested in technical criteria for public playground equipment.…

Solid low level waste management guidelines: Final report

International Nuclear Information System (INIS)

Castagnacci, A.; Dalton, D.; Genoa, P.

1994-11-01

Since 1989, the nuclear industry has been moving in the direction of greater minimization of low level radioactive waste (LLW). This has been driven in part by increasing regulatory attention, but it also is in response to the desire on the part of nuclear utilities to be more cost efficient and to be environmentally responsive. Over the past half-dozen years, LLW disposal costs have increased dramatically. In addition, improvements in LLW volume reduction technologies have substantially reduced the volume of LLW that is disposed. At the same time, utilities are implementing aggressive source reduction programs and programs to reuse materials so as to extend the useful life of many materials. Thus, there has been a dramatic change in LLW economics and LLW management practices in just the past few years. This report was developed by utility nuclear experts to provide guidance to all utilities on mechanisms for integrating the program economics, advanced volume reduction techniques, and approaches to source reduction. Thus, utilizes will be able to use this report as a guide to optimizing their LLW program economics and minimizing LLW disposal volumes to the smallest reasonable fraction. This report discusses the implementation of these guidelines, management support, waste materials and waste inventory, radioactive tool and equipment management, protective clothing management, processing and volume reduction, solid LLW tracking, outage LLW management, and interim storage of LLW

Strategy Guideline. Compact Air Distribution Systems

Energy Technology Data Exchange (ETDEWEB)

Burdick, Arlan [IBACOS, Inc., Pittsburgh, PA (United States)

2013-06-01

This guideline discusses the benefits and challenges of using a compact air distribution system to handle the reduced loads and reduced air volume needed to condition the space within an energy efficient home. The decision criteria for a compact air distribution system must be determined early in the whole-house design process, considering both supply and return air design. However, careful installation of a compact air distribution system can result in lower material costs from smaller equipment, shorter duct runs, and fewer outlets; increased installation efficiencies, including ease of fitting the system into conditioned space; lower loads on a better balanced HVAC system, and overall improved energy efficiency of the home.

Research to develop guidelines for cathodic protection of concentric neutral cables, volume 3

Science.gov (United States)

Hanck, J. A.; Nekoksa, G.

1982-08-01

Data associated with the corrosion of concentric neutral (CN) wires of direct buried primary cables were statistically analyzed, and guidelines for cathodic protection of CN wires for the electric utility industry were developed. The cathodic protection are reported. Field tests conducted at 36 bellholes excavated in California, Oklahoma, and North Carolina are described. Details of the electrochemical, chemical, bacteriological, and sieve analyses of native soil and imported backfill samples are also included.

Blanket comparison and selection study. Volume II

International Nuclear Information System (INIS)

1983-10-01

This volume contains extensive data for the following chapters: (1) solid breeder tritium recovery, (2) solid breeder blanket designs, (3) alternate blanket concept screening, and (4) safety analysis. The following appendices are also included: (1) blanket design guidelines, (2) power conversion systems, (3) helium-cooled, vanadium alloy structure blanket design, (4) high wall loading study, and (5) molten salt safety studies

Pediatric blood volumes: a one-page reference guide.

Science.gov (United States)

Smiley, J; Reitan, J

1998-10-01

At our institution, a multidisciplinary team met to work out a blood volume policy for our pediatric patients' laboratory testing. Because we are a cancer center, many of our patients are on protocols and/or are in the hospital for an extended period of time. These factors result in multiple blood draws. It is important to manage the volumes used so that we do not compromise the hematological status of our pediatric patients. The concerns of nurses and laboratory technologists were discussed and a three-tiered system was designed consisting of adult volumes, volumes for inflexibility to verify or add to the original order without resticking the patient increase at each tier. It is imperative to the overall quality of care for all patients that discretion is used when following these guidelines. When it is medically prudent to restrict the blood volumes taken from any patient, it should be done. However, when it is not medically necessary, the increased costs and potential decrease in the quality of laboratory service outweighs the desire to use smaller blood volumes.

Prescription Dose Guideline Based on Physical Criterion for Multiple Metastatic Brain Tumors Treated With Stereotactic Radiosurgery

International Nuclear Information System (INIS)

Sahgal, Arjun; Barani, Igor J.; Novotny, Josef; Zhang Beibei; Petti, Paula; Larson, David A.; Ma Lijun

2010-01-01

Purpose: Existing dose guidelines for intracranial stereotactic radiosurgery (SRS) are primarily based on single-target treatment data. This study investigated dose guidelines for multiple targets treated with SRS. Methods and Materials: A physical model was developed to relate the peripheral isodose volume dependence on an increasing number of targets and prescription dose per target. The model was derived from simulated and clinical multiple brain metastatic cases treated with the Leksell Gamma Knife Perfexion at several institutions, where the total number of targets ranged from 2 to 60. The relative increase in peripheral isodose volumes, such as the 12-Gy volume, was studied in the multitarget treatment setting based on Radiation Therapy Oncology Group 90-05 study dose levels. Results: A significant increase in the 12-Gy peripheral isodose volumes was found in comparing multiple target SRS to single-target SRS. This increase strongly correlated (R 2 = 0.92) with the total number of targets but not the total target volumes (R 2 = 0.06). On the basis of the correlated curve, the 12-Gy volume for multiple target treatment was found to increase by approximately 1% per target when a low target dose such as 15 Gy was used, but approximately 4% per target when a high dose such as 20-24 Gy was used. Reduction in the prescription dose was quantified for each prescription level in maintaining the 12-Gy volume. Conclusion: Normal brain dose increases predictably with increasing number of targets for multitarget SRS. A reduction of approximately 1-2 Gy in the prescribed dose is needed compared with single target radiosurgery.

Practical guidelines for small-volume additions of uninhibited water to waste storage tanks

International Nuclear Information System (INIS)

Hsu, T.C.; Wiersma, B.J.; Zapp, P.E.; Pike, J.A.

1994-01-01

Allowable volumes of uninhibited water additions to waste tanks are limited to volumes in which hydroxide and nitrite inhibitors reach required concentrations by diffusion from the bulk waste within five days. This diffusion process was modeled conservatively by Fick's second law of diffusion. The solution to the model was applied to all applicable conditions which exist in the waste tanks. Plant engineers adapted and incorporated the results into a practical working procedure for controlling and monitoring the addition of uninhibited water. Research, technical support, and field engineers worked together to produce an effective solution to a potential waste tank corrosion problem

Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

Energy Technology Data Exchange (ETDEWEB)

Carter, R.J.

1997-07-01

This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

International Nuclear Information System (INIS)

Carter, R.J.

1997-07-01

This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT

International Nuclear Information System (INIS)

Chao, K.S. Clifford; Wippold, Franz J.; Ozyigit, Gokhan; Tran, Binh N.; Dempsey, James F.

2002-01-01

Purpose: We present the guidelines for target volume determination and delineation of head-and-neck lymph nodes based on the analysis of the patterns of nodal failure in patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Data pertaining to the natural course of nodal metastasis for each head-and-neck cancer subsite were reviewed. A system was established to provide guidance for nodal target volume determination and delineation. Following these guidelines, 126 patients (52 definitive, 74 postoperative) were treated between February 1997 and December 2000 with IMRT for head-and-neck cancer. The median follow-up was 26 months (range 12-55), and the patterns of nodal failure were analyzed. Results: These guidelines define the nodal target volume based on the location of the primary tumor and the probability of microscopic metastasis to the ipsilateral and contralateral (Level I-V) nodal regions. Following these guidelines, persistent or recurrent nodal disease was found in 6 (12%) of 52 patients receiving definitive IMRT, and 7 (9%) of 74 patients receiving postoperative IMRT had failure in the nodal region. Conclusion: On the basis of our clinical experience in implementing inverse-planning IMRT for head-and-neck cancer, we present guidelines using a simplified, but clinically relevant, method for nodal target volume determination and delineation. The intention was to provide a foundation that enables different institutions to exchange clinical experiences in head-and-neck IMRT. These guidelines will be subject to future refinement when the clinical experience in head-and-neck IMRT advances

[Guidelines for management of epilepsy--commentary on Scottish ("SIGN") guidelines].

Science.gov (United States)

Planjar-Prvan, Miljenka; Granić, Davorka

2005-01-01

The choice of AED (antiepileptic drug), worldwide and in Croatia, is been still based on the physician's subjective decision, personal experience, knowledge and marketing pressure made by big pharmaceutical industries. Therefore, according to some opinions, there is a need of treatment guidelines for epilepsy that would provide relevant information based on scientific evidence on the efficacy, tolerability and safety of AEDs. The guidelines, published by a competent source, should be designed as to allow for easy access to the information on the best practice in specific cases. An extensive background literature review was made to identify such a type of guidelines for the management of epilepsy. The literature review revealed a number of references with the recommendations for treating epilepsy in different groups of patients and from various, specific aspects of epilepsy treatment. However, only one comprehensive set of guidelines for the diagnosis and treatment of epilepsy treatment was found, i.e. the evidence-based guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). The development of this set of guidelines is quite extensively described in order to illustrate how rigorous and long-lasting the process was, including a great number of health professionals at the national level. Such a type of well designed guidelines facilitates access to highest educational standards for all professionals involved in the primary and secondary care of people with epilepsy. However, it is clear that guidelines can fully replace the standards of clinical practice based on critical evaluation and integration of all clinical data of each individual patient. No guidelines can replace the physician's obligation to keep informed of the novel achievements in the epileptology either.

The development of oncology treatment guidelines: an analysis of the National Guidelines Clearinghouse.

Science.gov (United States)

Palta, Manisha; Lee, W Robert

2011-01-01

In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity.(1) This prompted us to review oncology treatment guidelines to determine if such limitations are widespread. We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions. Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [P <.0001]). The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline. Copyright

Consensus Contouring Guidelines for Postoperative Stereotactic Body Radiation Therapy for Metastatic Solid Tumor Malignancies to the Spine

International Nuclear Information System (INIS)

Redmond, Kristin J.; Robertson, Scott; Lo, Simon S.; Soltys, Scott G.; Ryu, Samuel; McNutt, Todd; Chao, Samuel T.; Yamada, Yoshiya; Ghia, Amol; Chang, Eric L.; Sheehan, Jason; Sahgal, Arjun

2017-01-01

Purpose: To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases. Methods and Materials: Ten spine SBRT specialists representing 10 international centers independently contoured the clinical target volume (CTV), planning target volume (PTV), spinal cord, and spinal cord planning organ at risk volume (PRV) for 10 representative clinical scenarios in postoperative spine SBRT for metastatic solid tumor malignancies. Contours were imported into the Computational Environment for Radiotherapy Research. Agreement between physicians was calculated with an expectation minimization algorithm using simultaneous truth and performance level estimation with κ statistics. Target volume definition guidelines were established by finding optimized confidence level consensus contours using histogram agreement analyses. Results: Nine expert radiation oncologists and 1 neurosurgeon completed contours for all 10 cases. The mean sensitivity and specificity were 0.79 (range, 0.71-0.89) and 0.94 (range, 0.90-0.99) for the CTV and 0.79 (range, 0.70-0.95) and 0.92 (range, 0.87-0.99) for the PTV), respectively. Mean κ agreement, which demonstrates the probability that contours agree by chance alone, was 0.58 (range, 0.43-0.70) for CTV and 0.58 (range, 0.37-0.76) for PTV (P<.001 for all cases). Optimized consensus contours were established for all patients with 80% confidence interval. Recommendations for CTV include treatment of the entire preoperative extent of bony and epidural disease, plus immediately adjacent bony anatomic compartments at risk of microscopic disease extension. In particular, a “donut-shaped” CTV was consistently applied in cases of preoperative circumferential epidural extension, regardless of extent of residual epidural extension. Otherwise more conformal anatomic-based CTVs were determined and described. Spinal instrumentation was consistently excluded from the CTV. Conclusions: We provide

NASA System Safety Handbook. Volume 2: System Safety Concepts, Guidelines, and Implementation Examples

Science.gov (United States)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Feather, Martin; Rutledge, Peter; Sen, Dev; Youngblood, Robert

2015-01-01

This is the second of two volumes that collectively comprise the NASA System Safety Handbook. Volume 1 (NASASP-210-580) was prepared for the purpose of presenting the overall framework for System Safety and for providing the general concepts needed to implement the framework. Volume 2 provides guidance for implementing these concepts as an integral part of systems engineering and risk management. This guidance addresses the following functional areas: 1.The development of objectives that collectively define adequate safety for a system, and the safety requirements derived from these objectives that are levied on the system. 2.The conduct of system safety activities, performed to meet the safety requirements, with specific emphasis on the conduct of integrated safety analysis (ISA) as a fundamental means by which systems engineering and risk management decisions are risk-informed. 3.The development of a risk-informed safety case (RISC) at major milestone reviews to argue that the systems safety objectives are satisfied (and therefore that the system is adequately safe). 4.The evaluation of the RISC (including supporting evidence) using a defined set of evaluation criteria, to assess the veracity of the claims made therein in order to support risk acceptance decisions.

Guidelines and workbook for assessment of organization and administration of utilities seeking operating license for a nuclear power plant. Guidelines for utility organization and administration plan. Volume 1

International Nuclear Information System (INIS)

Thurber, J.A.; Olson, J.; Osborn, R.N.; Sommers, P.; Widrig, R.D.

1985-08-01

The Guidelines are intended to provide guidance to the user in preparing a written plan for a proposed nuclear organization and administration. The Guidelines allow for individual approaches to organizational structures to account for differences in plant size, number of operating units, number of plant sites, and the individual utility approach to providing technical support. These unique approaches, however, should meet the criteria of a reasoned, fully developed, and logically consistent focus on the user's organization in terms of organization of work, policies and procedures, staffing, and external relationships

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

International Nuclear Information System (INIS)

Wu, Abraham J.; Bosch, Walter R.; Chang, Daniel T.; Hong, Theodore S.; Jabbour, Salma K.; Kleinberg, Lawrence R.; Mamon, Harvey J.; Thomas, Charles R.; Goodman, Karyn A.

2015-01-01

Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future

Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California.

Science.gov (United States)

Pfaendler, Krista S; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E; Penner, Kristine R

2018-05-01

To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB-IIA cervical cancer and to analyze the relationship between adherent care and survival. This is a retrospective population-based cohort study of patients with stage IB-IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer-specific 5-year survival. A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline-adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57-0.84), low-middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64-0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69-0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84-0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34-1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08-2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15-1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68-2.56) were all associated with increased

The engineering of microprocessor systems guidelines on system development

CERN Document Server

1979-01-01

The Engineering of Microprocessor Systems: Guidelines on System Development provides economical and technical guidance for use when incorporating microprocessors in products or production processes and assesses the alternatives that are available. This volume is part of Project 0251 undertaken by The Electrical Research Association, which aims to give managers and development engineers advice and comment on the development process and the hardware and software needed to support the engineering of microprocessor systems. The results of Phase 1 of the five-phase project are contained in this fir

Differences in delineation guidelines for head and neck cancer result in inconsistent reported dose and corresponding NTCP

International Nuclear Information System (INIS)

Brouwer, Charlotte L.; Steenbakkers, Roel J.H.M.; Gort, Elske; Kamphuis, Marije E.; Laan, Hans Paul van der; Veld, Aart A. van’t; Sijtsema, Nanna M.; Langendijk, Johannes A.

2014-01-01

Purpose: To test the hypothesis that delineation of swallowing organs at risk (SWOARs) based on different guidelines results in differences in dose–volume parameters and subsequent normal tissue complication probability (NTCP) values for dysphagia-related endpoints. Materials and methods: Nine different SWOARs were delineated according to five different delineation guidelines in 29 patients. Reference delineation was performed according to the guidelines and NTCP-models of Christianen et al. Concordance Index (CI), dosimetric consequences, as well as differences in the subsequent NTCPs were calculated. Results: The median CI of the different delineation guidelines with the reference guidelines was 0.54 for the pharyngeal constrictor muscles, 0.56 for the laryngeal structures and 0.07 for the cricopharyngeal muscle and esophageal inlet muscle. The average difference in mean dose to the SWOARs between the guidelines with the largest difference (maxΔD) was 3.5 ± 3.2 Gy. A mean ΔNTCP of 2.3 ± 2.7% was found. For two patients, ΔNTCP exceeded 10%. Conclusions: The majority of the patients showed little differences in NTCPs between the different delineation guidelines. However, large NTCP differences >10% were found in 7% of the patients. For correct use of NTCP models in individual patients, uniform delineation guidelines are of great importance

Matrix vaccination guidelines : 2015 ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries

NARCIS (Netherlands)

Hosie, Margaret J; Addie, Diane D; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hartmann, Katrin; Horzinek, Marian C; Lloret, Albert; Lutz, Hans; Marsilio, Fulvio; Pennisi, Maria Grazia; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Möstl, Karin

OVERVIEW: In 2013, the ABCD published 'Matrix vaccination guidelines: ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries' in a Special Issue of the Journal of Feline Medicine and Surgery (Volume 15, Issue 7, pages 540-544). The ABCD's vaccination recommendations

Guidelines for Description

NARCIS (Netherlands)

Links, P.; Horsman, Peter; Kühnel, Karsten; Priddy, M.; Reijnhoudt, Linda; Merenmies, Mark

2013-01-01

The Guidelines follow the conceptual metadata model (deliverable 17.2). They include guidelines for description of collection-holding institutions, document collections, organisations, personalities, events, camps and ghettos. As much as possible the guidelines comply with the descriptive standards

Radionuclide administration to nursing mothers: mathematically derived guidelines

International Nuclear Information System (INIS)

Romney, B.M.; Nickoloff, E.L.; Esser, P.D.; Alderson, P.O.

1986-01-01

We determined a formula to establish objective guidelines for the administration of radionuclides to nursing mothers. The formula is based on the maximum permissible dose to the infant's critical organ, serial measurements of breast milk activity, milk volume, and dose to the critical organ per microcurie in milk. Using worst-case assumptions, we believe that cessation of nursing for 24 hours after administration of technetium labeled radiopharmaceuticals is sufficient for safety. Longer-lived agents require greater delays. Iodine-123 radiopharmaceuticals are preferable to iodine-131 agents and should always be used when studying the unblocked thyroid

Light and sporadic physical activity overlooked by current guidelines makes older women more active than older men.

Science.gov (United States)

Amagasa, Shiho; Fukushima, Noritoshi; Kikuchi, Hiroyuki; Takamiya, Tomoko; Oka, Koichiro; Inoue, Shigeru

2017-05-02

Men are generally believed to be more physically active than women when evaluated using current physical activity (PA) guidelines, which count only moderate-to-vigorous physical activity (MVPA) in bouts lasting at least 10 min. However, it remains unclear men are truly more physically active provided that all-intensity PA are evaluated. This population based cross-sectional study aimed to examine gender differences in patterns of objectively-assessed PA in older adults. One thousand two hundred ten community-dwelling Japanese older adults who were originally randomly selected from residential registry of three municipalities were asked to respond a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare). The prevalence of achieving current PA guidelines, ≥150 min/week MVPA in bouts lasting at least 10 min, was calculated. Gender differences in volume of each-intensity activity (METs-hour) were assessed by analysis of covariance after adjustment for age and wear time. Data from 450 (255 men, mean 74 years) participants who had valid accelerometer data were analyzed. Women were less likely to meet the guidelines (men: 31.0, women: 21.5%; p women accumulated more light-intensity PA (LPA) and short-bout (1-9 min) MVPA, and thus established higher total volume of PA (men: 22.0 METs-hour/day, women: 23.9 METs-hour/day) (p women were less active when evaluated against current PA guidelines, but more active by total PA. Considering accumulated evidence on health benefits of LPA and short-bout MVPA, our findings highlight the potential for the limitation of assessing PA using current PA guidelines.

Primary care guidelines

DEFF Research Database (Denmark)

Ijäs, Jarja; Alanen, Seija; Kaila, Minna

2009-01-01

OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p ...: Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed....

Radiological risk comparison guidelines

International Nuclear Information System (INIS)

Hallinan, E.J.; Muhlestein, L.D.; Brown, L.F.; Yoder, R.E.

1992-01-01

An important aspect of DOE safety analyses is estimating potential accident risk. The estimates are used to: determine if additional controls are needed, identify Safety Class Items, and demonstrate adequate risk reduction. Thus, guidelines are needed to measure comparative risks. The Westinghouse M ampersand O Nuclear Facility Safety Committee and the Safety Envelope Working Group have developed radiological risk guidelines for comparing the risks from individual accident analyses. These guidelines were prepared under contract with the US Department of Energy. These guidelines are based on historical DOE guidelines and current requirements, and satisfy DOE and technical community proposals. for goals that demonstrate acceptable risk. The guidelines consist of a frequency versus consequence curve for credible accidents. Offsite and onsite guidelines are presented. The offsite risk acceptance guidelines are presented in Figure 1. The guidelines are nearly isorisk for anticipated events where impacts are chronic, and provide additional reduction for unlikely events where impacts may be acute and risk uncertainties may be significant. The guidelines are applied to individual release accident scenarios where a discrete frequency and consequence has been estimated. The guideline curves are not to be used for total risk assessments. Common cause events are taken into consideration only for an individual facility. Frequencies outside the guideline range are considered to be local site option (analyst judgement) as far as assessments of risk acceptance are concerned. If the curve is exceeded, then options include either a more detailed analysis or imposing additional preventive or mitigative features. Another presentation discusses implementation in detail. Additional work is needed to provide risk comparison guidelines for releases from multiple facilities and for toxic releases

Quality Guidelines

Science.gov (United States)

... this page: https://medlineplus.gov/criteria.html MedlinePlus Quality Guidelines To use the sharing features on this ... materials must also meet our existing quality guidelines. Quality, authority and accuracy of health content The organization's ...

Which points deserve special attention in the new guidelines on X-ray use (testing guidelines for experts and quality assurance guidelines)?

International Nuclear Information System (INIS)

Ewen, K.; Lauber, I.

2004-01-01

Two important guidelines for the application of X-rays in medicine became effective on 1 October 2003 and 1 December 2003. These are testing guidelines for experts and quality assurance guidelines. Both guidelines are very extensive and not always easy to interpret. In the present paper the authors try to explain in detail some chapters important for radiology and to make the necessary technical background transparent. Both authors took an essential part in forming the guidelines. (orig.) [de

Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise

Science.gov (United States)

Schünemann, Holger J.; Wiercioch, Wojtek; Etxeandia, Itziar; Falavigna, Maicon; Santesso, Nancy; Mustafa, Reem; Ventresca, Matthew; Brignardello-Petersen, Romina; Laisaar, Kaja-Triin; Kowalski, Sérgio; Baldeh, Tejan; Zhang, Yuan; Raid, Ulla; Neumann, Ignacio; Norris, Susan L.; Thornton, Judith; Harbour, Robin; Treweek, Shaun; Guyatt, Gordon; Alonso-Coello, Pablo; Reinap, Marge; Brožek, Jan; Oxman, Andrew; Akl, Elie A.

2014-01-01

Background: Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item. Methods: We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added. Results: We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items. Interpretation: The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date. PMID:24344144

Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture

Science.gov (United States)

Norgaard, Astrid; de Lichtenberg, Trine Honnens; Nielsen, Jens; Johansson, Pär I.

2014-01-01

Background The practice of transfusing red blood cells is still liberal in some centres suggesting a lack of compliance with guidelines recommending transfusion of red blood cells at haemoglobin levels of 6–8 g/dL in the non-bleeding patient. Few databases provide ongoing feedback of data on pre-transfusion haemoglobin levels at the departmental level. In a tertiary care hospital, no such data were produced before this study. Our aim was to establish a Patient Blood Management database based on electronic data capture in order to monitor compliance with transfusion guidelines at departmental and hospital levels. Materials and methods Hospital data on admissions, diagnoses and surgical procedures were used to define the populations of patients. Data on haemoglobin measurements and red blood cell transfusions were used to calculate pre-transfusion haemoglobin, percentage of transfused patients and transfusion volumes. Results The model dataset include 33,587 admissions, of which 10% had received at least one unit of red blood cells. Haemoglobin measurements preceded 96.7% of the units transfused. The median pre-transfusion haemoglobin was 8.9 g/dL (interquartile range 8.2–9.7) at the hospital level. In only 6.5% of the cases, transfusion was initiated at 7.3 g/dL or lower as recommended by the Danish national transfusion guideline. In 27% of the cases, transfusion was initiated when the haemoglobin level was 9.3 g/dL or higher, which is not recommended. A median of two units was transfused per transfusion episode and per hospital admission. Transfusion practice was more liberal in surgical and intensive care units than in medical departments. Discussion We described pre-transfusion haemoglobin levels, transfusion rates and volumes at hospital and departmental levels, and in surgical subpopulations. Initial data revealed an extensive liberal practice and low compliance with national transfusion guidelines, and identified wards in need of intervention. PMID

[Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].

Science.gov (United States)

Waldfahrer, F

2016-04-01

Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. © Georg Thieme Verlag KG Stuttgart · New York.

IMAGE Programming Guidelines

Energy Technology Data Exchange (ETDEWEB)

Stehfest, E; De Waal, L.

2010-09-15

This document describes the requirements and guidelines for the software of the IMAGE system. The motivation for this report was a substantial restructuring of the source code for IMAGE version 2.5. The requirements and guidelines relate to design considerations as well as to aspects of maintainability and portability. The design considerations determine guidelines about subjects, such as program structure, model hierarchy, the use of data modules, and the error message system. Maintainability and portability aspects determine the guidelines on, for example, the Fortran 90 standard, naming conventions, code lay-out, and internal documentation.

The Interplay of Media Violence Effects and Behaviorally Disordered Children and Adolescents: Guidelines for Practitioners.

Science.gov (United States)

Reich, Manuel D

2018-04-01

A robust body of scientific research explores the effects of violent media on youths. For practitioners, the volume of interdisciplinary research and controversial findings can be confusing and difficult to generalize for best practice. This article briefly reviews the literature and presents guidelines for parenting and treating youths exposed and enmeshed in violent media. Attention is given to at-risk populations and children presenting with aggressive, violent, and antisocial behavior. Guidelines assume a family based, cognitive-behavioral approach suitable for the eclectic practitioner, with a focus on the complex, developmental, and ecological factors that contribute to presenting symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

Photovoltaic system criteria documents. Volume 1: Guidelines for evaluating the management and operations planning of photovoltaic applications

Science.gov (United States)

Koenig, John C.; Billitti, Joseph W.; Tallon, John M.

1979-01-01

Guidelines are provided to the Field Centers for organization, scheduling, project and cost control, and performance in the areas of project management and operations planning for Photovoltaics Test and Applications. These guidelines may be used in organizing a T and A Project Team for system design/test, site construction and operation, and as the basis for evaluating T and A proposals. The attributes are described for project management and operations planning to be used by the Field Centers. Specifically, all project management and operational issues affecting costs, schedules and performance of photovoltaic systems are addressed. Photovoltaic tests and applications include residential, intermediate load center, central station, and stand-alone systems. The sub-categories of system maturity considered are: Initial System Evaluation Experiments (ISEE); System Readiness Experiments (SRE); and Commercial Readiness Demonstration Projects (CRDP).

The new hypertension guidelines.

Science.gov (United States)

Stern, Ralph H

2013-10-01

The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations. ©2013 Wiley Periodicals, Inc.

Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India

Science.gov (United States)

Sharma, Surendra K.; Ryan, H.; Khaparde, Sunil; Sachdeva, K. S.; Singh, Achintya D.; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

2017-01-01

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research. PMID:28862176

Public informations guidelines

International Nuclear Information System (INIS)

1986-06-01

The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities

Public informations guidelines

Energy Technology Data Exchange (ETDEWEB)

None

1986-06-01

The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities.

The CARE guidelines: consensus-based clinical case report guideline development.

Science.gov (United States)

Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David

2014-01-01

A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate, and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. Copyright © 2014 Reproduced with permission of Global Advances in Health and Medicine. Published by Elsevier Inc. All rights reserved.

RELAP5/MOD3 code manual. Volume 4, Models and correlations

International Nuclear Information System (INIS)

1995-08-01

The RELAP5 code has been developed for best-estimate transient simulation of light water reactor coolant systems during postulated accidents. The code models the coupled behavior of the reactor coolant system and the core for loss-of-coolant accidents and operational transients such as anticipated transient without scram, loss of offsite power, loss of feedwater, and loss of flow. A generic modeling approach is used that permits simulating a variety of thermal hydraulic systems. Control system and secondary system components are included to permit modeling of plant controls, turbines, condensers, and secondary feedwater systems. RELAP5/MOD3 code documentation is divided into seven volumes: Volume I presents modeling theory and associated numerical schemes; Volume II details instructions for code application and input data preparation; Volume III presents the results of developmental assessment cases that demonstrate and verify the models used in the code; Volume IV discusses in detail RELAP5 models and correlations; Volume V presents guidelines that have evolved over the past several years through the use of the RELAP5 code; Volume VI discusses the numerical scheme used in RELAP5; and Volume VII presents a collection of independent assessment calculations

Summary guidelines

Energy Technology Data Exchange (ETDEWEB)

Halsnaes, K.; Painuly, J.P.; Turkson, J.; Meyer, H.J.; Markandya, A.

1999-09-01

This document is a summary version of the methodological guidelines for climate change mitigation assessment developed as part of the Global Environment Facility (GEF) project Economics of Greenhouse Gas Limitations; Methodological Guidelines. The objectives of this project have been to develop a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change mitigation policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the Methodological Guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au) 13 refs.

Volumizing effects of a smooth, highly cohesive, viscous 20-mg/mL hyaluronic acid volumizing filler: prospective European study

Directory of Open Access Journals (Sweden)

Hoffmann Klaus

2009-08-01

Full Text Available Abstract Background Facial volume loss contributes significantly to facial aging. The 20-mg/mL hyaluronic acid (HA formulation used in this study is a smooth, highly cohesive, viscous, fully reversible, volumizing filler indicated to restore facial volume. This first prospective study evaluated use in current aesthetic clinical practice. Methods A pan-European evaluation conducted under guidelines of the World Association of Opinion and Marketing Research, the trial comprised a baseline visit (visit 1 and a follow-up (visit 2 at 14 ± 7 days posttreatment. Physicians photographed patients at each visit. Each patient was treated with the 20-mg/mL HA volumizing filler as supplied in standard packaging. Procedural details, aesthetic outcomes, safety, and physician and patient ratings of their experience were recorded. Results Fifteen physicians and 70 patients (91% female; mean age: 50 years participated. Mean volume loss at baseline was 3.7 (moderate on the Facial Volume Loss Scale. Local anesthesia was used in 64.3% of cases. Most injections (85% were administered with needles rather than cannulas. Of the 208 injections, 59% were in the malar region, primarily above the periosteum. Subcutaneous injections were most common for other sites. The mean total injection volume per patient was 4.6 mL. The mean volume loss score declined significantly (P Conclusion The 20-mg/mL smooth, highly cohesive, viscous, volumizing HA filler was effective, well tolerated, and easy to use in current clinical practice. Participants were very likely to recommend this product to colleagues and friends, and patients would be very or quite likely to request this product for future treatments.

Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

DEFF Research Database (Denmark)

Illidge, Tim; Specht, Lena; Yahalom, Joachim

2014-01-01

Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning...... tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles...... of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT...

On-Line Monitoring of Instrument Channel Performance: Volume 3: Applications to Nuclear Power Plant Technical Specification Instrumentation

International Nuclear Information System (INIS)

Davis, E.; Rasmussen, B.

2004-01-01

This report is a guide for a technical specification change submittal and subsequent implementation of on-line monitoring for safety-related applications. This report is the third in a three-volume set. Volume 1, ''Guidelines for Model Development and Implementation'', presents the various tasks that must be completed to prepare models for and to implement an on-line monitoring system

Alternative fuels for vehicles fleet demonstration program. Final report, volume 2: Appendices

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-06-01

The Alternative Fuels for Vehicles Fleet Demonstration Program (AFV-FDP) was a multiyear effort to collect technical data for use in determining the costs and benefits of alternative-fuel vehicles (AFVs) in typical applications in New York State. This report, Volume 2, includes 13 appendices to Volume 1 that expand upon issues raised therein. Volume 1 provides: (1) Information about the purpose and scope of the AFV-FDP; (2) A summary of AFV-FDP findings organized on the basis of vehicle type and fuel type; (3) A short review of the status of AFV technology development, including examples of companies in the State that are active in developing AFVs and AFV components; and (4) A brief overview of the status of AFV deployment in the State. Volume 3 provides expanded reporting of AFV-FDP technical details, including the complete texts of the brochure Garage Guidelines for Alternative Fuels and the technical report Fleet Experience Survey Report, plus an extensive glossary of AFV terminology. The appendices cover a wide range of issues including: emissions regulations in New York State; production and health effects of ozone; vehicle emissions and control systems; emissions from heavy-duty engines; reformulated gasoline; greenhouse gases; production and characteristics of alternative fuels; the Energy Policy Act of 1992; the Clean Fuel Fleet Program; garage design guidelines for alternative fuels; surveys of fleet managers using alternative fuels; taxes on conventional and alternative fuels; and zero-emission vehicle technology.

Author Guidelines

Directory of Open Access Journals (Sweden)

Yunisrina Qismullah Yusuf

2015-03-01

Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1 INTRODUCTION 1.1 Subheading of the content 1.1.1 Subheading of the content For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Back Matter| 79 80 | STUDIES IN ENGLISH LANGUAGE AND EDUCATION, Volume 1, Number 1, March 2014 Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v

Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

Directory of Open Access Journals (Sweden)

Surendra K Sharma

2017-01-01

Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

Global Imaging referral guidelines

International Nuclear Information System (INIS)

Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.

2010-01-01

The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement

Diversion path analysis handbook. Volume 2 (of 4 volumes). Example

International Nuclear Information System (INIS)

Goodwin, K.E.; Schleter, J.C.; Maltese, M.D.K.

1978-11-01

Volume 2 of the Handbook is divided into two parts, the workpaper documentation and the summary documentation. The former sets forth, in terms of the hypothetical process, the analysis guidelines, the information gathered, the characterization of the process, the specific diversion paths related to the process, and, finally, the results and findings of the Diversion Path Analysis (DPA). The summary documentation, made up of portions of sections already prepared for the workpapers, is a concise statement of results and recommendations for management use. Most of the details available in the workpapers are not used, or are held to a minimum, in this report. Also, some rearrangement of the excerpted sections has been made in order to permit rapid comprehension by a manager having only limited time to devote to study and review of the analysis

CONTAMINATED SOIL VOLUME ESTIMATE TRACKING METHODOLOGY

International Nuclear Information System (INIS)

Durham, L.A.; Johnson, R.L.; Rieman, C.; Kenna, T.; Pilon, R.

2003-01-01

The U.S. Army Corps of Engineers (USACE) is conducting a cleanup of radiologically contaminated properties under the Formerly Utilized Sites Remedial Action Program (FUSRAP). The largest cost element for most of the FUSRAP sites is the transportation and disposal of contaminated soil. Project managers and engineers need an estimate of the volume of contaminated soil to determine project costs and schedule. Once excavation activities begin and additional remedial action data are collected, the actual quantity of contaminated soil often deviates from the original estimate, resulting in cost and schedule impacts to the project. The project costs and schedule need to be frequently updated by tracking the actual quantities of excavated soil and contaminated soil remaining during the life of a remedial action project. A soil volume estimate tracking methodology was developed to provide a mechanism for project managers and engineers to create better project controls of costs and schedule. For the FUSRAP Linde site, an estimate of the initial volume of in situ soil above the specified cleanup guidelines was calculated on the basis of discrete soil sample data and other relevant data using indicator geostatistical techniques combined with Bayesian analysis. During the remedial action, updated volume estimates of remaining in situ soils requiring excavation were calculated on a periodic basis. In addition to taking into account the volume of soil that had been excavated, the updated volume estimates incorporated both new gamma walkover surveys and discrete sample data collected as part of the remedial action. A civil survey company provided periodic estimates of actual in situ excavated soil volumes. By using the results from the civil survey of actual in situ volumes excavated and the updated estimate of the remaining volume of contaminated soil requiring excavation, the USACE Buffalo District was able to forecast and update project costs and schedule. The soil volume

Breast cancer management: is volume related to quality? Clinical Advisory Panel.

Science.gov (United States)

Ma, M; Bell, J; Campbell, S; Basnett, I; Pollock, A; Taylor, I

1997-01-01

A method of carrying out region-wide audit for breast cancer was developed by collaboration between the cancer registry, providers and purchasers as part of work to fulfill the 'Calman-Hine' recommendations. In order to test the audit method, a retrospective audit in North Thames East compared practice in 1992 against current guidelines. The analysis compared care in specialist and non-specialist centres. A stratified random sample comprising 28% of all breast cancer patients diagnosed in 1992 was selected from the population-based Thames Cancer Registry. The data for 309 patients with stage I-III tumours were analysed by hospital type using local guidelines. No difference between specialist (high volume) and non-specialist centres was detected for factors important in survival. Pathological staging was good with over 70% reporting tumour size and grade. A small number of patients were undertreated; after conservative surgery, 10% (19) of women did not receive radiotherapy, and 15% (8) of node-positive premenopausal women did not receive chemotherapy or ovarian ablation. In contrast, a significant trend with hospital volume was found for several quality of life factors. These included access to a specialist breast surgeon and specialist breast nurses, availability of fine-needle aspiration (FNA), which ranged from 84% in high-volume to 42% in low-volume centres, and quality of surgery (axillary clearance rates ranged from 51% to 8% and sampling of less than three nodes from 3% to 25% for high- and very low-volume centres respectively). Confidential feedback of results to surgeons was welcomed and initiated change. The summary information gave purchasers information relevant to the evaluation of cancer services. While the audit applied present standards to past practice, it provided the impetus for prospective audit of current practice (now being implemented in North Thames).

Research to develop guidelines for cathodic protection of concentric neutral cables, volume 1

Science.gov (United States)

Hanck, J. A.; Nekoksa, G.

1981-08-01

Data associated with corrosion of concentric neutrals (CN) of direct buried cables from field tests conducted at 36 bellholes excavated in California, Oklahoma, and North Carolina are presented. The electrochemical, chemical, bacteriological, and sieve analyses of native soil and imported backfill samples are included. Up to 129 values were determined for each bellhole and stored on cards as a data bank. All values were statistically analyzed and correlated with corrosion found. The severity of corrosion correlated best with CN corrosion potentials, CN resistance measurements, coarseness of backfill, and soil resistivity. The guidelines for installation of cathodic protection on CN cables are to be based upon the evaluation of over 100 experimental cathodic protection systems and upon laboratory testing for protection criteria with and without ac effects.

ON-Line Monitoring of Instrument Channel Performance: Volume 3: Applications to Nuclear Power Plant Technical Specification Instrumentation

Energy Technology Data Exchange (ETDEWEB)

E Davis, B Rasmussen

2004-12-31

This report is a guide for a technical specification change submittal and subsequent implementation of on-line monitoring for safety-related applications. This report is the third in a three-volume set. Volume 1, ''Guidelines for Model Development and Implementation'', presents the various tasks that must be completed to prepare models for and to implement an on-line monitoring system.

Design patterns for modelling guidelines

NARCIS (Netherlands)

Serban, Radu; Ten Teije, Annette; Marcos, Mar; Polo-Conde, Cristina; Rosenbrand, Kitty C J G M; Wittenberg, Jolanda; van Croonenborg, Joyce

2005-01-01

It is by now widely accepted that medical guidelines can help to significantly improve the quality of medical care. Unfortunately, constructing the required medical guidelines is a very labour intensive and costly process. The cost of guideline construction would decrease if guidelines could be

7 CFR 622.5 - Guidelines.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Guidelines. 622.5 Section 622.5 Agriculture... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued by...

Development of cancer treatment guidelines

African Journals Online (AJOL)

Krystyna Kiel

2011-05-26

May 26, 2011 ... KEYWORDS. Cancer;. Therapy;. Guidelines. Contents. 1. Why develop guidelines? ... Widely available guideline resources in cancer care. ... The use of guidelines in medicine has a long history. Many .... She has a negative family history. ... The patient has 1 cm grade 3 infiltrating ductal carcinoma.

28 CFR 42.306 - Guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.306 Section 42.306... PROCEDURES Equal Employment Opportunity Program Guidelines § 42.306 Guidelines. (a) Recipient agencies are... guidelines under their equal employment opportunity program which will correct, in a timely manner, any...

28 CFR 42.404 - Guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.404 Section 42.404... Guidelines. (a) Federal agencies shall publish title VI guidelines for each type of program to which they extend financial assistance, where such guidelines would be appropriate to provide detailed information...

Visitor's Computer Guidelines | CTIO

Science.gov (United States)

Visitor's Computer Guidelines Network Connection Request Instruments Instruments by Telescope IR Instruments Guidelines Library Facilities Outreach NOAO-S EPO Program team Art of Darkness Image Gallery EPO/CADIAS ‹› You are here CTIO Home » Astronomers » Visitor's Computer Guidelines Visitor's Computer

Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections.

Science.gov (United States)

Solomkin, Joseph S; Mazuski, John; Blanchard, Joan C; Itani, Kamal M F; Ricks, Philip; Dellinger, E Patchen; Allen, George; Kelz, Rachel; Reinke, Caroline E; Berríos-Torres, Sandra I

Surgical site infection (SSI) is a common type of health-care-associated infection (HAI) and adds considerably to the individual, social, and economic costs of surgical treatment. This document serves to introduce the updated Guideline for the Prevention of SSI from the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). The Core section of the guideline addresses issues relevant to multiple surgical specialties and procedures. The second procedure-specific section focuses on a high-volume, high-burden procedure: Prosthetic joint arthroplasty. While many elements of the 1999 guideline remain current, others warrant updating to incorporate new knowledge and changes in the patient population, operative techniques, emerging pathogens, and guideline development methodology.

Nurses' experiences of guideline implementation

DEFF Research Database (Denmark)

Alanen, Seija; Välimäki, Marita; Kaila, Minna

2009-01-01

AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. DESIGN: Qualitative interview. METHODS: Data were generated by four focus group interviews involving nurses working in out-patient services in primary...... to nurses, (iii) factors related to the anticipated consequences and (iv) factors related to the patient group. Nurses' awareness and acceptance of guidelines and the anticipated positive consequences facilitate the implementation of guidelines. Organisational support, especially the adapting of guidelines...

76 FR 60017 - Technical Conference on Penalty Guidelines; Notice of Technical Conference on Penalty Guidelines

Science.gov (United States)

2011-09-28

... Conference on Penalty Guidelines; Notice of Technical Conference on Penalty Guidelines The staff of the... the Penalty Guidelines, which the Commission issued on September 17, 2010.\\1\\ The conference will be... impact of the Penalty Guidelines on compliance and enforcement matters. More information on the topics to...

Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

Energy Technology Data Exchange (ETDEWEB)

Illidge, Tim, E-mail: Tim.Illidge@ics.manchester.ac.uk [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Aleman, Berthe [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Constine, Louis [Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dharmarajan, Kavita [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Ricardi, Umberto [Radiation Oncology Unit, Department of Oncology, University of Torino, Torino (Italy); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

2014-05-01

Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.

Physical Activity Guidelines

Science.gov (United States)

... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource for ...

Compliance with European Guidelines for Diagnostic Mammography in a Decentralized Health-Care Setting

International Nuclear Information System (INIS)

Jensen, A.; Mikkelsen, G.J.; Vestergaard, M.; Lynge, E.; Vejborg, I.

2005-01-01

Purpose: To evaluate the compliance of Danish mammography clinics with requirements concerning organization, activity volume, and assessment procedures from two European guidelines for quality assurance in diagnostic mammography (EUSOMA and EUREF). Material and Methods: We used individual records on all diagnostic mammographies performed in Denmark in 2000, and questionnaires given to Danish mammography clinics in 2000, 2002, and 2004. Results: The study showed a marked centralization of the diagnostic activity from 2000 to 2004 to a smaller number of public breast assessment centers with full multidisciplinary breast assessment. However, a relatively large number of these centers did not comply with the activity volume requirement of 2000 mammograms per clinic per year. The number of private diagnostic mammography clinics performing basic diagnostic mammography has remained fairly stable in the period 2000 to 2004. Compared with public breast assessment centers, the private diagnostic mammography clinics had a lower compliance with activity volume requirements. Conclusion: A marked proportion of Danish public breast assessment centers operate with less than optimal activity volume, suggesting that further centralization would be appropriate. The situation in private diagnostic mammography clinics may cause concern, as our study showed that the majority of these clinics did not meet the activity volume requirements

An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol

Directory of Open Access Journals (Sweden)

Lemieux-Charles Louise

2009-07-01

Full Text Available Abstract Background Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. Methods The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension and institutional care (chronic ulcer, chronic heart failure topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Discussion Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective

Testing post-editing guidelines

DEFF Research Database (Denmark)

Flanagan, Marian; Christensen, Tina Paulsen

2014-01-01

guidelines to use in translator training programmes. Recently, the first set of publicly available industry-focused PE guidelines (for ‘good enough’ and ‘publishable’ quality) were developed by Translation Automation User Society (TAUS) in partnership with the Centre for Global Intelligent Content (CNGL......), which can be used as a basis on which to instruct post-editors in professional environments. This paper reports on a qualitative study that investigates how trainee translators on an MA course, which is aimed at preparing the trainees for the translation industry, interpret these PE guidelines...... for publishable quality. The findings suggest trainees have difficulties interpreting the guidelines, primarily due to trainee competency gaps, but also due to the wording of the guidelines. Based on our findings we propose training measures to address these competency gaps. Furthermore, we provide post...

The management of cytotoxic drug wastes in Shiraz, Iran: an overview of all government and private chemotherapy settings, and comparison with national and international guidelines.

Science.gov (United States)

Askarian, Mehrdad; Momeni, Mohsen; Danaei, Mina

2013-06-01

Excessive use of cytotoxic drugs owing to a dramatic increase in malignancy incidence leads to the production of high amounts of cytotoxic wastes. In Iran, management of hazardous wastes has been neglected in recent decades. The aim of this study was to determine the amount of intravenous cytotoxic drug wastes, their collection and disposal status in chemotherapy wards, and to compare the current status with standard guidelines in Shiraz, Iran. This cross-sectional study was performed using data collected during 2 consecutive months, from 22 June to 22 August 2011, in all 13 chemotherapy wards in Shiraz. The amount of prescribed drugs, drugs waste, collection and disposal status of cytotoxic drugs were recorded. We then compared the current status of waste collection and disposal in our samples with our national guideline. The prescription of cytotoxic drugs and the amount of total drugs waste reached approximately 6 and 0.2 kilograms respectively. Total vials volume was calculated to be approximately 1000 l in order to estimate the volume of containers required for the encapsulation method. The results demonstrated that the current status of cytotoxic waste collection and disposal is inappropriate, and none of the facilities under study followed our guidelines perfectly. The adherence to all recommendations and guidelines was poorer in private wards than in government-run ones. The management of cytotoxic wastes is inappropriate and our existing national guidelines are lacking. Suggestions for the best management of cytotoxic waste are revising the existing guidelines, allocating a sufficient budget, training healthcare workers, providing multiple administration options of cytotoxic drugs and accomplishing a surveillance system.

NASA Aerospace Flight Battery Program: Generic Safety, Handling and Qualification Guidelines for Lithium-Ion (Li-Ion) Batteries; Availability of Source Materials for Lithium-Ion (Li-Ion) Batteries; Maintaining Technical Communications Related to Aerospace Batteries (NASA Aerospace Battery Workshop). Volume 1, Part 1

Science.gov (United States)

Manzo, Michelle A.; Brewer, Jeffrey C.; Bugga, Ratnakumar V.; Darcy, Eric C.; Jeevarajan, Judith A.; McKissock, Barbara I.; Schmitz, Paul C.

2010-01-01

This NASA Aerospace Flight Battery Systems Working Group was chartered within the NASA Engineering and Safety Center (NESC). The Battery Working Group was tasked to complete tasks and to propose proactive work to address battery related, agency-wide issues on an annual basis. In its first year of operation, this proactive program addressed various aspects of the validation and verification of aerospace battery systems for NASA missions. Studies were performed, issues were discussed and in many cases, test programs were executed to generate recommendations and guidelines to reduce risk associated with various aspects of implementing battery technology in the aerospace industry. This document contains Part 1 - Volume I: Generic Safety, Handling and Qualification Guidelines for Lithium-Ion (Li-Ion) Batteries, Availability of Source Materials for Lithium-Ion (Li-Ion) Batteries, and Maintaining Technical Communications Related to Aerospace Batteries (NASA Aerospace Battery Workshop).

Appraising and comparing pressure ulcer guidelines.

Science.gov (United States)

Wimpenny, Peter; van Zelm, Ruben

2007-01-01

Whilst considerable activity has been related to guideline development for nurses regarding pressure ulcer prevention and management, no attempt has been made to comparatively evaluate these guidelines against some form of quality indicators. To compare and contrast four national pressure ulcer guidelines, and identify similarities and differences in their quality and content. An international comparative appraisal method, using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument, was undertaken to appraise four published pressure ulcer guidelines. Two further domains were added to the AGREE instrument to assess comparability of the guidelines and their perceived contribution to practice. An international group undertook the comparative appraisal. The domain scores for each guideline show some but not total agreement among reviewers. One particular set of guidelines was identified as scoring highest in a majority of AGREE domains. Overall, evidence of variability exists between pressure ulcer guidelines and common areas of development to consider for all guidelines. The results raise many questions concerning the "best" pressure ulcer guideline to use, particularly related to the AGREE scoring. Some notable shortcomings exist in all the pressure ulcer guidelines reviewed and these shortcomings need to be addressed from a quality perspective. However, other issues such as style of reporting and potential contribution to practice might more fully affect choice by practitioners as opposed to guideline developers. Notable differences exist among the four guidelines that are possibly explained by different approaches to development and also because of different cultural factors and intentions for use. Whilst the AGREE tool identifies the quality of the guideline development process it still requires local engagement with practitioners to determine which guideline should be implemented.

Japanese Guideline for Atopic Dermatitis

Directory of Open Access Journals (Sweden)

Ichiro Katayama

2011-01-01

The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2009 (ADGL2009” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle.

Using Hematology Data from Malaria Vaccine Research Trials in Humans and Rhesus Macaques (Macaca mulatta) To Guide Volume Limits for Blood Withdrawal.

Science.gov (United States)

Hegge, Sara R; Hickey, Bradley W; Mcgrath, Shannon M; Stewart, V Ann

2016-12-01

Guidelines on safe volume limits for blood collection from research participants in both humans and laboratory animals vary widely between institutions. The main adverse event that may be encountered in large blood volume withdrawal is iron-deficiency anemia. Monitoring various parameters in a standard blood panel may help to prevent this outcome. To this end, we analyzed the Hgb and MCV values from 43 humans and 46 macaques in malaria vaccine research trials. Although the percentage of blood volume removed was greater for macaques than humans, macaques demonstrated an overall increase of MCV over time, indicating the ability to respond appropriately to frequent volume withdrawals. In contrast, humans showed a consistent declining trend in MCV. These declines in human MCV and Hgb were significant from the beginning to end of the study despite withdrawals that were smaller than recommended volume limits. Limiting the volume withdrawn to no more than 12.5% seemed to be sufficient for macaques, and at 14% or more individual animals tended to fail to respond appropriately to large-volume blood loss, as demonstrated by a decrease in MCV. The overall positive erythropoietic response seen in macaques was likely due to the controlled, iron-fortified diet they received. The lack of erythropoietic response in the human subjects may warrant iron supplementation or reconsideration of current blood volume withdrawal guidelines.

Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

Directory of Open Access Journals (Sweden)

Gagliardi Anna R

2012-07-01

Full Text Available Abstract Background Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice. Methods We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements. Results Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients. Discussion Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.

10 CFR 960.3 - Implementation guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

[The German Program for Disease Management Guidelines: COPD Guideline 2006. Short review].

Science.gov (United States)

Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika

2007-01-15

In Germany, the first national consensus on evidence-based recommendations for COPD prevention and disease management was reached in spring 2006. After a development period of 9 months, the National Disease Management Guideline COPD was finalized by nominal group process under the authorship of the scientific societies for pneumology (DGP and Atemwegsliga), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the NICE COPD Guideline 2004, the GOLD Recommendations as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline COPD 2006 (www.copd.versorgungsleitlinien.de).

Classroom acoustics design guidelines based on the optimization of speaker conditions

DEFF Research Database (Denmark)

Pelegrin Garcia, David; Brunskog, Jonas

2012-01-01

School teachers suffer frequently from voice problems due to the high vocal load that they experience and the not-always-ideal conditions under which they have to teach. Traditionally, the purpose of the acoustic design of classrooms has been to optimize speech intelligibility. New guidelines...... and noise level measurements in classrooms. Requirements of optimum vocal comfort, average A-weighted speech levels across the audience higher than 50 dB, and a physical volume higher than 6 m3/student are combined to extract optimum acoustic conditions, which depend on the number of students....... These conditions, which are independent on the position of the speaker, cannot be optimum for more than 50 students. For classrooms with 10 students, the reverberation time in occupied conditions shall be between 0.5 and 0.65 s, and the volume between 60 and 170 m3. For classrooms with 40 students...

Maintenance Trades Guidelines

Science.gov (United States)

Weidner, Theodore J.

2008-01-01

In 2002, APPA published "Maintenance Staffing Guidelines for Educational Facilities," the first building maintenance trades staffing guideline designed to assist educational facilities professionals with their staffing needs. addresses how facilities professionals can determine the appropriate size and mix of their organization. Contents…

10 CFR 960.5 - Preclosure guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Preclosure guidelines. 960.5 Section 960.5 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5 Preclosure guidelines. The guidelines in this subpart specify the...

10 CFR 960.4 - Postclosure guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Postclosure guidelines. 960.4 Section 960.4 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4 Postclosure guidelines. The guidelines in this subpart specify the...

Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines

NARCIS (Netherlands)

Tabbers, M.M.; Boluyt, N.; Offringa, M.

2010-01-01

There is little experience with the nationwide implementation of an evidence-based pediatric guideline on first-choice fluid for resuscitation in hypovolemia. We investigated fluid prescribing behavior at (1) guideline development, (2) after guideline development, and (3) after active implementation

RSK-guidelines for PWR reactors

International Nuclear Information System (INIS)

1979-01-01

The RSK guidelines for PWA reactors of April 24, 1974, have been revised and amended in this edition. The RSK presents a summary of safety requirements to be observed in the design, construction, and operation of PWR reactors in the form of guidelines. From January 1979 onwards these guidelines will be the basis of siting and safety considerations for new PWR reactors, and newly built nuclear power plants will have to form these guidelines. They are not binding for existing nuclear power plants under construction or in operation. It will be a matter of individual discussion whether or not the guidelines will be applied in these plants. The main purpose of the guidelines is to facilitate discussion among RSK members and to give early information on necessary safety requirements. If the guidelines are observed by producers and operators, the RSK will make statements on individual projects at short notice. (orig./HP) [de

A review of clinical guidelines.

LENUS (Irish Health Repository)

Andrews, E J

2012-02-03

BACKGROUND: Clinical guidelines are increasingly used in patient management but few clinicians are familiar with their origin or appropriate application. METHODS: A Medline search using the terms \\'clinical guidelines\\' and \\'practice guidelines\\' was conducted. Additional references were sourced by manual searching from the bibliographies of articles located. RESULTS AND CONCLUSION: Clinical guidelines originated in the USA in the early 1980s, initially as a cost containment exercise. Significant improvements in the process and outcomes of care have been demonstrated following their introduction, although the extent of improvement varies considerably. The principles for the development of guidelines are well established but many published guidelines fall short of these basic quality criteria. Guidelines are only one aspect of improving quality and should be used within a wider framework of promoting clinical effectiveness. Understanding their limitations as well as their potential benefits should enable clinicians to have a clearer view of their place in everyday practice.

From Clinical Practice Guidelines to Computer-interpretable Guidelines. A Literature Overview

NARCIS (Netherlands)

Latoszek-Berendsen, A.; Tange, H.; van den Herik, H. J.; Hasman, A.

2010-01-01

Background: Guidelines are among us for over 30 years. Initially they were used as algorithmic protocols by nurses and other ancillary personnel. Many physicians regarded the use of guidelines as cookbook medicine. However, quality and patient safety issues have changed the attitude towards

Guidelines for radiological interventions

International Nuclear Information System (INIS)

Kauffmann, G.W.

1998-01-01

The German Radiological Society, in cooperation with other German professional bodies, set up draft Guidelines for Radiological Interventions and submitted them to the professional community for discussion. The Guidelines are meant to assess the potential of radiological interventions as treatment alternatives to surgery or aggressive therapy such as chemotherapy. In fact, technical practicability on its own is insufficient to warrant intervention. The Guidelines are systematically compiled notions and recommendations whose aim it is to provide support to physicians and patients in choosing suitable medical care provisions (prevention, diagnosis, therapy, aftertreatment) in specific circumstances. A complete Czech translation of the Guidelines is given. (P.A.)

Implications of the 2014 Androgen Excess and Polycystic Ovary Syndrome Society guidelines on polycystic ovarian morphology for polycystic ovary syndrome diagnosis

NARCIS (Netherlands)

Christ, J. P.; Gunning, M. N.; Fauser, B. C.J.M.

2017-01-01

The Androgen Excess and Polycystic Ovary Syndrome Society (AEPCOS) has recommended an updated threshold for polycystic ovarian morphology (PCOM) of 25 follicles or more, 10 ml or more of ovarian volume, or both. We describe the effect of these guidelines on reproductive and metabolic characteristics

Japanese Guideline for Atopic Dermatitis 2014

Directory of Open Access Journals (Sweden)

Ichiro Katayama

2014-01-01

The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2012 (ADGL2012" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2013" together with those for other allergic diseases.

Visibility in health statistics: a population data linkage study more accurately identifying Aboriginal and Torres Strait Islander Births in Victoria, Australia, 1988-2008

Directory of Open Access Journals (Sweden)

Rebecca Ritte

2017-04-01

This is the first time that the VPDC and RBDM birth data were linked in Victoria. The matched birth information established a more complete population profile of Aboriginal and/or Torres Strait Islander births. These data will provide a more accurate baseline to enhance the Victorian and Australian governments’ ability to plan services, allocate resources and evaluate funded activities aimed at eliminating disparity experienced by Aboriginal and/or Torres Strait Islander peoples. Importantly, it has established a more accurate denominator from which to calculate Aboriginal infant mortality rates for Victoria, Australia. *Until 2009, the mother’s Indigenous identification only was recorded in the VPDC

Incorporating a gender perspective into the development of clinical guidelines: a training course for guideline developers

Directory of Open Access Journals (Sweden)

Burgers Jako S

2007-11-01

Full Text Available Abstract Background Dutch guideline-developing organizations do not focus systematically on differences between men and women when developing guidelines, even though there is increasing evidence that being male or female may have an effect on health and health outcomes. In collaboration with two prominent Dutch guideline-developing organizations, we designed a training course to encourage systematic attention to sex differences in guideline development procedures. Methods The course is targeted towards guideline developers. Its aims are to improve awareness concerning the relevance of considering sex differences in the guideline development process, as well as the competence and skills necessary for putting this into practice. The design and teaching methods of the course are based on adult learning styles and principles of changing provider behaviour. It was adjusted to the working methods of guideline organizations. The course was taught to, and evaluated by, a group of staff members from two guideline organizations in the Netherlands. Results The course consists of five modules, each of which corresponds to a key step in the guideline development process. The participants rated the training course positively on content, programme, and trainers. Their written comments suggest that the course met its objectives. Conclusion The training course is the first to address sex differences in guideline development. Results from the pilot test suggest that the course achieved its objectives. Because its modules and teaching methods of the course are widely transferable, the course could be useful for many organizations that are involved in developing guidelines. Follow-up studies are needed to assess the long-term effect of the course on the actions of guideline developers and its utility in other settings.

The System 80+ Standard Plant design control document. Volume 23

International Nuclear Information System (INIS)

1997-01-01

This Design Control Document (DCD) is a repository of information comprising the System 80+trademark Standard Plant Design. The DCD also provides that design-related information to be incorporated by reference in the design certification rule for the System 80+ Standard Plant Design. Applicants for a combined license pursuant to 10 CFR 52 must ensure that the final Design Certification Rule and the associated Statements of Consideration are used when making all licensing decisions relevant to the System 80+ Standard Plant Design. The Design Control Document contains the DCD introduction, The Certified Design Material (CDM) [i.e., ''Tier 1''] and the Approved Design Material (ADM) [i.e., ''Tier 2''] for the System 80+ Standard Plant Design. The CDM includes the following sections: (1) Introductory material; (2) Certified Design Material for System 80+ systems and structures; (3) Certified Design Material for non-system-based aspects of the System 80+ Certified design; (4) Interface requirements; and (5) Site parameters. The ADM, to the extent applicable for the System 80+ Standard Plant Design, includes: (1) the information required for the final safety analysis report under 20 CFR 50.34; (2) other relevant information required by 10 CFR 52.47; and (3) emergency operations guidelines. This volume contains part 16 References and Appendix 19 A Design Alternatives for section 19 (Probabilistic Risk Assessment) of the ADM Design and Analysis. Also covered is section 20 Unresolved Safety Issues of the ADM Design and Analysis. Finally sections 1--6 of the ADM Emergency Operations Guidelines are contained in this volume. Information covered in these sections include: standard post-trip actions; diagnostic actions; reactor trip recovery guideline; LOCA recovery; SG tube rupture recovery

[The German Program for Disease Management Guidelines: CHD Guideline 2006. Short review].

Science.gov (United States)

Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina

2006-12-15

In Germany, the first national consensus on evidence-based recommendations for disease management in patients with chronic coronary heart disease was reached in summer 2006. After a development period of 4 years, the National Disease Management Guideline Chronic Coronary Heart Disease was finalized by nominal group process under the authorship of the scientific associations for cardiac rehabilitation (DGPR), cardiac surgery (DGTHG), cardiology (DGK), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the ACC/AHA guidelines 2002 updates as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Chronic Coronary Heart Disease 2006 (www.khk.versorgungsleitlinie.de).

Japanese guidelines for atopic dermatitis 2017

Directory of Open Access Journals (Sweden)

Ichiro Katayama

2017-04-01

The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2015 (ADGL2015” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the “Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2016” together with those for other allergic diseases.

Load research manual. Volume 1. Load research procedures

Energy Technology Data Exchange (ETDEWEB)

Brandenburg, L.; Clarkson, G.; Grund, Jr., C.; Leo, J.; Asbury, J.; Brandon-Brown, F.; Derderian, H.; Mueller, R.; Swaroop, R.

1980-11-01

This three-volume manual presents technical guidelines for electric utility load research. Special attention is given to issues raised by the load data reporting requirements of the Public Utility Regulatory Policies Act of 1978 and to problems faced by smaller utilities that are initiating load research programs. In Volumes 1 and 2, procedures are suggested for determining data requirements for load research, establishing the size and customer composition of a load survey sample, selecting and using equipment to record customer electricity usage, processing data tapes from the recording equipment, and analyzing the data. Statistical techniques used in customer sampling are discussed in detail. The costs of load research also are estimated, and ongoing load research programs at three utilities are described. The manual includes guides to load research literature and glossaries of load research and statistical terms.

OSART guidelines

International Nuclear Information System (INIS)

1988-02-01

The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the operational safety of nuclear power plants. These OSART Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness

Optimal contouring of seminal vesicle for definitive radiotherapy of localized prostate cancer: comparison between EORTC prostate cancer radiotherapy guideline, RTOG0815 protocol and actual anatomy

International Nuclear Information System (INIS)

Qi, Xin; Gao, Xian-Shu; Asaumi, Junichi; Zhang, Min; Li, Hong-Zhen; Ma, Ming-Wei; Zhao, Bo; Li, Fei-Yu; Wang, Dian

2014-01-01

Intermediate- to-high-risk prostate cancer can locally invade seminal vesicle (SV). It is recommended that anatomic proximal 1-cm to 2-cm SV be included in the clinical target volume (CTV) for definitive radiotherapy based on pathology studies. However, it remains unclear whether the pathology indicated SV extent is included into the CTV defined by current guidelines. The purpose of this study is to compare the volume of proximal SV included in CTV defined by EORTC prostate cancer radiotherapy guideline and RTOG0815 protocol with the actual anatomic volume. Radiotherapy planning CT images from 114 patients with intermediate- (36.8%) or high-risk (63.2%) prostate cancer were reconstructed with 1-mm-thick sections. The starting and ending points of SV and the cross sections of SV at 1-cm and 2-cm from the starting point were determined using 3D-view. Maximum (D 1H , D 2H ) and minimum (D 1L , D 2L ) vertical distance from these cross sections to the starting point were measured. Then, CTV of proximal SV defined by actual anatomy, EORTC guideline and RTOG0815 protocol were contoured and compared (paired t test). Median length of D 1H , D 1L , D 2H and D 2L was 10.8 mm, 2.1 mm, 17.6 mm and 8.8 mm (95th percentile: 13.5mm, 5.0mm, 21.5mm and 13.5mm, respectively). For intermediate-risk patients, the proximal 1-cm SV CTV defined by EORTC guideline and RTOG0815 protocol inadequately included the anatomic proximal 1-cm SV in 62.3% (71/114) and 71.0% (81/114) cases, respectively. While for high-risk patients, the proximal 2-cm SV CTV defined by EORTC guideline inadequately included the anatomic proximal 2-cm SV in 17.5% (20/114) cases. SV involvement indicated by pathology studies was not completely included in the CTV defined by current guidelines. Delineation of proximal 1.4 cm and 2.2 cm SV in axial plane may be adequate to include the anatomic proximal 1-cm and 2-cm SV. However, part of SV may be over-contoured

Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines.

Science.gov (United States)

Grégoire, Vincent; Evans, Mererid; Le, Quynh-Thu; Bourhis, Jean; Budach, Volker; Chen, Amy; Eisbruch, Abraham; Feng, Mei; Giralt, Jordi; Gupta, Tejpal; Hamoir, Marc; Helito, Juliana K; Hu, Chaosu; Hunter, Keith; Johansen, Jorgen; Kaanders, Johannes; Laskar, Sarbani Ghosh; Lee, Anne; Maingon, Philippe; Mäkitie, Antti; Micciche', Francesco; Nicolai, Piero; O'Sullivan, Brian; Poitevin, Adela; Porceddu, Sandro; Składowski, Krzysztof; Tribius, Silke; Waldron, John; Wee, Joseph; Yao, Min; Yom, Sue S; Zimmermann, Frank; Grau, Cai

2018-01-01

Few studies have reported large inter-observer variations in target volume selection and delineation in patients treated with radiotherapy for head and neck squamous cell carcinoma. Consensus guidelines have been published for the neck nodes (see Grégoire et al., 2003, 2014), but such recommendations are lacking for primary tumour delineation. For the latter, two main schools of thoughts are prevailing, one based on geometric expansion of the Gross Tumour Volume (GTV) as promoted by DAHANCA, and the other one based on anatomical expansion of the GTV using compartmentalization of head and neck anatomy. For each anatomic location within the larynx, hypopharynx, oropharynx and oral cavity, and for each T-stage, the DAHANCA proposal has been comprehensively reviewed and edited to include anatomic knowledge into the geometric Clinical Target Volume (CTV) delineation concept. A first proposal was put forward by the leading authors of this publication (VG and CG) and discussed with opinion leaders in head and neck radiation oncology from Europe, Asia, Australia/New Zealand, North America and South America to reach a worldwide consensus. This consensus proposes two CTVs for the primary tumour, the so called CTV-P1 and CVT-P2, corresponding to a high and lower tumour burden, and which should be associated with a high and a lower dose prescription, respectively. Implementation of these guidelines in the daily practice of radiation oncology should contribute to reduce treatment variations from clinicians to clinicians, facilitate the conduct of multi-institutional clinical trials, and contribute to improved care of patients with head and neck carcinoma. Copyright © 2017 Elsevier B.V. All rights reserved.

36 CFR 1191.1 - Accessibility guidelines.

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Accessibility guidelines... COMPLIANCE BOARD AMERICANS WITH DISABILITIES ACT (ADA) ACCESSIBILITY GUIDELINES FOR BUILDINGS AND FACILITIES; ARCHITECTURAL BARRIERS ACT (ABA) ACCESSIBILITY GUIDELINES § 1191.1 Accessibility guidelines. (a) The...

A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

Science.gov (United States)

Poitras, Stéphane; Avouac, Jérôme; Rossignol, Michel; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Éric; Hilliquin, Pascal

2007-01-01

Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed. PMID:18062805

Seismic design technology for breeder reactor structures. Volume 2. Special topics in soil/structure interaction analyses

International Nuclear Information System (INIS)

Reddy, D.P.

1983-04-01

This volume is divided into six chapters: definition of seismic input ground motion, review of state-of-the-art procedures, analysis guidelines, rock/structure interaction analysis example, comparison of two- and three-dimensional analyses, and comparison of analyses using FLUSH and TRI/SAC Codes

Guidelines on Building Regulations 2008

DEFF Research Database (Denmark)

Thse guidelines clarify and intepret the provisions of the Building Regulations of 2008 (BR08). The Guidelines, which match BR08 in terms of organisation into Parts, are accompanied by the full text of the regulations and the explanatory notes issued by the Danish Enterprise and Construction...... Authority. The Guidelines refer the reader to sources such as relevant standards, instructions and other background material which provides more detailed information. The Guidelines cover the same ground as BR08, including building control regulations, layout, fitting out, structures, fire safety, indoor...... climate, energy consumotion and services. The Guidelines are aimed at all professionals involved in building projects, particularly building design consultants, contractors and municipal application officers....

Managing challenging interactions with family caregivers in the cancer setting: Guidelines for clinicians (TRIO Guidelines-2).

Science.gov (United States)

Laidsaar-Powell, Rebekah; Butow, Phyllis; Boyle, Frances; Juraskova, Ilona

2018-06-01

Family caregivers can, at times, add complexity to clinical encounters. Difficult family caregivers and dynamics may: derail consultation communication, reduce patient autonomy, and compromise effective clinical care. A paucity of practical strategies guiding effective clinician-family communication exists. This study aimed to develop and evaluate the first comprehensive, evidence-based guidelines (the TRIO guidelines) for oncology physicians and nurses to better manage several complex/challenging situations involving family members. TRIO Guidelines were based on a comprehensive review of literature, relevant guidelines, and feedback from an expert advisory group (n = 10). Draft guidelines underwent two rounds of evaluation via an online Delphi consensus process involving international experts (n = 35). Guidelines incorporate topic areas, strategies, and sub-strategies on managing challenging family involvement (7 topics). Example wording, behaviours and level of evidence are provided. Challenging triadic interactions require skillful navigation, and the TRIO Guidelines provide clear, specific, and evidence-based strategies for clinicians to utilise in these potentially stressful encounters. Training based on these guidelines may improve both patient care and clinician confidence. Implementation of these guidelines into medical/nursing curricula and as a component of continuing professional development programs will likely be highly beneficial. Copyright © 2018 Elsevier B.V. All rights reserved.

Evidence-based guidelines

DEFF Research Database (Denmark)

Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

2015-01-01

diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...

Adopting preoperative fasting guidelines.

Science.gov (United States)

Anderson, Megan; Comrie, Rhonda

2009-07-01

In 1999, the American Society of Anesthesiologists adopted preoperative fasting guidelines to enhance the quality and efficiency of patient care. Guidelines suggest that healthy, non-pregnant patients should fast six hours from solids and two hours from liquids. Although these guidelines are in place, studies suggest that providers are still using the blanket statement "NPO after midnight" without regard to patient characteristics, the procedure, or the time of the procedure. Using theory to help change provider's beliefs may help make change more successful. Rogers' Theory of Diffusion of Innovations can assist in changing long-time practice by laying the groundwork for an analysis of the benefits and disadvantages of proposed changes, such as changes to fasting orders, while helping initiate local protocols instead of additional national guidelines.

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

Energy Technology Data Exchange (ETDEWEB)

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

2015-05-01

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

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

International Nuclear Information System (INIS)

Yahalom, Joachim; Illidge, Tim; Specht, Lena; Hoppe, Richard T.; Li, Ye-Xiong; Tsang, Richard; Wirth, Andrew

2015-01-01

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

32 CFR 231.11 - Guidelines.

Science.gov (United States)

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Guidelines. 231.11 Section 231.11 National... PROCEDURES GOVERNING BANKS, CREDIT UNIONS AND OTHER FINANCIAL INSTITUTIONS ON DOD INSTALLATIONS Guidelines for Application of the Privacy Act to Financial Institution Operations § 231.11 Guidelines. (a) The...

Methodological quality of guidelines in gastroenterology.

Science.gov (United States)

Malheiro, Rui; de Monteiro-Soares, Matilde; Hassan, Cesare; Dinis-Ribeiro, Mário

2014-06-01

Clinical guidelines are a common feature in modern endoscopy practice and they are being produced faster than ever. However, their methodological quality is rarely assessed. This study evaluated the methodological quality of current clinical guidelines in the field of gastroenterology, with an emphasis on endoscopy. Practice guidelines published by the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), British Society of Gastroenterology (BSG), National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN) were searched between September and October 2012 and evaluated using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument (23 items, scores 1 - 7 for each item; higher scores mean better quality). A total of 100 guidelines were assessed. The mean number of items scoring 6 or 7 per guideline was 9.2 (out of 23 items). Overall, 99 % of guidelines failed to include the target population in the development process, and 96 % did not report facilitators and barriers to guideline application. In addition, 86 % did not include advice or tools, and 94 % did not present monitoring or auditing criteria. The global methodological quality of clinical guidelines in the field of gastroenterology is poor, particularly regarding involvement of the target population in the development of guidelines and in the provision of clear suggestions to practitioners. © Georg Thieme Verlag KG Stuttgart · New York.

BWR emergency procedure guidelines

International Nuclear Information System (INIS)

Post, J.S.; Karner, E.F.; Stratman, R.A.

1984-01-01

This chapter describes plans for dealing with reactor accidents developed by the Boiling Water Reactor (BWR) Owners' Group in response to post-Three Mile Island US NRC requirements. The devised Emergency Procedure Guidelines (EPGs), applicable to all BWRs, are symptom-based rather than event-based. According to the EPGs, the operator does not need to identify what event is occurring in the plant in order to decide what action to take, but need only observe the symptoms (values and trends of key control parameters) which exist and take appropriate action to control these symptoms. The original objective was to provide reactor operator guidance in responding to a small break loss-of-coolant accident (LOCA), but subsequent revisions have included other types of reactor accidents. Topics considered include the reactor pressure vessel (RPV) control guideline, the primary containment control guideline, the secondary containment control guideline, the radioactivity release control guideline, multiple failures vs. the design basis, safe limits vs. technical specifications, the technical status, licensing, and implementation. The EPGs are based upon maintaining both adequate core cooling and primary containment integrity

Are BTS guidelines followed?

Science.gov (United States)

2002-03-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax. The study's aim was to determine the level of adherence to these guidelines at a London teaching hospital. A retrospective case note audit of 59 episodes was performed. In patients undergoing intervention, the initial procedure was simple aspiration in 32 (73 per cent) and chest tube insertion in 12 (27 per cent) cases, contrasting with the BTS recommendation that aspiration should be attempted first in all such patients. Simple aspiration was successful on 34 per cent of occasions. Successful aspiration was associated with a significantly shorter hospital stay (median 3, range 1-11 days) than either failed aspiration (7, 3-66 days) or chest tube insertion without aspiration (9, 3-16 days). Other areas where practice differed from the BTS guidelines were clamping of chest tubes and use of a pursestring suture for wound closure. A follow up questionnaire suggested a lack of familiarity with the guidelines. These findings indicate that current management of spontaneous pneumothorax deviates from the BTS guidelines in potentially important respects.

36 CFR 910.67 - Square guidelines.

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Square guidelines. 910.67... GUIDELINES AND UNIFORM STANDARDS FOR URBAN PLANNING AND DESIGN OF DEVELOPMENT WITHIN THE PENNSYLVANIA AVENUE DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

28 CFR 2.36 - Rescission guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Rescission guidelines. 2.36 Section 2.36... guidelines. (a) The following guidelines shall apply to the sanctioning of disciplinary infractions or new... such period of confinement has resulted from initial parole to a detainer). These guidelines specify...

Prospective Randomized Double-Blind Pilot Study of Site-Specific Consensus Atlas Implementation for Rectal Cancer Target Volume Delineation in the Cooperative Group Setting

International Nuclear Information System (INIS)

Fuller, Clifton D.; Nijkamp, Jasper; Duppen, Joop C.; Rasch, Coen R.N.; Thomas, Charles R.; Wang, Samuel J.; Okunieff, Paul; Jones, William E.; Baseman, Daniel; Patel, Shilpen; Demandante, Carlo G.N.; Harris, Anna M.; Smith, Benjamin D.; Katz, Alan W.; McGann, Camille

2011-01-01

Purpose: Variations in target volume delineation represent a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the effect of a consensus guideline-based visual atlas on contouring the target volumes. Methods and Materials: A representative case was contoured (Scan 1) by 14 physician observers and a reference expert with and without target volume delineation instructions derived from a proposed rectal cancer clinical trial involving conformal radiotherapy. The gross tumor volume (GTV), and two clinical target volumes (CTVA, including the internal iliac, presacral, and perirectal nodes, and CTVB, which included the external iliac nodes) were contoured. The observers were randomly assigned to receipt (Group A) or nonreceipt (Group B) of a consensus guideline and atlas for anorectal cancers and then instructed to recontour the same case/images (Scan 2). Observer variation was analyzed volumetrically using the conformation number (CN, where CN = 1 equals total agreement). Results: Of 14 evaluable contour sets (1 expert and 7 Group A and 6 Group B observers), greater agreement was found for the GTV (mean CN, 0.75) than for the CTVs (mean CN, 0.46-0.65). Atlas exposure for Group A led to significantly increased interobserver agreement for CTVA (mean initial CN, 0.68, after atlas use, 0.76; p = .03) and increased agreement with the expert reference (initial mean CN, 0.58; after atlas use, 0.69; p = .02). For the GTV and CTVB, neither the interobserver nor the expert agreement was altered after atlas exposure. Conclusion: Consensus guideline atlas implementation resulted in a detectable difference in interobserver agreement and a greater approximation of expert volumes for the CTVA but not for the GTV or CTVB in the specified case. Visual atlas inclusion should be considered as a feature in future clinical trials incorporating conformal RT.

Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting

Science.gov (United States)

Fuller, Clifton D.; Nijkamp, Jasper; Duppen, Joop; Rasch, Coen R.N.; Thomas, Charles R.; Wang, Samuel J.; Okunieff, Paul; Jones, William E.; Baseman, Daniel; Patel, Shilpen; Demandante, Carlo G. N.; Harris, Anna M.; Smith, Benjamin D.; Katz, Alan W.; McGann, Camille; Harper, Jennifer L.; Chang, Daniel T.; Smalley, Stephen; Marshall, David T.; Goodman, Karyn A.; Papanikolaou, Niko; Kachnic, Lisa A.

2010-01-01

Purpose Variation in target volume delineation represents a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the impact of a consensus guideline-based visual atlas on contouring of target volumes. Methods A representative case and target volume delineation instructions derived from a proposed rectal cancer clinical trial involving conformal radiotherapy were contoured (Scan1) by 14 physician observers and a reference expert. Gross tumor volume (GTV), and 2 clinical target volumes (CTVA, comprising internal iliac, pre-sacral, and peri-rectal nodes, and CTVB, external iliac nodes) were contoured. Observers were randomly assigned to receipt (Group_A) /non-receipt (Group_B) of a consensus guideline and atlas for anorectal cancers, then instructed to re-contour the same case/images (Scan2). Observer variation was analyzed volumetrically using conformation number (CN, where CN=1 equals a total agreement). Results In 14 evaluable contour sets (1 expert, 7 Group_A, 6 Group_B), there was greater agreement for GTV (mean CN 0.75) than CTVs (mean CN 0.46–0.65). Atlas exposure for Group_A led to a significant increased inter-observer agreement for CTVA (mean initial CN 0.68, post-atlas 0.76; p=0.03), as well as increased agreement with the expert reference (initial mean CN 0.58, 0.69 post-atlas; p=0.02). For GTV and CTVB, neither inter-observer nor expert agreement was altered after atlas exposure. Conclusion Consensus guideline atlas implementation resulted in a detectable difference in inter-observer agreement and greater approximation of expert volumes for CTVA, but not GTV or CTVB, in the specified case. Visual atlas inclusion should be considered as a feature in future clinical trials incorporating conformal radiotherapy. PMID:20400244

15 CFR 1170.4 - Guidelines.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Guidelines. 1170.4 Section 1170.4... ADMINISTRATION, DEPARTMENT OF COMMERCE METRIC CONVERSION POLICY FOR FEDERAL AGENCIES § 1170.4 Guidelines. Each... agency actions, activities or programs undertaken in compliance with these guidelines or other laws or...

ESUR prostate MR guidelines 2012

DEFF Research Database (Denmark)

Barentsz, Jelle O; Richenberg, Jonathan; Clements, Richard

2012-01-01

The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated......, but a compromise, reflected by "minimal" and "optimal" requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines...... provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. Clinical indications, and minimal and optimal imaging acquisition protocols are provided. A structured reporting system (PI-RADS) is described....

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.; Dressler, J.; Gruenwald, F.; Leisner, B.; Moser, E.; Reiners, C.; Schneider, P.; Schober, O.

2004-01-01

The version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves' disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves' disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient's preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients' preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3 rd version. (orig.) [de

Safety in Academic Chemistry Laboratories: Volume 2. Accident Prevention for Faculty and Administrators, 7th Edition.

Science.gov (United States)

American Chemical Society, Washington, DC.

This book contains volume 2 of 2 and describes safety guidelines for academic chemistry laboratories to prevent accidents for college and university students. Contents include: (1) "Organizing for Accident Prevention"; (2) "Personal Protective Equipment"; (3) "Labeling"; (4) "Material Safety Data Sheets (MSDSs)"; (5) "Preparing for Medical…

Guidelines for District Heating Substations

Energy Technology Data Exchange (ETDEWEB)

2009-07-15

The present guidelines contain a set of recommendations focusing on planning, installation, use and maintenance of district heating (DH) substations within district heating systems throughout Europe. The recommendations were developed in order to enable readers to develop well-functioning substations and an effective heat and domestic warm water delivery. These guidelines are intended to give the most effective overall solutions for various parts of the customer installation. The guidelines are not meant to specify the different components of the substation such as meters or heat exchangers. The guidelines deal with a wide variety of issues concerning both present systems of today and district heating systems of the future. Specific handling and maintenance recommendations are mainly focused on present modern systems but are also intended to cover the future situation as much as is feasible. For this reason, certain existing systems are not dealt with in these guidelines. For instance, these guidelines do not cover steam systems, systems with temperatures exceeding 110 deg C and pressure levels above 1.6 MPa. The guidelines include a chapter on the heat meter, as the meter and especially the meter installation is always installed simultaneously with the rest of the substation. These guidelines aim to provide best-practice and easy-to-handle recommendations for: - those who are responsible for relations between district heating utilities and customers; - those who own or maintain a building connected to the district heating network; - those who manufacture, plan, purchase, test and install substations. These guidelines do not deal with investment or cost aspects, but in general, Euroheat and Power recommends looking at the lifetime cost of all components of the substation, instead of investment costs alone. An example of this is provided in Chapter 7.8. The Guidelines were developed based on the most optimal operating principles of substations and meters

Strategy Guideline: Compact Air Distribution Systems

Energy Technology Data Exchange (ETDEWEB)

Burdick, A.

2013-06-01

This Strategy Guideline discusses the benefits and challenges of using a compact air distribution system to handle the reduced loads and reduced air volume needed to condition the space within an energy efficient home. Traditional systems sized by 'rule of thumb' (i.e., 1 ton of cooling per 400 ft2 of floor space) that 'wash' the exterior walls with conditioned air from floor registers cannot provide appropriate air mixing and moisture removal in low-load homes. A compact air distribution system locates the HVAC equipment centrally with shorter ducts run to interior walls, and ceiling supply outlets throw the air toward the exterior walls along the ceiling plane; alternatively, high sidewall supply outlets throw the air toward the exterior walls. Potential drawbacks include resistance from installing contractors or code officials who are unfamiliar with compact air distribution systems, as well as a lack of availability of low-cost high sidewall or ceiling supply outlets to meet the low air volumes with good throw characteristics. The decision criteria for a compact air distribution system must be determined early in the whole-house design process, considering both supply and return air design. However, careful installation of a compact air distribution system can result in lower material costs from smaller equipment, shorter duct runs, and fewer outlets; increased installation efficiencies, including ease of fitting the system into conditioned space; lower loads on a better balanced HVAC system, and overall improved energy efficiency of the home.

32 CFR 143.8 - Guidelines.

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Guidelines. 143.8 Section 143.8 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN DOD POLICY ON... BARGAINING § 143.8 Guidelines. The guidelines for making certain factual determinations are as follows: (a...

Transparent Guideline Methodology Needed

DEFF Research Database (Denmark)

Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

2013-01-01

As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working ...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....... Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...

The System 80+ Standard Plant design control document. Volume 24

International Nuclear Information System (INIS)

1997-01-01

This Design Control Document (DCD) is a repository of information comprising the System 80+trademark Standard Plant Design. The DCD also provides that design-related information to be incorporated by reference in the design certification rule for the System 80+ Standard Plant Design. Applicants for a combined license pursuant to 10 CFR 52 must ensure that the final Design Certification Rule and the associated Statements of Consideration are used when making all licensing decisions relevant to the System 80+ Standard Plant Design. The Design Control Document contains the DCD introduction, The Certified Design Material (CDM) [i.e., ''Tier 1''] and the Approved Design Material (ADM) [i.e., ''Tier 2''] for the System 80+ Standard Plant Design. The CDM includes the following sections: (1) Introductory material; (2) Certified Design Material for System 80+ systems and structures; (3) Certified Design Material for non-system-based aspects of the System 80+ Certified design; (4) Interface requirements; and (5) Site parameters. The ADM, to the extent applicable for the System 80+ Standard Plant Design, includes: (1) the information required for the final safety analysis report under 20 CFR 50.34; (2) other relevant information required by 10 CFR 52.47; and (3) emergency operations guidelines. This volume contains sections 7--11 of the ADM Emergency Operations Guidelines. Topics covered are: excess steam demand recovery; loss of all feedwater; loss of offsite power; station blackout recovery; and functional recovery guideline. Appendix A Severe Accident Management Guidelines and Appendix B Lower Mode Operational Guidelines are also included

Addressing implementation challenges during guideline development - a case study of Swedish national guidelines for methods of preventing disease.

Science.gov (United States)

Richter-Sundberg, Linda; Kardakis, Therese; Weinehall, Lars; Garvare, Rickard; Nyström, Monica E

2015-01-22

Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines. Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework. The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues. This case study

Reduced Albumin Dosing During Large-Volume Paracentesis Is Not Associated with Adverse Clinical Outcomes.

Science.gov (United States)

Johnson, Kara B; Mueller, Jessica L; Simon, Tracey G; Zheng, Hui; King, Lindsay Y; Makar, Robert S; Gervais, Debra A; Chung, Raymond T

2015-07-01

LVP is used to manage diuretic-resistant ascites in cirrhotic patients. Albumin administration prevents complications including acute kidney injury and paracentesis-induced circulatory dysfunction, but the optimal dose is unclear. We sought to assess adherence to guidelines enacted in July 2011 at our center for reducing the albumin dose administered at large-volume paracentesis (LVP) and evaluate the cost and rate of complications of LVPs before and after guideline enactment. All LVPs performed on cirrhotic patients in our center's Department of Radiology between July 2009 and January 2014 were studied. Outcomes included adherence to guidelines, LVP complications, and administered albumin cost. Groups were compared using Student's t tests for continuous data and Chi-square or Fisher's exact tests for categorical data. A repeated measurements model accounted for patients with multiple LVPs. Of the 935 LVPs, 288 occurred before guideline implementation (group 1) and 647 occurred after (group 2). The mean dose of albumin administered was 13.7 g/L of ascites removed in group 1 versus 10.3 g/L in group 2 (p albumin administration and associated cost savings was still observed. There was no increase in LVP-related complications after guideline implementation or in the adherent group, suggesting that albumin dose can be safely reduced. Future efforts should be directed at enhancing guideline adherence and potentially further reducing albumin dosing.

Behavioral consequences of conflict-oriented health news coverage: the 2009 mammography guideline controversy and online information seeking.

Science.gov (United States)

Weeks, Brian E; Friedenberg, Laura M; Southwell, Brian G; Slater, Jonathan S

2012-01-01

Building on channel complementarity theory and media-system dependency theory, this study explores the impact of conflict-oriented news coverage of health issues on information seeking online. Using Google search data as a measure of behavior, we demonstrate that controversial news coverage of the U.S. Preventive Services Task Force's November 2009 recommendations for changes in breast cancer screening guidelines strongly predicted the volume of same-day online searches for information about mammograms. We also found that this relationship did not exist 1 year prior to the coverage, during which mammography news coverage did not focus on the guideline controversy, suggesting that the controversy frame may have driven search behavior. We discuss the implications of these results for health communication scholars and practitioners.

Validation of the American Society for Reproductive Medicine guidelines/recommendations in white European men presenting for couple's infertility.

Science.gov (United States)

Ventimiglia, Eugenio; Capogrosso, Paolo; Boeri, Luca; Ippolito, Silvia; Scano, Roberta; Moschini, Marco; Gandaglia, Giorgio; Papaleo, Enrico; Montorsi, Francesco; Salonia, Andrea

2016-10-01

To retrospectively validate the American Society for Reproductive Medicine (ASRM) guidelines/recommendations concerning endocrine evaluation in a cohort of white European men presenting for couple's infertility. Retrospective study. Academic reproductive medicine outpatient clinic. Cohort of 1,056 consecutive infertile men (noninterracial infertile couples). Testicular volume was assessed with a Prader orchidometer. Serum hormones were measured (8-10 a.m.) in all cases. Hypogonadism was defined as total T Society definition. Semen analysis values were assessed based on the 2010 World Health Organisation reference criteria. ASRM indications for endocrine assessment in infertile men (sperm concentration Society classification criteria. Conversely, 37 (23.7%) out of 156 patients with biochemical hypogonadism would have been overlooked. The overall predictive accuracy, sensitivity, and specificity of the ASRM guidelines was 58%, 76%, and 39%, respectively. Our nomogram was not reliable enough to predict hypogonadism, despite demonstrating a significantly higher predictive accuracy (68%) than the ASRM guidelines. The current findings show that the ASRM guidelines/recommendations for male infertility workup may not be suitable for application in white European infertile men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

International Nuclear Information System (INIS)

Wu, Jackson Sai-Yiu; Wong, Rebecca KS; Lloyd, Nancy S; Johnston, Mary; Bezjak, Andrea; Whelan, Timothy

2004-01-01

This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

Science.gov (United States)

Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.

2011-01-01

Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more

Ecologo guidelines spark disagreement

International Nuclear Information System (INIS)

Anon.

1999-01-01

Defining what renewable means has been a challenge, but the authors of a new set of guidelines for the Ecologo certification of renewable low-impact electrcity expect after some delay to have the new rules on the street by March 2000.. There was contention in developing the guideline, according to Terra Choice Environmental Services, the company that created and applied criteria for Ecologo certification under the federal government's Environmetal Choice Program. Interim guidleines were developed and have been in place for renewable power since 1996, and have since been used to certify wood-waste biomass, landfill gas, small hydro and wind power plants, in addition to three green power marketing programs. The first draft of the revised guidelines was issued in March. It was one of the harder guidelines to have been worked on because Canadian power producers did not readily agree on what should qualify as renewable, particularly around the whole area of hydro. While small run-of-river hydro plants will continue to fit within the Ecologo guidelines, larger projects will not. Wind power producers are relatively happy with the latest version of TerraChoice's draft guidelines, released at the end of November. A significant revision of the original rules is a limit on the amount of older generation green power marketers who want to promote the green power Ecologo electricity can sell. At least 50% of their capacity must originate from plants installed after January 1, 1991

Web Accessibility and Guidelines

Science.gov (United States)

Harper, Simon; Yesilada, Yeliz

Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

10 CFR 960.4-2 - Technical guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Technical guidelines. 960.4-2 Section 960.4-2 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-2 Technical guidelines. The technical guidelines in this subpart...

International Variation in Asthma and Bronchiolitis Guidelines.

Science.gov (United States)

Bakel, Leigh Anne; Hamid, Jemila; Ewusie, Joycelyne; Liu, Kai; Mussa, Joseph; Straus, Sharon; Parkin, Patricia; Cohen, Eyal

2017-11-01

Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines. National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly. There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis, there were 46 recommendation topics, with 21 recommendation topics provided in ≥2 guidelines. The overall κ for asthma was 0.03, both unweighted (95% confidence interval [CI]: -0.01 to 0.07) and weighted (95% CI: -0.01 to 0.10); for bronchiolitis, it was 0.32 unweighted (95% CI: 0.16 to 0.52) and 0.15 weighted (95% CI: -0.01 to 0.5). Less agreement was found in national and international guidelines for asthma than for bronchiolitis. Additional studies are needed to determine if differences are based on patient preferences and values and economic considerations or if other recommendation-level, guideline-level, and condition-level factors are driving these differences. Copyright © 2017 by the American Academy of Pediatrics.

Surfing the best practice guidelines: national clinical guideline clearinghouse in development.

Science.gov (United States)

1997-08-01

The growth in development and usage of clinical guidelines during the last five years has been remarkable. Not only are health care practitioners reaching for what's deemed to be the best in protocols and practice, consumers, too, are looking toward standards and guidelines as they become more educated about the quality and quantity of health care services they should be receiving.

Guidelines for the verification and validation of expert system software and conventional software: User's manual. Volume 7

International Nuclear Information System (INIS)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A.

1995-03-01

This report provides a step-by-step guide, or user manual, for personnel responsible for the planning and execution of the verification and validation (V ampersand V), and developmental testing, of expert systems, conventional software systems, and various other types of artificial intelligence systems. While the guide was developed primarily for applications in the utility industry, it applies well to all industries. The user manual has three sections. In Section 1 the user assesses the stringency of V ampersand V needed for the system under consideration, identifies the development stage the system is in, and identifies the component(s) of the system to be tested next. These three pieces of information determine which Guideline Package of V ampersand V methods is most appropriate for those conditions. The V ampersand V Guideline Packages are provided in Section 2. Each package consists of an ordered set of V ampersand V techniques to be applied to the system, guides on choosing the review/evaluation team, measurement criteria, and references to a book or report which describes the application of the method. Section 3 presents details of 11 of the most important (or least well-explained in the literature) methods to assist the user in applying these techniques accurately

10 CFR 960.5-2 - Technical guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Technical guidelines. 960.5-2 Section 960.5-2 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-2 Technical guidelines. The technical guidelines in this subpart set...

Metric Guidelines Inservice and/or Preservice

Science.gov (United States)

Granito, Dolores

1978-01-01

Guidelines are given for designing teacher training for going metric. The guidelines were developed from existing guidelines, journal articles, a survey of colleges, and the detailed reactions of a panel. (MN)

The appraisal of clinical guidelines in dentistry.

Science.gov (United States)

Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco

2009-01-01

To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

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

Science.gov (United States)

Van der Wees, Philip J; Hendriks, Erik J M; Custers, Jan W H; Burgers, Jako S; Dekker, Joost; de Bie, Rob A

2007-11-23

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

Glaucoma-service provision in Scotland: introduction and need for Scottish Intercollegiate Guidelines Network guidelines.

Science.gov (United States)

Syrogiannis, Andreas; Rotchford, Alan P; Agarwal, Pankaj Kumar; Kumarasamy, Manjula; Montgomery, Donald; Burr, Jennifer; Sanders, Roshini

2015-01-01

To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.

Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics.

NARCIS (Netherlands)

Heins, M.J.; Jong, J.D. de; Spronk, I.; Ho, V.K.; Brink, M.; Korevaar, J.C.

2017-01-01

Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and

D 59 Design Guidelines

DEFF Research Database (Denmark)

Burcharth, Hans F.; Lamberti, Alberto

The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

Safety in Academic Chemistry Laboratories: Volume 1. Accident Prevention for College and University Students, 7th Edition.

Science.gov (United States)

American Chemical Society, Washington, DC.

This book contains volume 1 of 2 and describes safety guidelines for academic chemistry laboratories to prevent accidents for college and university students. Contents include: (1) "Your Responsibility for Accident Prevention"; (2) "Guide to Chemical Hazards"; (3) "Recommended Laboratory Techniques"; and (4) "Safety Equipment and Emergency…

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

International Nuclear Information System (INIS)

Specht, Lena; Yahalom, Joachim; Illidge, Tim; Berthelsen, Anne Kiil; Constine, Louis S.; Eich, Hans Theodor; Girinsky, Theodore; Hoppe, Richard T.; Mauch, Peter; Mikhaeel, N. George; Ng, Andrea

2014-01-01

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

Public safety around dams guidelines

Energy Technology Data Exchange (ETDEWEB)

Bennett, T [Canadian Dam Association, Edmonton, AB (Canada)

2010-07-01

This presentation discussed Canadian and international initiatives for improving dam safety and described some of the drivers for the development of new Canadian Dam Association (CDA) public safety guidelines for dams. The CDA guidelines were divided into the following 3 principal sections: (1) managed system elements, (2) risk assessment and management, and (3) technical bulletins. Public and media responses to the drownings have called for improved safety guidelines. While the public remains unaware of the hazards of dams, public interaction with dams is increasing as a result of interest in extreme sports and perceived rights of access. Guidelines are needed for dam owners in order to provide due diligence. Various organizations in Canada are preparing technical and public safety dam guidelines. CDA guidelines have also been prepared for signage, booms and buoys, and audible and visual alerts bulletins. Working groups are also discussing recommended practices for spill procedures, spillways and the role of professional engineers in ensuring public safety. Methods of assessing risk were also reviewed. Managed system elements for risk assessment and public interactions were also discussed, and stepped control measures were presented. tabs., figs.

Evaluation of maximum voided volume in Korean children by use of a 48-h frequency volume chart.

Science.gov (United States)

Kim, Sun-Ouck; Kim, Kyung Do; Kim, Young Sig; Kim, Jun Mo; Moon, Du Geon; Park, Sungchan; Lee, Sang Don; Chung, Jae Min; Cho, Won Yeol

2012-08-01

Study Type - Diagnostic (validating cohort). Level of Evidence 2a. What's known on the subject? and What does the study add? The relationship between the maximum voided volume followed a linear curve. The formula presented, bladder capacity (mL) = 12 ×[age (years) + 11], is thought to be a reasonable one for Korean children. Korean children have a smaller bladder capacity than that reported in previous Western studies. • To develop practical guidelines for the prediction of normal bladder capacity in Korean children measured by a frequency volume chart (FVC), maximum voided volume (MVV) is an important factor in the diagnosis of children with abnormal voiding function. • In all, 298 children, aged 3-13 years, with no history of voiding disorders volunteered for the study. The MVV was determined in 219 subjects by use of a completely recorded FVC. • Linear regression analysis was used to define the exact relationship between age and bladder capacity. An approximate formula related age to bladder capacity as follows: bladder capacity (mL) = 12 ×[age (years) + 11]. • The relationship between the MVV measured by a FVC by age (3-13 years) of Korean children followed a linear curve. • When applied to normal voiding patterns, the formula presented appears to be a reasonable one for Korean children. © 2011 BJU INTERNATIONAL.

The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Directory of Open Access Journals (Sweden)

Johnson Lorraine

2010-06-01

Full Text Available Abstract Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA. Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.

CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines

International Nuclear Information System (INIS)

Gregoire, Vincent; Levendag, Peter; Ang, Kian K.; Bernier, Jacques; Braaksma, Marijel; Budach, Volker; Chao, Cliff; Coche, Emmanuel; Cooper, Jay S.; Cosnard, Guy; Eisbruch, Avraham; El-Sayed, Samy; Emami, Bahman; Grau, Cai; Hamoir, Marc; Lee, Nancy; Maingon, Philippe; Muller, Karin; Reychler, Herve

2003-01-01

Background and purpose: The appropriate application of 3-D CRT and IMRT for HNSCC requires a standardization of the procedures for the delineation of the target volumes. Over the past few years, two proposals - the so-called Brussels guidelines from Gregoire et al., and the so-called Rotterdam guidelines from Nowak et al. - emerged from the literature for the delineation of the neck node levels. Detailed examination of these proposals however revealed some important discrepancies. Materials and methods: Within this framework, the Brussels and Rotterdam groups decided to review their guidelines and derive a common set of recommendations for delineation of neck node levels. This proposal was then discussed with representatives of major cooperative groups in Europe (DAHANCA, EORTC, GORTEC) and in North America (NCIC, RTOG), which, after some additional refinements, have endorsed them. The objective of the present article is to present the consensus guidelines for the delineation of the node levels in the node-negative neck. Results and conclusions: First a short discussion of the discrepancies between the previous Brussels and the Rotterdam guidelines is presented. The general philosophy of the consensus guidelines and the methodology used to resolve the various discrepancies are then described. The consensus proposal is then presented and representative CTVs that are consistent with these guidelines are illustrated on CT sections. Last, the limitations of the consensus guidelines are discussed and some concerns about the direct applications of these guidelines to the node-positive neck and the post-operative neck are described

Nurses' perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units.

Science.gov (United States)

Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine

2012-01-01

To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

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

Directory of Open Access Journals (Sweden)

Burgers Jako S

2007-11-01

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

Evidence-based guidelines for the wise use of computers by children: physical development guidelines.

Science.gov (United States)

Straker, L; Maslen, B; Burgess-Limerick, R; Johnson, P; Dennerlein, J

2010-04-01

Computer use by children is common and there is concern over the potential impact of this exposure on child physical development. Recently principles for child-specific evidence-based guidelines for wise use of computers have been published and these included one concerning the facilitation of appropriate physical development. This paper reviews the evidence and presents detailed guidelines for this principle. The guidelines include encouraging a mix of sedentary and whole body movement tasks, encouraging reasonable postures during computing tasks through workstation, chair, desk, display and input device selection and adjustment and special issues regarding notebook computer use and carriage, computing skills and responding to discomfort. The evidence limitations highlight opportunities for future research. The guidelines themselves can inform parents and teachers, equipment designers and suppliers and form the basis of content for teaching children the wise use of computers. STATEMENT OF RELEVANCE: Many children use computers and computer-use habits formed in childhood may track into adulthood. Therefore child-computer interaction needs to be carefully managed. These guidelines inform those responsible for children to assist in the wise use of computers.

AIDS guidelines.

Science.gov (United States)

Berger, R

1986-04-30

The Sun article, "Employers finding that AIDS in the workplace is a managerial nightmare" (April 3), did not accurately portray the status of AIDS in the workplace. The AIDS virus, HTLV III, is transmitted by body fluids, primarily semen and blood, and there is no known risk of transmitting the virus by casual contact in the workplace. The Center for Disease Control (CDC) released guidelines for child care workers last August. Guidelines on preventing transmission of AIDS in the workplace were issued by CDC in November 1985. These guidelines specifically discussed health care, personal service, and food service workers. The recommendations were against routine screening. Furthermore, employment should not be restricted on the basis of a positive HTLV III antibody test. A person with HTLV III infection should be exempt from the workplace only if there are circumstances interfering with job performance. In Maryland, the Governor's Task Force on AIDS has gone on record as endorsing CDC guidelines related to employment. Furthermore, the task force condemns discrimination based on the disease AIDS, AIDS Related Complex (ARC), or HTLV III infection. Increasingly AIDS patients are being considered legally disabled and therefore are protected by federal and state laws prohibiting discrimination on the basis of a handicap. Marylanders who are subjected to mandatory HTLV III screening in the workplace, or if discriminated against on the basis of HTLV III inefction, should contact the Maryland Commission on Human Relations, the Maryland Department of Health and Mental Hygiene, or the Health Education Resource Organization (HERO). All 3 of these resources guarantee confidentiality. It is only by employees reporting incidents that a nightmare in the workplace can be avoided in Maryland. full text

Guidelines for nuclear reactor equipments safety-analysis

International Nuclear Information System (INIS)

1978-01-01

The safety analysis in approving the applications for nuclear reactor constructions (or alterations) is performed by the Committee on Examination of Reactor Safety in accordance with various guidelines prescribed by the Atomic Energy Commission. In addition, the above Committee set forth its own regulations for the safety analysis on common problems among various types of nuclear reactors. This book has collected and edited those guidelines and regulations. It has two parts: Part I includes the guidelines issued to date by the Atomic Energy Commission: and Part II - regulations of the Committee. Part I has collected 8 categories of guidelines which relate to following matters: nuclear reactor sites analysis guidelines and standards for their applications; standard exposure dose of plutonium; nuclear ship operation guidelines; safety design analysis guidelines for light-water type, electricity generating nuclear reactor equipments; safety evaluation guidelines for emergency reactor core cooling system of light-water type power reactors; guidelines for exposure dose target values around light-water type electricity generating nuclear reactor equipments, and guidelines for evaluation of above target values; and meteorological guidelines for the safety analysis of electricity generating nuclear reactor equipments. Part II includes regulations of the Committee concerning - the fuel assembly used in boiling-water type and in pressurized-water type reactors; techniques of reactor core heat designs, etc. in boiling-water reactors; and others

Incremental guideline formalization with tool support

NARCIS (Netherlands)

Serban, Radu; Puig-Centelles, Anna; ten Teije, Annette

2006-01-01

Guideline formalization is recognized as an important component in improving computerized guidelines, which in turn leads to better informedness, lower inter-practician variability and, ultimately, to higher quality healthcare. By means of a modeling exercise, we investigate the role of guideline

Quality of evidence-based pediatric guidelines

NARCIS (Netherlands)

Boluyt, Nicole; Lincke, Carsten R.; Offringa, Martin

2005-01-01

Objective. To identify evidence-based pediatric guidelines and to assess their quality. Methods. We searched Medline, Embase, and relevant Web sites of guideline development programs and national pediatric societies to identify evidence-based pediatric guidelines. A list with titles of identified

Building Chronic Kidney Disease Clinical Practice Guidelines Using the openEHR Guideline Definition Language.

Science.gov (United States)

Lin, Ching-Heng; Lo, Ying-Chih; Hung, Pei-Yuan; Liou, Der-Ming

2016-12-07

As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality. Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation. Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation. Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.

Singapore Urological Association Clinical Guidelines for Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia.

Science.gov (United States)

2017-08-01

The first clinical guidelines for male lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) were published in 2005. An update is urgently needed in view of BPH being recognised as one of ten chronic illnesses by the Ministry of Health, Singapore. This review summarises the definition of BPH and the epidemiology of male LUTS/BPH in Singapore. BPH can be phenotyped with noninvasive transabdominal ultrasonography, according to intravesical prostatic protrusion and prostate volume, and classified according to severity (staging) for individualised treatment. At the initial evaluation, the majority of patients (59%) can be managed with fluid adjustment, exercise and diet; 32% with medications, using alpha blockers and/or 5-alpha reductase inhibitors for prostates weighing more than 30 g; and 9% with surgical intervention for more advanced disease. The 2015 guidelines comprise updated evidence that will help family medicine practitioners and specialists manage this common ailment more cost-effectively. Copyright: © Singapore Medical Association.

Whitebark pine planting guidelines

Science.gov (United States)

Ward McCaughey; Glenda L. Scott; Kay L. Izlar

2009-01-01

This article incorporates new information into previous whitebark pine guidelines for planting prescriptions. Earlier 2006 guidelines were developed based on review of general literature, research studies, field observations, and standard US Forest Service survival surveys of high-elevation whitebark pine plantations. A recent study of biotic and abiotic factors...

Measure Guideline: Ventilation Cooling

Energy Technology Data Exchange (ETDEWEB)

Springer, D. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), David, CA (United States)

2012-04-01

The purpose of this measure guideline is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

Standards and Guidelines in Telemedicine and Telehealth

Science.gov (United States)

Krupinski, Elizabeth A.; Bernard, Jordana

2014-01-01

The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. PMID:27429261

Raising the Bar with Trades Staffing Guidelines.

Science.gov (United States)

Weidner, Theodore J.

2000-01-01

Examines the APPA's Trades Staffing Guidelines Task Force for college campus building maintenance and presents descriptions of the proposed guideline levels and a matrix of indicators for the Trades Staffing Guidelines. The levels and matrix are intended to mimic features of the custodial staffing guidelines. (GR)

78 FR 38102 - Passenger Vessels Accessibility Guidelines

Science.gov (United States)

2013-06-25

... Costs and Benefits The primary estimates of the costs and benefits of the proposed guidelines are shown... quantify the benefits of the proposed guidelines due to the nature of the benefits. The proposed guidelines..., transportation, public accommodation, and leisure. The proposed guidelines would enable these individuals to...

28 CFR 23.30 - Funding guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Funding guidelines. 23.30 Section 23.30 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.30 Funding guidelines. The following funding guidelines shall apply to all Crime Control Act funded...

5 CFR 724.403 - Advisory guidelines.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Advisory guidelines. 724.403 Section 724.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...

Electrical safety guidelines

Energy Technology Data Exchange (ETDEWEB)

1993-09-01

The Electrical Safety Guidelines prescribes the DOE safety standards for DOE field offices or facilities involved in the use of electrical energy. It has been prepared to provide a uniform set of electrical safety standards and guidance for DOE installations in order to affect a reduction or elimination of risks associated with the use of electrical energy. The objectives of these guidelines are to enhance electrical safety awareness and mitigate electrical hazards to employees, the public, and the environment.

Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

Science.gov (United States)

Brigl, B; Ammenwerth, E; Dujat, C; Gräber, S; Grosse, A; Häber, A; Jostes, C; Winter, A

2005-01-01

Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

Inspector qualification guidelines

International Nuclear Information System (INIS)

Batty, A.C.; Van Binnebeek, J.J.; Ericsson, P.O.; Fisher, J.C.; Geiger, P.; Grandame, M.; Grimes, B.K.; Joode, A. de; Kaufer, B.; Kinoshita, M.; Klonk, H.; Koizumi, H.; Maeda, N.; Maqua, M.; Perez del Moral, C.; Roselli, F.; Warren, T.; Zimmerman, R.

1994-07-01

The OECD Nuclear Energy Agency Committee on Nuclear Regulatory Activities (CNRA) has a Working Group on Inspection Practices (WGIP). The WGIP provides a forum for the exchange of Information and experience on the safety Inspection practices of regulatory authorities In the CNRA member countries. A consistent qualification process and well defined level of training for all Inspectors who participate In the safety Inspections are needed to provide consistent Inspections and reliable Inspection results. The WGIP organized in 1992 a workshop on the conduct of inspections, inspector qualification and training, and shutdown inspections at the Technical Training Center of the US NRC in Chattanooga, Tennessee. In the connection of workshop the WGIP identified a need to develop guidance for inspector qualification which could be used as a model by those who are developing their qualification practices. The inspector qualification journals of US NRC provided a good basis for the work. The following inspector qualification guideline has been developed for guidance of qualification of a new inspector recruited to the regulatory body. This guideline has been developed for helping the supervisors and training officers to give the initial training and familiarization to the duties of a new inspector in a controlled manner. US NRC inspector qualification journals have been used to define the areas of attention. This guideline provides large flexibility for application in different type organizations. Large organizations can develop separate qualification journals for each inspector positions. Small regulatory bodies can develop individual training programmes by defining the necessary training topics on case by case basis. E.g. the guideline can be used to define the qualifications of contracted inspectors used in some countries. The appropriate part would apply. Annex 1 gives two examples how this guideline could be applied

Inspector qualification guidelines

Energy Technology Data Exchange (ETDEWEB)

Batty, A. C.; Van Binnebeek, J. J.; Ericsson, P. O.; Fisher, J. C.; Geiger, P.; Grandame, M.; Grimes, B. K.; Joode, A. de; Kaufer, B.; Kinoshita, M.; Klonk, H.; Koizumi, H.; Maeda, N.; Maqua, M.; Perez del Moral, C.; Roselli, F.; Warren, T.; Zimmerman, R.

1994-07-15

The OECD Nuclear Energy Agency Committee on Nuclear Regulatory Activities (CNRA) has a Working Group on Inspection Practices (WGIP). The WGIP provides a forum for the exchange of Information and experience on the safety Inspection practices of regulatory authorities In the CNRA member countries. A consistent qualification process and well defined level of training for all Inspectors who participate In the safety Inspections are needed to provide consistent Inspections and reliable Inspection results. The WGIP organized in 1992 a workshop on the conduct of inspections, inspector qualification and training, and shutdown inspections at the Technical Training Center of the US NRC in Chattanooga, Tennessee. In the connection of workshop the WGIP identified a need to develop guidance for inspector qualification which could be used as a model by those who are developing their qualification practices. The inspector qualification journals of US NRC provided a good basis for the work. The following inspector qualification guideline has been developed for guidance of qualification of a new inspector recruited to the regulatory body. This guideline has been developed for helping the supervisors and training officers to give the initial training and familiarization to the duties of a new inspector in a controlled manner. US NRC inspector qualification journals have been used to define the areas of attention. This guideline provides large flexibility for application in different type organizations. Large organizations can develop separate qualification journals for each inspector positions. Small regulatory bodies can develop individual training programmes by defining the necessary training topics on case by case basis. E.g. the guideline can be used to define the qualifications of contracted inspectors used in some countries. The appropriate part would apply. Annex 1 gives two examples how this guideline could be applied.

Guidelines for Posting Soil Contamination Areas

Energy Technology Data Exchange (ETDEWEB)

Mcnaughton, Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Eisele, William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-02-01

All soil guidelines were determined using RESRAD, version 6.1. All offsite guidelines are based on 15 mrem/year. This dose rate is sufficiently low to protect human health and is in accordance with DOE guidance and the proposed EPA 40-CFR-196 regulations for members of the public (never promulgated). For those onsite areas where general employees (non-radiological workers) could have routine access, soil concentrations should be based on a dose rate of 30 mrem/year (approximately one-third of the onsite LANL non-radiological worker dose of 100 mrem/year). In this case, soil concentration guidelines may be obtained by doubling the 15 mrem/year guidelines. Several scenarios were developed to provide maximum flexibility for application of the guidelines. The offsite guidelines were developed using: residential scenarios for both adults and children; a construction worker scenario; a resource user (e.g., a hunter) scenario; a child playing within canyon reaches scenario, a trail using jogger within canyon reaches scenario, and a trail using hiker within canyon reaches scenario. The residential guidelines represent the lowest values from both the adult residential scenario and the child residential scenario.

40 CFR 766.12 - Testing guidelines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Testing guidelines. 766.12 Section 766... DIBENZO-PARA-DIOXINS/DIBENZOFURANS General Provisions § 766.12 Testing guidelines. Analytical test methods must be developed using methods equivalent to those described or reviewed in Guidelines for the...

5 CFR 720.206 - Selection guidelines.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Selection guidelines. 720.206 Section 720... guidelines. This subpart sets forth requirements for a recruitment program, not a selection program... procedures and criteria must be consistent with the Uniform Guidelines on Employee Selection Procedures (43...

76 FR 63565 - Event Reporting Guidelines

Science.gov (United States)

2011-10-13

...-2011-0237] Event Reporting Guidelines AGENCY: Nuclear Regulatory Commission. ACTION: Draft NUREG... comments on Draft NUREG-1022, Revision 3, ``Event Reporting Guidelines: 10 CFR 50.72 and 50.73''. The NUREG-1022 contains guidelines that the NRC staff considers acceptable for use in meeting the event reporting...

Reporting of financial conflicts of interest in clinical practice guidelines: a case study analysis of guidelines from the Canadian Medical Association Infobase.

Science.gov (United States)

Shnier, Adrienne; Lexchin, Joel; Romero, Mirna; Brown, Kevin

2016-08-15

Clinical practice guidelines are widely distributed by medical associations and relied upon by physicians for the best available clinical evidence. International findings report that financial conflicts of interest (FCOI) with drug companies may influence drug recommendations and are common among guideline authors. There is no comparable study on exclusively Canadian guidelines; therefore, we provide a case study of authors' FCOI declarations in guidelines from the Canadian Medical Association (CMA) Infobase. We also assess the financial relationships between guideline-affiliated organizations and drug companies. Using a population approach, we extracted first-line drug recommendations and authors' FCOI disclosures in guidelines from the CMA Infobase. We contacted the corresponding authors on guidelines when FCOI disclosures were missing for some or all authors. We also extracted guideline-affiliated organizations and searched each of their websites to determine if they had financial relationships with drug companies. We analyzed 350 authors from 28 guidelines. Authors were named on one, two, or three guidelines, yielding 400 FCOI statements. In 75.0 % of guidelines at least one author, and in 21.4 % of guidelines all authors, disclosed FCOI with drug companies. In 54.0 % of guidelines at least one author, and in 28.6 % of guidelines over half of the authors, disclosed FCOI with manufacturers of drugs that they recommended. Twenty of 48 authors on multiple guidelines reported different FCOI in their disclosures. Eight guidelines identified affiliated organizations with financial relationships with manufacturers of drugs recommended in those guidelines. This is the first study to systematically describe FCOI disclosures by authors of Canadian guidelines and financial relationships between guideline-affiliated organizations and pharmaceutical companies. These financial relationships are common. Because authoritative value is assigned to guidelines distributed by

Guidelines for identifying suspect/counterfeit material

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-09-01

These guidelines are intended to assist users of products in identifying: substandard, misrepresented, or fraudulently marked items. The guidelines provide information about such topics as: precautions, inspection and testing, dispositioning identified items, installed inspection and reporting suspect/counterfeit materials. These guidelines apply to users who are developing procurement documents, product acceptance/verification methods, company procedures, work instructions, etc. The intent of these SM guidelines in relation to the Quality Assurance Program Description (QAPD) and implementing company Management Control Procedures is not to substitute or replace existing requirements, as defined in either the QAPD or company implementing instructions (Management Control Procedures). Instead, the guidelines are intended to provide a consolidated source of information addressing the issue of Suspect/Counterfeit materials. These guidelines provide an extensive suspect component listing and suspect indications listing. Users can quickly check their suspect items against the list of manufacturers products (i.e., type, LD. number, and nameplate information) by consulting either of these listings.

Strengthening the Enforcement of CSR Guidelines

DEFF Research Database (Denmark)

Olsen, Birgitte Egelund; Sørensen, Karsten Engsig

2014-01-01

the extensive right to refer complaints to them, the broad scope of the recommendations in the Guidelines and especially the use of naming and shaming in cases of breaches of the Guidelines, has changed the original character of the Guidelines as a purely soft law instrument. Furthermore, it is shown...... that the use of very broad and vague terminology in the Guidelines makes it very difficult for enterprises to comply with them. This is further complicated by the fact that many of the terms, which lay down when the NCPs have jurisdiction, are not clearly defined or explained. The three NCPs examined have...... implemented the Guidelines very differently. In particular the Danish NCP stands out. It has a jurisdiction which in many respects goes far beyond that envisioned in the Guidelines. This may put in question the legitimacy and effectiveness of the Danish NCP, but at the same time it can also be viewed...

Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center.

Science.gov (United States)

Kim, Min Gyu; Kwon, Sung Joon

2014-05-01

The volume-outcome relationship in laparoscopic surgery is controversial. This study was designed to identify differences in laparoscopic gastrectomy outcomes between a low-volume hospital and a high-volume center and to provide guidelines for overcoming the problems associated with a low-volume hospital. From April 2009 to November 2012, one surgeon performed 134 totally laparoscopic distal gastrectomies (TLDGs) at a high-volume center (HVC; ASAN Medical Center) and at a low-volume hospital (LVH; Hanyang University Guri Hospital). All laparoscopically assisted gastrectomies were excluded from this study. During the early period of laparoscopic gastrectomy at the low-volume hospital, TLDG with Roux-en-Y gastrojejunostomy (RYGJ) was performed according to the surgeon's choice. The reconstruction method was classified as gastroduodenostomy (GD) or RYGJ. Early surgical outcomes achieved at the LVH were investigated and compared with those obtained at the HVC. The early surgical outcomes differed significantly between the two hospitals. In particular, the postoperative complication rate for the patients who underwent TLDG RYGJ at the LVH was higher than at the HVC (LVH 15.4 % vs. HVC 0 %; p = 0.037). Furthermore, significant differences were observed in the mean operation time (TLDG GD: LVH 141.0 min vs. HVC 117.4 min, p = 0.001; TLDG RYGJ: LVH 186.3 min vs. HVC 134.6 min, p = 0.009) and length of hospital stay (TLDG GD: LVH 8.1 days vs. HVC 7.2 days, p = 0.044; TLDG RYGJ: LVH 11.5 day vs. HVC 6.8 day, p = 0.009). Although all the operations were performed by one experienced surgeon, the early surgical outcomes differed significantly between the low- and high-volume hospitals. Low-volume hospitals often lack well-trained surgical professionals such as first assistants and scrub nurses. Therefore, the authors recommend that a surgeon who works at an LVH should assess potential personnel shortages and find a solution before operating.

10 CFR 960.5-1 - System guidelines.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false System guidelines. 960.5-1 Section 960.5-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-1 System guidelines. (a) Qualifying conditions—(1) Preclosure...

32 CFR 310.36 - OMB training guidelines.

Science.gov (United States)

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false OMB training guidelines. 310.36 Section 310.36... PROGRAM DOD PRIVACY PROGRAM Training Requirements § 310.36 OMB training guidelines. The OMB guidelines (OMB Privacy Guidelines, 40 FR 28948 (July 9, 1975) require all agencies additionally to: (a) Instruct...

Technical Reviews and Audits for Systems, Equipment and Computer Software. Volume 1

Science.gov (United States)

2009-09-15

acquisitions and technology developments. 2. This new-issue SMC standard comprises the text of The Aerospace Corporation report number TOR-2007( 8583 )-6414...TRA) Deskbook – DUSD(S&T) (May 2005) 17. IMP & IMS Preparation and Use Guide Version 0.9 (21 October 2005) 18. ISO /IEC STD 15939 Software...1521B, TOR-2007( 8583 )-6414_Volume 1. 110.2 Purpose A. The guidelines contained herein implement the Department of Defense Directive 4120.21

[Preoperative fasting guidelines: an update].

Science.gov (United States)

López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

2015-03-01

Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Procedure guideline for radioiodine test. Version; Verfahrensanweisung zum Radioiodtest. Version 2

Energy Technology Data Exchange (ETDEWEB)

Dietlein, M.; Dressler, J.; Leisner, B.; Reiners, C.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Eschner, W.; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany)

2003-06-01

The version 2 of the procedure guideline for radioiodine test is an update of the guideline published in 1999. The following statements were added or modified: The procedure guideline discusses the pros and cons of a single measurement or of repeated measurements of the iodine-131 uptake and their optimal timing. Different formulas are described when one, two or three values of the radioiodine kinetic are available. The probe with a sodium iodide crystal, alternative or additionally the gamma-camera using the ROI-technique are instrumentations for the measurement of iodine-131 uptake. A possible source of error is an inappropriate measurement (sonography) of the target volume. The patients' preparation includes the withdrawal of antithyroid drugs 2-3 days before radioiodine administration. The patient has to avoid iodine-containing medication and the possibility of additives of iodide in vitamin- or electrolyte-supplementation has to be considered. (orig.) [German] Mit der Version 2 der Verfahrensanweisung zum Radioiodtest wird die in 1999 publizierte Verfahrensanweisung aktualisiert. Ergaenzungen und Modifikationen betreffen die notwendige Anzahl und die Zeitintervalle der Iod-131-Uptake-Messungen. Diskutiert werden die Argumente fuer die ein- oder mehrmalige Uptake-Messung. Berechnungsformeln fuer ein, zwei und drei Messpunkte werden angegeben. Als Messgeraete koennen die Uptake-Messsonde, alternativ oder zusaetzlich die Gammakamera mit ROI-Technik zum Einsatz kommen. Fehler bei der Volumetrie (Sonographie) des Zielvolumens gehen unmittelbar in die Berechnung der Therapieaktivitaet ein. Zur Vorbereitung der Patienten wird ein Absetzen der thyreostatischen Medikation 2 bis 3 Tage vor dem Radioiodtest empfohlen. Moeglich Iod(id) zusaetze in Multivitamin- und Spurenelementkombinationen sollten bedacht werden. (orig.)

Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

Directory of Open Access Journals (Sweden)

Bezjak Andrea

2004-10-01

Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

[Graphic synopsis of implementation of German guideline clearing reports in national disease management guidelines].

Science.gov (United States)

Thole, Henning

2011-01-01

While methods for the production of guidelines (evidence analysis, assessment, adaptation) have been continually refined throughout the past years, there is a lack of instruments for the production of easily understandable synopses. Definition of a methodological approach to encompass synopses by Spidernet diagrams. Tables of synopses can be generated with distinct information to bring down the main results in one Spidernet diagram. This is possible for both the entire synopsis and parts of it. Guideline comparisons require detailed analyses on the one hand and easily understandable presentations of their results on the other. Guideline synopses can be substantially supported by graphic presentation of the results of synopsis. Graphic synopsis is also helpful in other cases; it may be used, for example, to summarise HTA reports, systematic reviews or guidelines. Copyright © 2011. Published by Elsevier GmbH.

Water chemistry guidelines for BWRs

International Nuclear Information System (INIS)

Bilanin, W.J.; Jones, R.L.; Welty, C.S.

1984-01-01

Guidelines for BWR water chemistry control have been prepared by a committee of experienced utility industry personnel sponsored by the BWR Owners Group on IGSCC Research and coordinated by the Electric Power Research Institute. The guidelines are based on extensive plant operational experience and laboratory research data. The purpose of the guidelines is to provide guidance to the electric utility industry on water chemistry control to help reduce corrosion, especially stress corrosion cracking, in boiling water reactors

Olympic emblem guidelines: London 2012

OpenAIRE

2013-01-01

These guidelines issued by the London Organising Committee of the Olympic Games and Paralympic Games Ltd (“LOCOG”) provide standards, requirements and guidelines for use of the London 2012 Olympic Games Emblem (the “Emblem”) by LOCOG and the International Olympic Committee (IOC) creative, marketing and communications personnel, agencies and consultants only who are authorised to use the London 2012 marks. The purpose of these guidelines is to preserve and enhance the value of the Emblem for t...

5 CFR 1310.1 - Policy guidelines.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Policy guidelines. 1310.1 Section 1310.1 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES OMB CIRCULARS § 1310.1 Policy guidelines. In carrying out its responsibilities, the Office of Management and Budget issues policy guidelines to...

Design Guidelines for Low Crested Structures

DEFF Research Database (Denmark)

Burcharth, H. F.; Lamberti, Alberto

2004-01-01

1998-2002. The Guidelines comprise engineering aspects related to morphological impact and structure stability, biological aspects related to ecological impact, and socio-economical aspects related to the implementation of LCS-schemes. The guidelines are limited to submerged and regularly overtopped......The paper presents an overview of the design guidelines for low crested structures (LCS's) to be applied in coastal protection schemes. The design guidelines are formulated as a part of the research project: Environmental Design of Low Crested Coastal Defence Structures (DELOS) within the EC 5FP...

Methodological Quality of Consensus Guidelines in Implant Dentistry.

Science.gov (United States)

Faggion, Clovis Mariano; Apaza, Karol; Ariza-Fritas, Tania; Málaga, Lilian; Giannakopoulos, Nikolaos Nikitas; Alarcón, Marco Antonio

2017-01-01

Consensus guidelines are useful to improve clinical decision making. Therefore, the methodological evaluation of these guidelines is of paramount importance. Low quality information may guide to inadequate or harmful clinical decisions. To evaluate the methodological quality of consensus guidelines published in implant dentistry using a validated methodological instrument. The six implant dentistry journals with impact factors were scrutinised for consensus guidelines related to implant dentistry. Two assessors independently selected consensus guidelines, and four assessors independently evaluated their methodological quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Disagreements in the selection and evaluation of guidelines were resolved by consensus. First, the consensus guidelines were analysed alone. Then, systematic reviews conducted to support the guidelines were included in the analysis. Non-parametric statistics for dependent variables (Wilcoxon signed rank test) was used to compare both groups. Of 258 initially retrieved articles, 27 consensus guidelines were selected. Median scores in four domains (applicability, rigour of development, stakeholder involvement, and editorial independence), expressed as percentages of maximum possible domain scores, were below 50% (median, 26%, 30.70%, 41.70%, and 41.70%, respectively). The consensus guidelines and consensus guidelines + systematic reviews data sets could be compared for 19 guidelines, and the results showed significant improvements in all domain scores (p dentistry journals is needed. The findings of the present study may help researchers to better develop consensus guidelines in implant dentistry, which will improve the quality and trust of information needed to make proper clinical decisions.

Clinical practice guidelines in breast cancer

Science.gov (United States)

Tyagi, N. Kumar; Dhesy-Thind, S.

2018-01-01

Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability. Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor–positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario’s Program in Evidence Based Care (cco’s pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool. Results The quality of the cpgs was greatest for the guidelines developed by asco and cco’s pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory. Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations—such as intrinsic guideline characteristics and the needs of end users—is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.

Assessing Clinical Microbiology Practice Guidelines: American Society for Microbiology Ad Hoc Committee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment.

Science.gov (United States)

Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney

2017-11-01

As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.

Data Qualification guidelines

International Nuclear Information System (INIS)

Edwards, T.B.; Shine, E.P.

1992-01-01

Data Qualification (DQ) is a formal, technical process whose objective is to affirm that experimental data are suitable for their intended use. Although it is not possible to develop a fixed recipe for the DQ process to cover all test situations, these general guidelines have been developed for the Nuclear Engineering Section to establish a framework for qualifying data from steady-state processing. These guidelines outline the role of the DQ team providing insight into the planning and conducting of the DQ process

Guidelines for Learning Stations.

Science.gov (United States)

Fehrle, Carl C.; Schulz, Jolene

Guidelines for designing and planning learning stations for pupils at the elementary grade level include suggestions on how to develop a station that will be successful in meeting the learners' needs. Instructions for the use of tapes at a station and matching pupils with stations are given, as are guidelines on classroom arrangement and record…

42 CFR 438.236 - Practice guidelines.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Practice guidelines. 438.236 Section 438.236 Public... Improvement Standards § 438.236 Practice guidelines. (a) Basic rule: The State must ensure, through its...) Adoption of practice guidelines. Each MCO and, when applicable, each PIHP and PAHP adopts practice...

22 CFR 214.42 - Uniform pay guidelines.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Uniform pay guidelines. 214.42 Section 214.42... Advisory Committees § 214.42 Uniform pay guidelines. (a) A.I.D. follows OMB/CSC guidelines in section 11 of... experts, their compensation shall be fixed in accordance with CSC guidelines and regulations, and the...

Mexican Asthma Guidelines: GUIMA 2017

Directory of Open Access Journals (Sweden)

Désirée Larenas-Linnemann

2017-04-01

Full Text Available Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included. After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Suggested Curriculum Guidelines for an Effective Bilingual Program. 1972-1973. Destrezas Comunicativas del Idioma Espanol. Spanish Language Skills. Second Grade, Level 2.

Science.gov (United States)

Artesia Public Schools, NM.

This volume contains suggested curriculum guidelines for an effective bilingual program, with specific focus on Spanish language skills for the second grade level. The philosophy of the program views bilingual education as a vehicle and pedagogical tool to be used to better prepare all children to function in society. The point of departure for…

Suggested Curriculum Guidelines for an Effective Bilingual Program, 1972-1973. Destrezas Comunicativas del Idioma Espanol. Spanish Language Skills. Third Grade, Level 3.

Science.gov (United States)

Artesia Public Schools, NM.

This volume contains suggested curriculum guidelines for an effective bilingual program, with specific focus on Spanish language skills for the third grade level. The philosophy of the program views bilingual education as a vehicle and pedagogical tool to be used to better prepare all children to function in society. The point of departure for…

Target volume delineation and field setup. A practical guide for conformal and intensity-modulated radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Lee, Nancy Y. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States). Radiation Oncology; Lu, Jiade J. (eds.) [National Univ. Health System, Singapore (Singapore). Dept. of Radiation Oncology; National Univ. of Singapore (Singapore). Dept. of Medicine

2013-03-01

Practical handbook on selection and delineation of tumor volumes and fields for conformal radiation therapy, including IMRT. Helpful format facilitating use on a step-by-step basis in daily practice. Designed to ensure accurate coverage of commonly encountered tumors along their routes of spread. This handbook is designed to enable radiation oncologists to appropriately and confidently delineate tumor volumes/fields for conformal radiation therapy, including intensity-modulated radiation therapy (IMRT), in patients with commonly encountered cancers. The orientation of this handbook is entirely practical, in that the focus is on the illustration of clinical target volume (CTV) delineation for each major malignancy. Each chapter provides guidelines and concise knowledge on CTV selection for a particular disease, explains how the anatomy of lymphatic drainage shapes the selection of the target volume, and presents detailed illustrations of volumes, slice by slice, on planning CT images. While the emphasis is on target volume delineation for three-dimensional conformal therapy and IMRT, information is also provided on conventional radiation therapy field setup and planning for certain malignancies for which IMRT is not currently suitable.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome

Directory of Open Access Journals (Sweden)

Young-Jae Cho

2016-05-01

Full Text Available There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS. We generate strong (1 and weak (2 grade of recommendations based on high (A, moderate (B and low (C grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A and prone position if it is not contraindicated (1B to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B and inhaled nitric oxide (1A as a standard treatment. We also suggest high positive end-expiratory pressure (2B, extracorporeal membrane oxygenation as a rescue therapy (2C, and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B. The application of recruitment maneuver may reduce mortality (2B, however, the use of systemic steroids cannot reduce mortality (2B. In mechanically ventilated patients, we recommend light sedation (1B and low tidal volume even without ARDS (1B and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B. Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A. In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Clinical practice guidelines in patient management

Directory of Open Access Journals (Sweden)

Santosh Kumar

2001-01-01

Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

Guidelines in lower-middle income countries.

Science.gov (United States)

Olayemi, Edeghonghon; Asare, Eugenia V; Benneh-Akwasi Kuma, Amma A

2017-06-01

Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower-middle income countries (LMICs), there is a paucity of well-designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation. © 2017 John Wiley & Sons Ltd.

BWR water chemistry guidelines and PWR primary water chemistry guidelines in Japan – Purpose and technical background

Energy Technology Data Exchange (ETDEWEB)

Kawamura, Hirotaka, E-mail: kawamuh@criepi.denken.or.jp [Central Research Institute of Electric Power Industry (Japan); Hirano, Hideo [Central Research Institute of Electric Power Industry (Japan); Katsumura, Yousuke [University of Tokyo (Japan); Uchida, Shunsuke [Tohoku University (Japan); Mizuno, Takayuki [Mie University (Japan); Kitajima, Hideaki; Tsuzuki, Yasuo [Japan Nuclear Safety Institute (Japan); Terachi, Takumi [Institute of Nuclear Safety System, Inc. (Japan); Nagase, Makoto; Usui, Naoshi [Hitachi-GE Nuclear Energy, Ltd. (Japan); Takagi, Junichi; Urata, Hidehiro [Toshiba Corporation (Japan); Shoda, Yasuhiko; Nishimura, Takao [Mitsubishi Heavy Industry, Ltd. (Japan)

2016-12-01

Highlights: • Framework of BWR/PWR water chemistry Guidelines in Japan are presented. • Guideline necessity, definitions, philosophy and technical background are mentioned. • Some guideline settings for control parameters and recommendations are explaines. • Chemistry strategy is also mentioned. - Abstract: After 40 years of light water reactor (LWR) operations in Japan, the sustainable development of water chemistry technologies has aimed to ensure the highest coolant system component integrity and fuel reliability performance for maintaining LWRs in the world; additionally, it aimed to achieve an excellent dose rate reduction. Although reasonable control and diagnostic parameters are utilized by each boiling water reactor (BWR) and pressurized water reactor (PWR) owner, it is recognized that specific values are not shared among everyone involved. To ensure the reliability of BWR and PWR operation and maintenance, relevant members of the Atomic Energy Society of Japan (AESJ) decided to establish guidelines for water chemistry. The Japanese BWR and PWR water chemistry guidelines provide strategies to improve material and fuel reliability performance as well as to reduce dosing rates. The guidelines also provide reasonable “control values”, “diagnostic values” and “action levels” for multiple parameters, and they stipulate responses when these levels are exceeded. Specifically, “conditioning parameters” are adopted in the Japanese PWR primary water chemistry guidelines. Good practices for operational conditions are also discussed with reference to long-term experience. This paper presents the purpose, technical background and framework of the preliminary water chemistry guidelines for Japanese BWRs and PWRs. It is expected that the guidelines will be helpful as an introduction to achieve safety and reliability during operations.

Guidelines for Better Heart Health

Science.gov (United States)

Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...

2012 Guidelines for Water Reuse

Science.gov (United States)

This manual is a revision of the "2004 Water Reuse Guidelines." This document is a summary of reuse guidelines, with supporting information, for the benefit of utilities of utilities and regulatory agencies, particularly EPA.

Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries

NARCIS (Netherlands)

Burgers, Jako S.; Bailey, Julia V.; Klazinga, Niek S.; van der Bij, Akke K.; Grol, Richard; Feder, Gene

2002-01-01

OBJECTIVE: To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence. RESEARCH DESIGN AND METHODS: We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using

ASSET guidelines. Revised 1991 Edition

International Nuclear Information System (INIS)

1991-12-01

The present publication is an updated version of the IAEA Assessment of Safety Significant Events Team (ASSET) Guidelines, IAEA-TECDOC-573, published in 1990. Sections 5 and 6 include revised definitions and investigation guidelines for identification of both direct and root causes. These revisions were recommended by a Consultants Meeting held in Vienna on 3-7 December 1990. This guidance is not intended to infringe an expert's prerogative to investigate additional items. Its main purpose is to provide a basic structure and ensure consistency in the assessments. Use of the ASSET guidelines should also facilitate comparison between the observations made in different nuclear power plants and harmonize the reporting of generic ASSET results. The guidelines should always be used with a critical attitude and a view to possible improvements

Total quality management implementation guidelines

Energy Technology Data Exchange (ETDEWEB)

1993-12-01

These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Harris, Victoria A. [Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London (United Kingdom); Staffurth, John [Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales (United Kingdom); Naismith, Olivia [Joint Department of Physics, Institute of Cancer Research, and Royal Marsden NHS Foundation Trust, London (United Kingdom); Esmail, Alikhan [Ipswich Hospital NHS Foundation Trust, Ipswich (United Kingdom); Gulliford, Sarah [Joint Department of Physics, Institute of Cancer Research, and Royal Marsden NHS Foundation Trust, London (United Kingdom); Khoo, Vincent [Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London (United Kingdom); Lewis, Rebecca [Clinical Trials and Statistics Unit, Institute of Cancer Research, London (United Kingdom); Littler, John [Clatterbridge Cancer Centre, Liverpool (United Kingdom); McNair, Helen [Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London (United Kingdom); Sadoyze, Azmat [Beatson West of Scotland Cancer Centre, Scotland, Glasgow (United Kingdom); Scrase, Christopher [Ipswich Hospital NHS Foundation Trust, Ipswich (United Kingdom); Sohaib, Aslam [Department of Radiology, The Royal Marsden NHS Foundation Trust, London (United Kingdom); Syndikus, Isabel [Clatterbridge Cancer Centre, Liverpool (United Kingdom); Zarkar, Anjali [University Hospitals Birmingham NHS Foundation Trust, Birmingham (United Kingdom); Hall, Emma [Clinical Trials and Statistics Unit, Institute of Cancer Research, London (United Kingdom); Dearnaley, David, E-mail: David.Dearnaley@icr.ac.uk [Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London (United Kingdom)

2015-07-15

Purpose: The purpose of this study was to establish reproducible guidelines for delineating the clinical target volume (CTV) of the pelvic lymph nodes (LN) by combining the freehand Royal Marsden Hospital (RMH) and Radiation Therapy Oncology Group (RTOG) vascular expansion techniques. Methods and Materials: Seven patients with prostate cancer underwent standard planning computed tomography scanning. Four different CTVs (RMH, RTOG, modified RTOG, and Prostate and pelvIs Versus prOsTate Alone treatment for Locally advanced prostate cancer [PIVOTAL] trial) were created for each patient, and 6 different bowel expansion margins (BEM) were created to assess bowel avoidance by the CTV. The resulting CTVs were compared visually and by using Jaccard conformity indices. The volume of overlap between bowel and planning target volume (PTV) was measured to aid selection of an appropriate BEM to enable maximal LN yet minimal normal tissue coverage. Results: In total, 84 nodal contours were evaluated. LN coverage was similar in all groups, with all of the vascular-expansion techniques (RTOG, modified RTOG, and PIVOTAL), resulting in larger CTVs than that of the RMH technique (mean volumes: 287.3 cm{sup 3}, 326.7 cm{sup 3}, 310.3 cm{sup 3}, and 256.7 cm{sup 3}, respectively). Mean volumes of bowel within the modified RTOG PTV were 19.5 cm{sup 3} (with 0 mm BEM), 17.4 cm{sup 3} (1-mm BEM), 10.8 cm{sup 3} (2-mm BEM), 6.9 cm{sup 3} (3-mm BEM), 5.0 cm{sup 3} (4-mm BEM), and 1.4 cm{sup 3} (5-mm BEM) in comparison with an overlap of 9.2 cm{sup 3} seen using the RMH technique. Evaluation of conformity between LN-CTVs from each technique revealed similar volumes and coverage. Conclusions: Vascular expansion techniques result in larger LN-CTVs than the freehand RMH technique. Because the RMH technique is supported by phase 1 and 2 trial safety data, we proposed modifications to the RTOG technique, including the addition of a 3-mm BEM, which resulted in LN-CTV coverage similar

Clinical decisions for anterior restorations: the concept of restorative volume.

Science.gov (United States)

Cardoso, Jorge André; Almeida, Paulo Júlio; Fischer, Alex; Phaxay, Somano Luang

2012-12-01

The choice of the most appropriate restoration for anterior teeth is often a difficult decision. Numerous clinical and technical factors play an important role in selecting the treatment option that best suits the patient and the restorative team. Experienced clinicians have developed decision processes that are often more complex than may seem. Less experienced professionals may find difficulties making treatment decisions because of the widely varied restorative materials available and often numerous similar products offered by different manufacturers. The authors reviewed available evidence and integrated their clinical experience to select relevant factors that could provide a logical and practical guideline for restorative decisions in anterior teeth. The presented concept of restorative volume is based on structural, optical, and periodontal factors. Each of these factors will influence the short- and long-term behavior of restorations in terms of esthetics, biology, and function. Despite the marked evolution of esthetic restorative techniques and materials, significant limitations still exist, which should be addressed by researchers. The presented guidelines must be regarded as a mere orientation for risk analysis. A comprehensive individual approach should always be the core of restorative esthetic treatments. The complex decision process for anterior esthetic restorations can be clarified by a systematized examination of structural, optical, and periodontal factors. The basis for the proposed thought process is the concept of restorative volume that is a contemporary interpretation of restoration categories and their application. © 2012 Wiley Periodicals, Inc.

Guidelines for the verification and validation of expert system software and conventional software: User`s manual. Volume 7

Energy Technology Data Exchange (ETDEWEB)

Mirsky, S.M.; Hayes, J.E.; Miller, L.A. [Science Applications International Corp., McLean, VA (United States)

1995-03-01

This report provides a step-by-step guide, or user manual, for personnel responsible for the planning and execution of the verification and validation (V&V), and developmental testing, of expert systems, conventional software systems, and various other types of artificial intelligence systems. While the guide was developed primarily for applications in the utility industry, it applies well to all industries. The user manual has three sections. In Section 1 the user assesses the stringency of V&V needed for the system under consideration, identifies the development stage the system is in, and identifies the component(s) of the system to be tested next. These three pieces of information determine which Guideline Package of V&V methods is most appropriate for those conditions. The V&V Guideline Packages are provided in Section 2. Each package consists of an ordered set of V&V techniques to be applied to the system, guides on choosing the review/evaluation team, measurement criteria, and references to a book or report which describes the application of the method. Section 3 presents details of 11 of the most important (or least well-explained in the literature) methods to assist the user in applying these techniques accurately.

A Critical Review of Low Back Pain Guidelines.

Science.gov (United States)

Chetty, Laran

2017-09-01

Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.

Investigation of tDCS volume conduction effects in a highly realistic head model

Science.gov (United States)

Wagner, S.; Rampersad, S. M.; Aydin, Ü.; Vorwerk, J.; Oostendorp, T. F.; Neuling, T.; Herrmann, C. S.; Stegeman, D. F.; Wolters, C. H.

2014-02-01

Objective. We investigate volume conduction effects in transcranial direct current stimulation (tDCS) and present a guideline for efficient and yet accurate volume conductor modeling in tDCS using our newly-developed finite element (FE) approach. Approach. We developed a new, accurate and fast isoparametric FE approach for high-resolution geometry-adapted hexahedral meshes and tissue anisotropy. To attain a deeper insight into tDCS, we performed computer simulations, starting with a homogenized three-compartment head model and extending this step by step to a six-compartment anisotropic model. Main results. We are able to demonstrate important tDCS effects. First, we find channeling effects of the skin, the skull spongiosa and the cerebrospinal fluid compartments. Second, current vectors tend to be oriented towards the closest higher conducting region. Third, anisotropic WM conductivity causes current flow in directions more parallel to the WM fiber tracts. Fourth, the highest cortical current magnitudes are not only found close to the stimulation sites. Fifth, the median brain current density decreases with increasing distance from the electrodes. Significance. Our results allow us to formulate a guideline for volume conductor modeling in tDCS. We recommend to accurately model the major tissues between the stimulating electrodes and the target areas, while for efficient yet accurate modeling, an exact representation of other tissues is less important. Because for the low-frequency regime in electrophysiology the quasi-static approach is justified, our results should also be valid for at least low-frequency (e.g., below 100 Hz) transcranial alternating current stimulation.

Librarian contributions to clinical practice guidelines.

Science.gov (United States)

Cruse, Peggy; Protzko, Shandra

2014-01-01

Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.

Singapore Paediatric Resuscitation Guidelines 2016.

Science.gov (United States)

Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

Review: Christine von Blanckenburg, Birgit Böhm, Hans-Luidger Dienel & Heiner Legewie (2005. Leitfaden für interdisziplinäre Forschergruppen: Projekte initiieren – Zusammenarbeit gestalten [Guidelines for Interdisciplinary Research Teams: Initiating Projects—Developing Cooperation

Directory of Open Access Journals (Sweden)

Iris Rittenhofer

2008-01-01

Full Text Available Today, project-oriented work is an integral part of academic life. However, not all academics are ready to cope with this organizational aspect of scientific work or with the management of research teams. "Guidelines for Interdisciplinary Research Teams" provides a detailed outline of the various project stages, the potential conflicts and burgeoning power issues, as well as the basics and techniques of moderation. This volume offers excellent insight into the scientific enterprise and provides useful strategic options for managing teamwork. Thus, the volume is suitable for two purposes, namely as a set of guidelines for those inexperienced in scientific cooperation, and as a reference book for those who want to master their previous project experiences and utilize them in future enterprises. However, the intercultural aspect of scientific project organization is not discussed in the volume. URN: urn:nbn:de:0114-fqs0801179

State Emergency Department Opioid Guidelines: Current Status.

Science.gov (United States)

Broida, Robert I; Gronowski, Tanner; Kalnow, Andrew F; Little, Andrew G; Lloyd, Christopher M

2017-04-01

The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.

The complete European guidelines on phenylketonuria

DEFF Research Database (Denmark)

van Wegberg, A M J; MacDonald, A; Ahring, K

2017-01-01

severe intellectual disability, epilepsy and behavioural problems. PKU management differs widely across Europe and therefore these guidelines have been developed aiming to optimize and standardize PKU care. Professionals from 10 different European countries developed the guidelines according to the AGREE...... (Appraisal of Guidelines for Research and Evaluation) method. Literature search, critical appraisal and evidence grading were conducted according to the SIGN (Scottish Intercollegiate Guidelines Network) method. The Delphi-method was used when there was no or little evidence available. External consultants....... In addition, knowledge gaps are identified which require further research in order to direct better care for the future....

Misguided guidelines for managing labor.

Science.gov (United States)

Cohen, Wayne R; Friedman, Emanuel A

2015-06-01

In a recent review we expressed concerns about new guidelines for the assessment and management of labor recommended jointly by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These guidelines are based heavily on a new concept of how cervical dilatation and fetal descent progress, derived from the work of Zhang et al. In their Viewpoint article they have addressed, but not allayed, the concerns we described in our review. We assert that the dilatation curve promulgated by Zhang et al cannot be reconciled with direct clinical observation. Even if they were correct, however, it still does not follow that the ACOG/SMFM guidelines should recommend replacing the coherent system of identifying and managing labor aberrations described by Friedman. That system is grounded in well-established clinical principles based on decades of use and the objectively documented association of some labor abnormalities with poor fetal and maternal outcomes. Recommendations for new clinical management protocols should require the demonstration of superior outcomes through extensive, preferably prospective, assessment. Using untested guidelines for the management of labor may adversely affect women and children. Even if those guidelines were to reduce the currently excessive cesarean delivery rate, the price of that benefit is likely to be a trade-off in harm to parturients and their offspring. The nature and degree of that harm needs to be documented before considering adoption of the guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

Paralympic emblem guidelines: London 2012

OpenAIRE

2015-01-01

The purpose of these guidelines is to preserve and enhance the value of the Emblem for the benefit of all authorised users. These guidelines apply to LOCOG and IPC creative, marketing and communications personnel, agencies and consultants only.

Reporting guidelines and journal quality in otolaryngology.

Science.gov (United States)

Henderson, A H; Upile, T; Pilavakis, Y; Patel, N N

2016-10-01

Journals increasingly use reporting guidelines to standardise research papers, partly to improve quality. Although defining journal quality is difficult, various calculated metrics are used. This study investigates guideline adoption by otolaryngology journals and whether a relationship exists between this and journal quality. Retrospective MEDLINE database review for English language, Index Medicus, journals of interest to otolaryngologists (October 2013). The resulting journals were examined for the number of guidelines endorsed and then tabulated against surrogate measures of journal quality (Impact factor, Eigenfactor, SCImago, Source-Normalised rank). The primary outcome measure was the number of recognised reporting guidelines endorsed per journal. This was then correlated against journal quality scores. For comparison, a further small sample correlation was performed with 6 randomly selected and 6 high-profile clinical non-otolaryngology journals. 37 otolaryngology journals were identified. Number of guidelines used and quality scores were not normally distributed. Mean guideline usage was 1.0 for otolaryngology journals, 1.5 for randomly selected, and 5.5 for the high-profile journals. Only 18/37 (49%) otolaryngology journals endorsed any guidelines, compared with 11/12 non-otolaryngology journals. Within otolaryngology, Eigenfactor positively correlated with guideline use (r = 0.4, n = 44, p otolaryngology journals is low. Although it might be expected that use of reporting guidelines improved quality, this is not reflected in the derived quality scores in otolaryngology. This may reflect low levels of use/enforcement, that quality indicators are inherently flawed, or that generalised guidelines are not always appropriate or valued by editors. © 2015 John Wiley & Sons Ltd.

The 2015 Dutch food-based dietary guidelines.

Science.gov (United States)

Kromhout, D; Spaaij, C J K; de Goede, J; Weggemans, R M

2016-08-01

The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. Completely food-based dietary guidelines can be derived in a systematic and transparent way.

How do SAGES members rate its guidelines?

Science.gov (United States)

Hope, William W; Richardson, William; Fanelli, Robert; Stefanidis, Dimitrios

2014-04-01

The development of practice guidelines should take into consideration the opinions of end users. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has implemented several changes in its guideline development and dissemination process based on previous end-user input. An anonymous electronic survey was conducted via e-mail solicitation in September 2011. Respondents were asked to submit their feedback on the 26 guidelines produced by our society using a 32-item questionnaire and to suggest topics for new guideline development and areas of improvement. Responses from the survey were received by 494 people, of whom 474 (96 %) were clinicians; 373 (75 %) were general, laparoscopic, or bariatric surgeons; and 324 (65 %) held leadership roles within their institution. Most respondents were 35-44 years old (36 %), male (83 %), and had been in practice for over 10 years (54 %). A total of 383 (81 %) had used our guidelines, and, of those, 96 % agreed with their content. Guideline quality was rated 4.34; value 4.27; and ease of access 3.97 on a five-point Likert scale. The most commonly referenced guideline in the survey regarded surgical treatment of reflux (67 %), followed by laparoscopy during pregnancy (51 %). The three most common reasons guidelines were accessed were to update knowledge (68 %), to maximize patient care through evidence-based treatment (51 %), and to obtain a critical literature review. The majority of respondents indicated they greatly value and agree with our guidelines. These results indicate that recent efforts to improve our guidelines have succeeded.

Interconnection Guidelines

Science.gov (United States)

The Interconnection Guidelines provide general guidance on the steps involved with connecting biogas recovery systems to the utility electrical power grid. Interconnection best practices including time and cost estimates are discussed.

NCCN Guidelines® Insights Bladder Cancer, Version 2.2016 Featured Updates to the NCCN Guidelines

Science.gov (United States)

Clark, Peter E.; Spiess, Philippe E.; Agarwal, Neeraj; Bangs, Rick; Boorjian, Stephen A.; Buyyounouski, Mark K.; Efstathiou, Jason A.; Flaig, Thomas W.; Friedlander, Terence; Greenberg, Richard E.; Guru, Khurshid A.; Hahn, Noah; Herr, Harry W.; Hoimes, Christopher; Inman, Brant A.; Kader, A. Karim; Kibel, Adam S.; Kuzel, Timothy M.; Lele, Subodh M.; Meeks, Joshua J.; Michalski, Jeff; Montgomery, Jeffrey S.; Pagliaro, Lance C.; Pal, Sumanta K.; Patterson, Anthony; Petrylak, Daniel; Plimack, Elizabeth R.; Pohar, Kamal S.; Porter, Michael P.; Sexton, Wade J.; Siefker-Radtke, Arlene O.; Sonpavde, Guru; Tward, Jonathan; Wile, Geoffrey; Dwyer, Mary A.; Smith, Courtney

2017-01-01

These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the recommendation of intravesical bacillus Calmette-Guérin, (2) strengthening the recommendations for perioperative systemic chemotherapy, and (3) incorporating immunotherapy into second-line therapy for locally advanced or metastatic disease. These NCCN Guidelines Insights further discuss factors that affect integration of these recommendations into clinical practice. PMID:27697976

Guidelines for the verification and validation of expert system software and conventional software: Survey and documentation of expert system verification and validation methodologies. Volume 3

Energy Technology Data Exchange (ETDEWEB)

Groundwater, E.H.; Miller, L.A.; Mirsky, S.M. [Science Applications International Corp., McLean, VA (United States)

1995-03-01

This report is the third volume in the final report for the Expert System Verification and Validation (V&V) project which was jointly sponsored by the Nuclear Regulatory Commission and the Electric Power Research Institute. The ultimate objective is the formulation of guidelines for the V&V of expert systems for use in nuclear power applications. The purpose of this activity was to survey and document techniques presently in use for expert system V&V. The survey effort included an extensive telephone interviewing program, site visits, and a thorough bibliographic search and compilation. The major finding was that V&V of expert systems is not nearly as established or prevalent as V&V of conventional software systems. When V&V was used for expert systems, it was almost always at the system validation stage after full implementation and integration usually employing the non-systematic dynamic method of {open_quotes}ad hoc testing.{close_quotes} There were few examples of employing V&V in the early phases of development and only weak sporadic mention of the possibilities in the literature. There is, however, a very active research area concerning the development of methods and tools to detect problems with, particularly, rule-based expert systems. Four such static-testing methods were identified which were not discovered in a comprehensive review of conventional V&V methods in an earlier task.

Effluent Guidelines

Science.gov (United States)

Effluent guidelines are national standards for wastewater discharges to surface waters and municipal sewage treatment plants. We issue the regulations for industrial categories based on the performance of treatment and control technologies.

IT governance guidelines for directors

CERN Document Server

Calder, Alan

2005-01-01

This important new book – 'IT Governance: Guidelines for Directors' provides directors, executives, managers and professional advisers with clear, pragmatic guidelines for ensuring that IT and the business work together for the same strategic objectives. 

Exploiting thesauri knowledge in medical guideline formalization

OpenAIRE

Serban, R.C.; ten Teije, A.C.M.

2009-01-01

Objectives: As in software product lifecycle, the effort spent in maintaining medical knowl edge in guidelines can be reduced, if modularization, formalization and tracking of domain knowledge are employed across the guideline development phases. Methods: We propose to exploit and combine knowledge templates with medical background knowledge from existing thesauri in order to produce reusable building blocks used in guideline development. These tem- plates enable easier guideline formalizatio...

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

Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.

Science.gov (United States)

McDonald, Catherine H; Heggie, James; Jones, Christopher M; Thorne, Christopher J; Hulme, Jonathan

2013-08-01

Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance. 62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. 49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue. Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.

Manual for implementing residual radioactivity guidelines

International Nuclear Information System (INIS)

Gilbert, T.L.; Eckerman, K.F.; Hansen, W.R.; Healy, J.W.; Kennedy, W.E.; Napier, B.A.; Solday, J.K.

1986-01-01

The US Department of Energy (DOE) has recently issued guidelines for residual radioactivity at Formerly Utilized Sites Remedial Action Program (FUSRAP) and remote Surplus Facilities Management Program (SFMP) sites. A manual for implementing these guidelines has been prepared jointly by four DOE laboratories (ANL, LANL, ORNL, and PNL) and is being issued as a supplement to the guidelines. The manual presents procedures and tables for deriving site-specific guidelines for levels of residual radionuclide concentrations in soil that must not be exceeded if a site is to be released for unrestricted use. Guidance for implementing DOE ALARA policy for remedial actions is also included. The concentration factor method is used in the pathway analysis for deriving soil guidelines. The analysis has been structured in a manner that explicitly identifies all of the factors involved. Tables are provided for dose-conversion factors and pathway factors from which environmental transport factors for each radionuclide and pathway may be calculated. The scenarios used for deriving the environmental transport factors and dose conversion factors, and the manner in which the information provided in the manual is used to derive site-specific soil guidelines will be presented

[Guideline 'Organ donation following euthanasia"

NARCIS (Netherlands)

Mulder, H.; Olthuis, G.J.; Siebelink, M.; Gerritsen, R; Heurn, E. van

2017-01-01

- The multidisciplinary guideline 'Organ donation following euthanasia' was published in March 2017 at request of the Minister of Health, Welfare and Sport.- This guideline provides recommendations for the organisation and implementation of a request to donate organs expressed by a patient who asks

Guidelines for the verification and validation of expert system software and conventional software. Volume 7, User's manual: Final report

International Nuclear Information System (INIS)

Miller, L.A.; Hayes, J.E.; Mirsky, S.M.

1995-05-01

Reliable software is required for nuclear power industry applications. Verification and validation techniques applied during the software development process can help eliminate errors that could inhibit the proper operation of digital systems and cause availability and safety problems. Most of the techniques described in this report are valid for conventional software systems as well as for expert systems. The project resulted in a set of 16 V ampersand V guideline packages and 11 sets of procedures based on the class, development phase, and system component being tested. These guideline packages and procedures help a utility define the level of V ampersand V, which involves evaluating the complexity and type of software component along with the consequences of failure. In all, the project identified 153 V ampersand V techniques for conventional software systems and demonstrated their application to all aspects of expert systems except for the knowledge base, which requires specially developed tools. Each of these conventional techniques covers anywhere from 2-52 total types of conventional software defects, and each defect is covered by 21-50 V ampersand V techniques. The project also identified automated tools to Support V ampersand V activities

Medical Malpractice Implications of Clinical Practice Guidelines.

Science.gov (United States)

Ruhl, Douglas S; Siegal, Gil

2017-08-01

Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

Lupus nephritis management guidelines compared.

Science.gov (United States)

Wilhelmus, Suzanne; Bajema, Ingeborg M; Bertsias, George K; Boumpas, Dimitrios T; Gordon, Caroline; Lightstone, Liz; Tesar, Vladimir; Jayne, David R

2016-06-01

In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation. In this review, we summarize the guidelines, determine the common ground between them, highlight the differences and discuss recent literature. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Characteristics of effective clinical guidelines for general practice.

NARCIS (Netherlands)

Burgers, J.S.; Grol, R.P.T.M.; Zaat, J.O.M.; Spies, T.H.; Bij, A.K. van der; Mokkink, H.G.A.

2003-01-01

BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for

Guidelines for Reporting Medical Research

DEFF Research Database (Denmark)

Johansen, Mathilde; Thomsen, Simon Francis

2016-01-01

As a response to a low quality of reporting of medical research, guidelines for several different types of study design have been developed to secure accurate reporting and transparency for reviewers and readers from the scientific community. Herein, we review and discuss the six most widely...... accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...... reporting of medical research findings....

Implementation guidelines for seismic PSA

International Nuclear Information System (INIS)

Coman, Ovidiu; Samaddar, Sujit; Hibino, Kenta; )

2014-01-01

The presentation was devoted to development of guidelines for implementation of a seismic PSA. If successful, these guidelines can close an important gap. ASME/ANS PRA standards and the related IAEA Safety Guide (IAEA NS-G-2.13) describe capability requirements for seismic PSA in order to support risk-informed applications. However, practical guidance on how to meet these requirements is limited. Such guidelines could significantly contribute to improving risk-informed safety demonstration, safety management and decision making. Extensions of this effort to further PSA areas, particularly to PSA for other external hazards, can enhance risk-informed applications

Load research manual. Volume 2. Fundamentals of implementing load research procedures

Energy Technology Data Exchange (ETDEWEB)

Brandenburg, L.; Clarkson, G.; Grund, Jr., C.; Leo, J.; Asbury, J.; Brandon-Brown, F.; Derderian, H.; Mueller, R.; Swaroop, R.

1980-11-01

This three-volume manual presents technical guidelines for electric utility load research. Special attention is given to issues raised by the load data reporting requirements of the Public Utility Regulatory Policies Act of 1978 and to problems faced by smaller utilities that are initiating load research programs. In Volumes 1 and 2, procedures are suggested for determining data requirements for load research, establishing the size and customer composition of a load survey sample, selecting and using equipment to record customer electricity usage, processing data tapes from the recording equipment, and analyzing the data. Statistical techniques used in customer sampling are discussed in detail. The costs of load research also are estimated, and ongoing load research programs at three utilities are described. The manual includes guides to load research literature and glossaries of load research and statistical terms.

Maintaining formal models of living guidelines efficiently

NARCIS (Netherlands)

Seyfang, Andreas; Martínez-Salvador, Begoña; Serban, Radu; Wittenberg, Jolanda; Miksch, Silvia; Marcos, Mar; Ten Teije, Annette; Rosenbrand, Kitty C J G M

2007-01-01

Translating clinical guidelines into formal models is beneficial in many ways, but expensive. The progress in medical knowledge requires clinical guidelines to be updated at relatively short intervals, leading to the term living guideline. This causes potentially expensive, frequent updates of the

Compliance with practice guidelines: clinical autonomy revisited

NARCIS (Netherlands)

Klazinga, N.

1994-01-01

The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO

European guidelines for workplace drug testing in urine.

Science.gov (United States)

Taskinen, Sanna; Beck, Olof; Bosch, Tessa; Brcak, Michaela; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Weinmann, Wolfgang

2017-06-01

These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

[Elaboration and critical evaluation of clinical guidelines].

Science.gov (United States)

García Villar, C

2015-11-01

Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Closed cooling water chemistry guidelines revision

International Nuclear Information System (INIS)

McElrath, Joel; Breckenridge, Richard

2014-01-01

This second revision of the Closed Cooling Water Chemistry Guideline addresses the use of chemicals and monitoring methods to mitigate corrosion, fouling, and microbiological growth in the closed cooling-water (CCW) systems of nuclear and fossil-fueled power plants. This revision has been endorsed by the utility chemistry community and represents another step in developing a more proactive chemistry program to limit or control closed cooling system degradation with increased consideration of corporate resources and plant-specific design and operating concerns. These guidelines were developed using laboratory data, operating experience, and input from organizations and utilities within and outside of the United States of America. It is the intent of the Revision Committee that these guidelines are applicable to all nuclear and fossil-fueled generating stations around the world. A committee of industry experts—including utility specialists, Institute of Nuclear Power Operations representatives, water-treatment service-company representatives, consultants, a primary contractor, and EPRI staff—collaborated in reviewing available data on closed cooling-water system corrosion and microbiological issues. Recognizing that each plant owner has a unique set of design, operating, and corporate concerns, the Guidelines Committee developed a methodology for plant-specific optimization. The guideline provides the technical basis for a reasonable but conservative set of chemical treatment and monitoring programs. The use of operating ranges for the various treatment chemicals discussed in this guideline will allow a power plant to limit corrosion, fouling, and microbiological growth in CCW systems to acceptable levels. The guideline now includes closed cooling chemistry regimes proven successful in use in the international community. The guideline provides chemistry constraints for the use of phosphates control, as well as pure water with pH control. (author)

Guidelines for rating Global Assessment of Functioning (GAF

Directory of Open Access Journals (Sweden)

Aas IH Monrad

2011-01-01

Full Text Available Abstract Background Global Assessment of Functioning (GAF is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines. Methods A thorough literature search was conducted. Results Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1 general points about guidelines for rating GAF; (2 introduction to guidelines, with ground rules; (3 starting scoring at the top, middle or bottom level of the scale; (4 scoring for different time periods and of different values (highest, lowest or average; (5 the finer grading of the scale; (6 different guidelines for different conditions; and (7 different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding. Conclusions Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and

World Health Organization guideline development: an evaluation.

Directory of Open Access Journals (Sweden)

David Sinclair

Full Text Available BACKGROUND: Research in 2007 showed that World Health Organization (WHO recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own "Guidelines for Guidelines". In response, the WHO established a "Guidelines Review Committee" (GRC to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. METHODS AND FINDINGS: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for "Rigour of Development" (up 37.6%, from 30.7% to 68.3% and "Editorial Independence" (up 52.7%, from 20.9% to 73.6%. Four main themes emerged from the interviews: (1 high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2 views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3 staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4 the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. CONCLUSIONS: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance

Target volume determination in radiotherapy for non-small-cell lung cancer-facts and questions

International Nuclear Information System (INIS)

Kepka, L.; Bujko, K.

2003-01-01

Although the precise target volume definition in conformal radiotherapy is required by ICRU Report 50 and 62, this task in radiotherapy for non-small-cell lung cancer (NSCLC) is often controversial and strict accordance with ICRU requirements is hard to achieve. The Gross Tumour Volume (GTV) definition depends mainly on the imaging method used. We discuss the use of new imaging modalities, like PET, in GTV definition. The Clinical Target Volume (CTV) definition remains a separate, and still unresolved problem, especially in the part concerning the Elective Nodal Irradiation (ENI). Nowadays, there is no unified attitude among radiation oncologists regarding the necessity and extent of ENI. The common use of combined treatment modalities and the tendency to dose escalation, both increasing the potential toxicity, result in the more frequent use of involved-fields techniques. Problems relating to margins during Planning Target Volume (PTV) of lung cancer irradiation are also discussed. Another issue is the Interclinician variability in target volumes definition, especially when there is data indicating that the GTV, as defined by 3 D-treatment planning in NSCLC radiotherapy, may be highly prognostic for survival. We postulate that special attention should be paid to detailed precision of target volume determination in departmental and trial protocols. Careful analysis of patterns of failures from ongoing protocols will enable us to formulate the guidelines for target volume definition in radiotherapy for lung cancer. (author)

PIAAC Technical Standards and Guidelines

Science.gov (United States)

OECD Publishing, 2014

2014-01-01

The Programme for International Assessment of Adult Competencies (PIAAC) will establish technical standards and guidelines to ensure that the survey design and implementation processes of PIAAC yield high-quality and internationally comparable data. This document provides a revised version of the technical standards and guidelines originally…

Specialty Guidelines for Forensic Psychology

Science.gov (United States)

American Psychologist, 2013

2013-01-01

In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

ESUR prostate MR guidelines 2012

Energy Technology Data Exchange (ETDEWEB)

Barentsz, Jelle O.; Fuetterer, Jurgen J. [Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen (Netherlands); Richenberg, Jonathan [Brighton and Sussex University Hospital Trust, Brighton (United Kingdom); Clements, Richard [Royal Gwent Hospital, Department of Clinical Radiology, Newport, South Wales (United Kingdom); Choyke, Peter [National Cancer Institute, Molecular Imaging Program, Bethesda, MD (United States); Verma, Sadhna [University Of Cincinnati Medical Center, Cincinnati, OH (United States); Villeirs, Geert [Ghent University Hospital, Division of Genitourinary Radiology, Ghent (Belgium); Rouviere, Olivier [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Lyon (France); Universite de Lyon, Lyon (France); Universite Lyon 1, Faculte de Medecine Lyon Est, Lyon (France); Logager, Vibeke [Copenhagen University, Hospital Herlev, Herlev (Denmark)

2012-04-15

The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by ''minimal'' and ''optimal'' requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for ''detection'', ''staging'' and ''node and bone'' are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented. (orig.)

41 CFR 109-39.301 - Utilization guidelines.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Utilization guidelines... Management System Vehicles § 109-39.301 Utilization guidelines. DOE activities utilizing GSA IFMS motor... meeting DOE utilization guidelines or established local use objectives, as appropriate. Those vehicles not...

28 CFR 2.21 - Reparole consideration guidelines.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Reparole consideration guidelines. 2.21....21 Reparole consideration guidelines. (a)(1) If revocation is based upon administrative violation(s... analogy with listed federal offense behaviors. (b) The guidelines for parole consideration specified at 28...

Dutch physiotherapy guidelines for low back pain

NARCIS (Netherlands)

Bekkering, Geertruida E; Hendriks, H.J.M.; Koes, Bart W; Oostendorp, R. A B; Ostelo, R. W J G; Thomassen, J. M C; van Tulder, M. W.

2003-01-01

Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and

40 CFR 799.11 - Availability of test guidelines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Availability of test guidelines. 799.11... General Provisions § 799.11 Availability of test guidelines. (a) The TSCA and FIFRA guidelines for the...-487-4650). (b) The OECD guidelines for the various study plans are available from the following...

The nuclear codes and guidelines

International Nuclear Information System (INIS)

Sonter, M.

1984-01-01

This paper considers problems faced by the mining industry when implementing the nuclear codes of practice. Errors of interpretation are likely. A major criticism is that the guidelines to the codes must be seen as recommendations only. They are not regulations. Specific clauses in the guidelines are criticised

Bioassay guideline 2: guidelines for tritium bioassay

International Nuclear Information System (INIS)

1983-01-01

This guideline is one of a series under preparation by the Federal-Provincial Working Group on Bioassay and In Vivo Monitoring Criteria. In this report tritium compounds have been grouped into four categories for the purpose of calculating Annual Limits on Intake and Investigation Levels: tritium gas, tritiated water, tritium-labelled compounds and nucleic acid precursors

5 CFR 1312.10 - Systematic review guidelines.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Systematic review guidelines. 1312.10... Declassification of National Security Information § 1312.10 Systematic review guidelines. The EOP Security Officer will prepare and keep current such guidelines as are required by Executive Order 12958 for the...

50 CFR 253.18 - Program operating guidelines.

Science.gov (United States)

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Program operating guidelines. 253.18 Section 253.18 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC... Guarantee Program § 253.18 Program operating guidelines. The Division may issue Program operating guidelines...

Osteoarthritis guidelines: Barriers to implementation and solutions.

Science.gov (United States)

Ferreira de Meneses, Sarah; Rannou, Francois; Hunter, David J

2016-06-01

Osteoarthritis (OA) is a leading cause of disability worldwide. Clinical practice guidelines (CPGs) have been developed to facilitate improved OA management. Scientific communities worldwide have proposed CPGs for OA treatment. Despite the number of highly prominent guidelines available and their remarkable consistency, their uptake has been suboptimal. Possibly because of the multitude of barriers related to the implementation of CPGs. For example, different guidelines show contradictions, some lack evidence, and they lack a hierarchy or tools to facilitate their translation and application. Also, the guidelines do not acknowledge the effect of comorbidities on choosing the treatments. Finally, poor integration of multidisciplinary services within and across healthcare settings is a major barrier to the effective implementation of management guidelines. Here we describe the main problems related to the OA guidelines and some solutions so as to offer some guidance on the elaboration of future CPGs and their implementation in primary care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Guidelines for the use and interpretation of assays for monitoring autophagy.

Science.gov (United States)

Klionsky, Daniel J; Abdalla, Fabio C; Abeliovich, Hagai; Abraham, Robert T; Acevedo-Arozena, Abraham; Adeli, Khosrow; Agholme, Lotta; Agnello, Maria; Agostinis, Patrizia; Aguirre-Ghiso, Julio A; Ahn, Hyung Jun; Ait-Mohamed, Ouardia; Ait-Si-Ali, Slimane; Akematsu, Takahiko; Akira, Shizuo; Al-Younes, Hesham M; Al-Zeer, Munir A; Albert, Matthew L; Albin, Roger L; Alegre-Abarrategui, Javier; Aleo, Maria Francesca; Alirezaei, Mehrdad; Almasan, Alexandru; Almonte-Becerril, Maylin; Amano, Atsuo; Amaravadi, Ravi; Amarnath, Shoba; Amer, Amal O; Andrieu-Abadie, Nathalie; Anantharam, Vellareddy; Ann, David K; Anoopkumar-Dukie, Shailendra; Aoki, Hiroshi; Apostolova, Nadezda; Arancia, Giuseppe; Aris, John P; Asanuma, Katsuhiko; Asare, Nana Y O; Ashida, Hisashi; Askanas, Valerie; Askew, David S; Auberger, Patrick; Baba, Misuzu; Backues, Steven K; Baehrecke, Eric H; Bahr, Ben A; Bai, Xue-Yuan; Bailly, Yannick; Baiocchi, Robert; Baldini, Giulia; Balduini, Walter; Ballabio, Andrea; Bamber, Bruce A; Bampton, Edward T W; Bánhegyi, Gábor; Bartholomew, Clinton R; Bassham, Diane C; Bast, Robert C; Batoko, Henri; Bay, Boon-Huat; Beau, Isabelle; Béchet, Daniel M; Begley, Thomas J; Behl, Christian; Behrends, Christian; Bekri, Soumeya; Bellaire, Bryan; Bendall, Linda J; Benetti, Luca; Berliocchi, Laura; Bernardi, Henri; Bernassola, Francesca; Besteiro, Sébastien; Bhatia-Kissova, Ingrid; Bi, Xiaoning; Biard-Piechaczyk, Martine; Blum, Janice S; Boise, Lawrence H; Bonaldo, Paolo; Boone, David L; Bornhauser, Beat C; Bortoluci, Karina R; Bossis, Ioannis; Bost, Frédéric; Bourquin, Jean-Pierre; Boya, Patricia; Boyer-Guittaut, Michaël; Bozhkov, Peter V; Brady, Nathan R; Brancolini, Claudio; Brech, Andreas; Brenman, Jay E; Brennand, Ana; Bresnick, Emery H; Brest, Patrick; Bridges, Dave; Bristol, Molly L; Brookes, Paul S; Brown, Eric J; Brumell, John H; Brunetti-Pierri, Nicola; Brunk, Ulf T; Bulman, Dennis E; Bultman, Scott J; Bultynck, Geert; Burbulla, Lena F; Bursch, Wilfried; Butchar, Jonathan P; Buzgariu, Wanda; Bydlowski, Sergio P; Cadwell, Ken; Cahová, Monika; Cai, Dongsheng; Cai, Jiyang; Cai, Qian; Calabretta, Bruno; Calvo-Garrido, Javier; Camougrand, Nadine; Campanella, Michelangelo; Campos-Salinas, Jenny; Candi, Eleonora; Cao, Lizhi; Caplan, Allan B; Carding, Simon R; Cardoso, Sandra M; Carew, Jennifer S; Carlin, Cathleen R; Carmignac, Virginie; Carneiro, Leticia A M; Carra, Serena; Caruso, Rosario A; Casari, Giorgio; Casas, Caty; Castino, Roberta; Cebollero, Eduardo; Cecconi, Francesco; Celli, Jean; Chaachouay, Hassan; Chae, Han-Jung; Chai, Chee-Yin; Chan, David C; Chan, Edmond Y; Chang, Raymond Chuen-Chung; Che, Chi-Ming; Chen, Ching-Chow; Chen, Guang-Chao; Chen, Guo-Qiang; Chen, Min; Chen, Quan; Chen, Steve S-L; Chen, WenLi; Chen, Xi; Chen, Xiangmei; Chen, Xiequn; Chen, Ye-Guang; Chen, Yingyu; Chen, Yongqiang; Chen, Yu-Jen; Chen, Zhixiang; Cheng, Alan; Cheng, Christopher H K; Cheng, Yan; Cheong, Heesun; Cheong, Jae-Ho; Cherry, Sara; Chess-Williams, Russ; Cheung, Zelda H; Chevet, Eric; Chiang, Hui-Ling; Chiarelli, Roberto; Chiba, Tomoki; Chin, Lih-Shen; Chiou, Shih-Hwa; Chisari, Francis V; Cho, Chi Hin; Cho, Dong-Hyung; Choi, Augustine M K; Choi, DooSeok; Choi, Kyeong Sook; Choi, Mary E; Chouaib, Salem; Choubey, Divaker; Choubey, Vinay; Chu, Charleen T; Chuang, Tsung-Hsien; Chueh, Sheau-Huei; Chun, Taehoon; Chwae, Yong-Joon; Chye, Mee-Len; Ciarcia, Roberto; Ciriolo, Maria R; Clague, Michael J; Clark, Robert S B; Clarke, Peter G H; Clarke, Robert; Codogno, Patrice; Coller, Hilary A; Colombo, María I; Comincini, Sergio; Condello, Maria; Condorelli, Fabrizio; Cookson, Mark R; Coombs, Graham H; Coppens, Isabelle; Corbalan, Ramon; Cossart, Pascale; Costelli, Paola; Costes, Safia; Coto-Montes, Ana; Couve, Eduardo; Coxon, Fraser P; Cregg, James M; Crespo, José L; Cronjé, Marianne J; Cuervo, Ana Maria; Cullen, Joseph J; Czaja, Mark J; D'Amelio, Marcello; Darfeuille-Michaud, Arlette; Davids, Lester M; Davies, Faith E; De Felici, Massimo; de Groot, John F; de Haan, Cornelis A M; De Martino, Luisa; De Milito, Angelo; De Tata, Vincenzo; Debnath, Jayanta; Degterev, Alexei; Dehay, Benjamin; Delbridge, Lea M D; Demarchi, Francesca; Deng, Yi Zhen; Dengjel, Jörn; Dent, Paul; Denton, Donna; Deretic, Vojo; Desai, Shyamal D; Devenish, Rodney J; Di Gioacchino, Mario; Di Paolo, Gilbert; Di Pietro, Chiara; Díaz-Araya, Guillermo; Díaz-Laviada, Inés; Diaz-Meco, Maria T; Diaz-Nido, Javier; Dikic, Ivan; Dinesh-Kumar, Savithramma P; Ding, Wen-Xing; Distelhorst, Clark W; Diwan, Abhinav; Djavaheri-Mergny, Mojgan; Dokudovskaya, Svetlana; Dong, Zheng; Dorsey, Frank C; Dosenko, Victor; Dowling, James J; Doxsey, Stephen; Dreux, Marlène; Drew, Mark E; Duan, Qiuhong; Duchosal, Michel A; Duff, Karen; Dugail, Isabelle; Durbeej, Madeleine; Duszenko, Michael; Edelstein, Charles L; Edinger, Aimee L; Egea, Gustavo; Eichinger, Ludwig; Eissa, N Tony; Ekmekcioglu, Suhendan; El-Deiry, Wafik S; Elazar, Zvulun; Elgendy, Mohamed; Ellerby, Lisa M; Eng, Kai Er; Engelbrecht, Anna-Mart; Engelender, Simone; Erenpreisa, Jekaterina; Escalante, Ricardo; Esclatine, Audrey; Eskelinen, Eeva-Liisa; Espert, Lucile; Espina, Virginia; Fan, Huizhou; Fan, Jia; Fan, Qi-Wen; Fan, Zhen; Fang, Shengyun; Fang, Yongqi; Fanto, Manolis; Fanzani, Alessandro; Farkas, Thomas; Farré, Jean-Claude; Faure, Mathias; Fechheimer, Marcus; Feng, Carl G; Feng, Jian; Feng, Qili; Feng, Youji; Fésüs, László; Feuer, Ralph; Figueiredo-Pereira, Maria E; Fimia, Gian Maria; Fingar, Diane C; Finkbeiner, Steven; Finkel, Toren; Finley, Kim D; Fiorito, Filomena; Fisher, Edward A; Fisher, Paul B; Flajolet, Marc; Florez-McClure, Maria L; Florio, Salvatore; Fon, Edward A; Fornai, Francesco; Fortunato, Franco; Fotedar, Rati; Fowler, Daniel H; Fox, Howard S; Franco, Rodrigo; Frankel, Lisa B; Fransen, Marc; Fuentes, José M; Fueyo, Juan; Fujii, Jun; Fujisaki, Kozo; Fujita, Eriko; Fukuda, Mitsunori; Furukawa, Ruth H; Gaestel, Matthias; Gailly, Philippe; Gajewska, Malgorzata; Galliot, Brigitte; Galy, Vincent; Ganesh, Subramaniam; Ganetzky, Barry; Ganley, Ian G; Gao, Fen-Biao; Gao, George F; Gao, Jinming; Garcia, Lorena; Garcia-Manero, Guillermo; Garcia-Marcos, Mikel; Garmyn, Marjan; Gartel, Andrei L; Gatti, Evelina; Gautel, Mathias; Gawriluk, Thomas R; Gegg, Matthew E; Geng, Jiefei; Germain, Marc; Gestwicki, Jason E; Gewirtz, David A; Ghavami, Saeid; Ghosh, Pradipta; Giammarioli, Anna M; Giatromanolaki, Alexandra N; Gibson, Spencer B; Gilkerson, Robert W; Ginger, Michael L; Ginsberg, Henry N; Golab, Jakub; Goligorsky, Michael S; Golstein, Pierre; Gomez-Manzano, Candelaria; Goncu, Ebru; Gongora, Céline; Gonzalez, Claudio D; Gonzalez, Ramon; González-Estévez, Cristina; González-Polo, Rosa Ana; Gonzalez-Rey, Elena; Gorbunov, Nikolai V; Gorski, Sharon; Goruppi, Sandro; Gottlieb, Roberta A; Gozuacik, Devrim; Granato, Giovanna Elvira; Grant, Gary D; Green, Kim N; Gregorc, Aleš; Gros, Frédéric; Grose, Charles; Grunt, Thomas W; Gual, Philippe; Guan, Jun-Lin; Guan, Kun-Liang; Guichard, Sylvie M; Gukovskaya, Anna S; Gukovsky, Ilya; Gunst, Jan; Gustafsson, Asa B; Halayko, Andrew J; Hale, Amber N; Halonen, Sandra K; Hamasaki, Maho; Han, Feng; Han, Ting; Hancock, Michael K; Hansen, Malene; Harada, Hisashi; Harada, Masaru; Hardt, Stefan E; Harper, J Wade; Harris, Adrian L; Harris, James; Harris, Steven D; Hashimoto, Makoto; Haspel, Jeffrey A; Hayashi, Shin-ichiro; Hazelhurst, Lori A; He, Congcong; He, You-Wen; Hébert, Marie-Joseé; Heidenreich, Kim A; Helfrich, Miep H; Helgason, Gudmundur V; Henske, Elizabeth P; Herman, Brian; Herman, Paul K; Hetz, Claudio; Hilfiker, Sabine; Hill, Joseph A; Hocking, Lynne J; Hofman, Paul; Hofmann, Thomas G; Höhfeld, Jörg; Holyoake, Tessa L; Hong, Ming-Huang; Hood, David A; Hotamisligil, Gökhan S; Houwerzijl, Ewout J; Høyer-Hansen, Maria; Hu, Bingren; Hu, Chien-An A; Hu, Hong-Ming; Hua, Ya; Huang, Canhua; Huang, Ju; Huang, Shengbing; Huang, Wei-Pang; Huber, Tobias B; Huh, Won-Ki; Hung, Tai-Ho; Hupp, Ted R; Hur, Gang Min; Hurley, James B; Hussain, Sabah N A; Hussey, Patrick J; Hwang, Jung Jin; Hwang, Seungmin; Ichihara, Atsuhiro; Ilkhanizadeh, Shirin; Inoki, Ken; Into, Takeshi; Iovane, Valentina; Iovanna, Juan L; Ip, Nancy Y; Isaka, Yoshitaka; Ishida, Hiroyuki; Isidoro, Ciro; Isobe, Ken-ichi; Iwasaki, Akiko; Izquierdo, Marta; Izumi, Yotaro; Jaakkola, Panu M; Jäättelä, Marja; Jackson, George R; Jackson, William T; Janji, Bassam; Jendrach, Marina; Jeon, Ju-Hong; Jeung, Eui-Bae; Jiang, Hong; Jiang, Hongchi; Jiang, Jean X; Jiang, Ming; Jiang, Qing; Jiang, Xuejun; Jiang, Xuejun; Jiménez, Alberto; Jin, Meiyan; Jin, Shengkan; Joe, Cheol O; Johansen, Terje; Johnson, Daniel E; Johnson, Gail V W; Jones, Nicola L; Joseph, Bertrand; Joseph, Suresh K; Joubert, Annie M; Juhász, Gábor; Juillerat-Jeanneret, Lucienne; Jung, Chang Hwa; Jung, Yong-Keun; Kaarniranta, Kai; Kaasik, Allen; Kabuta, Tomohiro; Kadowaki, Motoni; Kagedal, Katarina; Kamada, Yoshiaki; Kaminskyy, Vitaliy O; Kampinga, Harm H; Kanamori, Hiromitsu; Kang, Chanhee; Kang, Khong Bee; Kang, Kwang Il; Kang, Rui; Kang, Yoon-A; Kanki, Tomotake; Kanneganti, Thirumala-Devi; Kanno, Haruo; Kanthasamy, Anumantha G; Kanthasamy, Arthi; Karantza, Vassiliki; Kaushal, Gur P; Kaushik, Susmita; Kawazoe, Yoshinori; Ke, Po-Yuan; Kehrl, John H; Kelekar, Ameeta; Kerkhoff, Claus; Kessel, David H; Khalil, Hany; Kiel, Jan A K W; Kiger, Amy A; Kihara, Akio; Kim, Deok Ryong; Kim, Do-Hyung; Kim, Dong-Hou; Kim, Eun-Kyoung; Kim, Hyung-Ryong; Kim, Jae-Sung; Kim, Jeong Hun; Kim, Jin Cheon; Kim, John K; Kim, Peter K; Kim, Seong Who; Kim, Yong-Sun; Kim, Yonghyun; Kimchi, Adi; Kimmelman, Alec C; King, Jason S; Kinsella, Timothy J; Kirkin, Vladimir; Kirshenbaum, Lorrie A; Kitamoto, Katsuhiko; Kitazato, Kaio; Klein, Ludger; Klimecki, Walter T; Klucken, Jochen; Knecht, Erwin; Ko, Ben C B; Koch, Jan C; Koga, Hiroshi; Koh, Jae-Young; Koh, Young Ho; Koike, Masato; Komatsu, Masaaki; Kominami, Eiki; Kong, Hee Jeong; Kong, Wei-Jia; Korolchuk, Viktor I; Kotake, Yaichiro; Koukourakis, Michael I; Kouri Flores, Juan B; Kovács, Attila L; Kraft, Claudine; Krainc, Dimitri; Krämer, Helmut; Kretz-Remy, Carole; Krichevsky, Anna M; Kroemer, Guido; Krüger, Rejko; Krut, Oleg; Ktistakis, Nicholas T; Kuan, Chia-Yi; Kucharczyk, Roza; Kumar, Ashok; Kumar, Raj; Kumar, Sharad; Kundu, Mondira; Kung, Hsing-Jien; Kurz, Tino; Kwon, Ho Jeong; La Spada, Albert R; Lafont, Frank; Lamark, Trond; Landry, Jacques; Lane, Jon D; Lapaquette, Pierre; Laporte, Jocelyn F; László, Lajos; Lavandero, Sergio; Lavoie, Josée N; Layfield, Robert; Lazo, Pedro A; Le, Weidong; Le Cam, Laurent; Ledbetter, Daniel J; Lee, Alvin J X; Lee, Byung-Wan; Lee, Gyun Min; Lee, Jongdae; Lee, Ju-Hyun; Lee, Michael; Lee, Myung-Shik; Lee, Sug Hyung; Leeuwenburgh, Christiaan; Legembre, Patrick; Legouis, Renaud; Lehmann, Michael; Lei, Huan-Yao; Lei, Qun-Ying; Leib, David A; Leiro, José; Lemasters, John J; Lemoine, Antoinette; Lesniak, Maciej S; Lev, Dina; Levenson, Victor V; Levine, Beth; Levy, Efrat; Li, Faqiang; Li, Jun-Lin; Li, Lian; Li, Sheng; Li, Weijie; Li, Xue-Jun; Li, Yan-bo; Li, Yi-Ping; Liang, Chengyu; Liang, Qiangrong; Liao, Yung-Feng; Liberski, Pawel P; Lieberman, Andrew; Lim, Hyunjung J; Lim, Kah-Leong; Lim, Kyu; Lin, Chiou-Feng; Lin, Fu-Cheng; Lin, Jian; Lin, Jiandie D; Lin, Kui; Lin, Wan-Wan; Lin, Weei-Chin; Lin, Yi-Ling; Linden, Rafael; Lingor, Paul; Lippincott-Schwartz, Jennifer; Lisanti, Michael P; Liton, Paloma B; Liu, Bo; Liu, Chun-Feng; Liu, Kaiyu; Liu, Leyuan; Liu, Qiong A; Liu, Wei; Liu, Young-Chau; Liu, Yule; Lockshin, Richard A; Lok, Chun-Nam; Lonial, Sagar; Loos, Benjamin; Lopez-Berestein, Gabriel; López-Otín, Carlos; Lossi, Laura; Lotze, Michael T; Lőw, Peter; Lu, Binfeng; Lu, Bingwei; Lu, Bo; Lu, Zhen; Luciano, Frédéric; Lukacs, Nicholas W; Lund, Anders H; Lynch-Day, Melinda A; Ma, Yong; Macian, Fernando; MacKeigan, Jeff P; Macleod, Kay F; Madeo, Frank; Maiuri, Luigi; Maiuri, Maria Chiara; Malagoli, Davide; Malicdan, May Christine V; Malorni, Walter; Man, Na; Mandelkow, Eva-Maria; Manon, Stéphen; Manov, Irena; Mao, Kai; Mao, Xiang; Mao, Zixu; Marambaud, Philippe; Marazziti, Daniela; Marcel, Yves L; Marchbank, Katie; Marchetti, Piero; Marciniak, Stefan J; Marcondes, Mateus; Mardi, Mohsen; Marfe, Gabriella; Mariño, Guillermo; Markaki, Maria; Marten, Mark R; Martin, Seamus J; Martinand-Mari, Camille; Martinet, Wim; Martinez-Vicente, Marta; Masini, Matilde; Matarrese, Paola; Matsuo, Saburo; Matteoni, Raffaele; Mayer, Andreas; Mazure, Nathalie M; McConkey, David J; McConnell, Melanie J; McDermott, Catherine; McDonald, Christine; McInerney, Gerald M; McKenna, Sharon L; McLaughlin, BethAnn; McLean, Pamela J; McMaster, Christopher R; McQuibban, G Angus; Meijer, Alfred J; Meisler, Miriam H; Meléndez, Alicia; Melia, Thomas J; Melino, Gerry; Mena, Maria A; Menendez, Javier A; Menna-Barreto, Rubem F S; Menon, Manoj B; Menzies, Fiona M; Mercer, Carol A; Merighi, Adalberto; Merry, Diane E; Meschini, Stefania; Meyer, Christian G; Meyer, Thomas F; Miao, Chao-Yu; Miao, Jun-Ying; Michels, Paul A M; Michiels, Carine; Mijaljica, Dalibor; Milojkovic, Ana; Minucci, Saverio; Miracco, Clelia; Miranti, Cindy K; Mitroulis, Ioannis; Miyazawa, Keisuke; Mizushima, Noboru; 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2012-04-01

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. A key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process vs. those that measure flux through the autophagy pathway (i.e., the complete process); thus, a block in macroautophagy that results in autophagosome accumulation needs to be differentiated from stimuli that result in increased autophagic activity, defined as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (in most higher eukaryotes and some protists such as Dictyostelium) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the field understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused

Guidelines for the use and interpretation of assays for monitoring autophagy

Science.gov (United States)

Klionsky, Daniel J.; Abdalla, Fabio C.; Abeliovich, Hagai; Abraham, Robert T.; Acevedo-Arozena, Abraham; Adeli, Khosrow; Agholme, Lotta; Agnello, Maria; Agostinis, Patrizia; Aguirre-Ghiso, Julio A.; Ahn, Hyung Jun; Ait-Mohamed, Ouardia; Ait-Si-Ali, Slimane; Akematsu, Takahiko; Akira, Shizuo; Al-Younes, Hesham M.; Al-Zeer, Munir A.; Albert, Matthew L.; Albin, Roger L.; Alegre-Abarrategui, Javier; Aleo, Maria Francesca; Alirezaei, Mehrdad; Almasan, Alexandru; Almonte-Becerril, Maylin; Amano, Atsuo; Amaravadi, Ravi K.; Amarnath, Shoba; Amer, Amal O.; Andrieu-Abadie, Nathalie; Anantharam, Vellareddy; Ann, David K.; Anoopkumar-Dukie, Shailendra; Aoki, Hiroshi; Apostolova, Nadezda; Arancia, Giuseppe; Aris, John P.; Asanuma, Katsuhiko; Asare, Nana Y.O.; Ashida, Hisashi; Askanas, Valerie; Askew, David S.; Auberger, Patrick; Baba, Misuzu; Backues, Steven K.; Baehrecke, Eric H.; Bahr, Ben A.; Bai, Xue-Yuan; Bailly, Yannick; Baiocchi, Robert; Baldini, Giulia; Balduini, Walter; Ballabio, Andrea; Bamber, Bruce A.; Bampton, Edward T.W.; Juhász, Gábor; Bartholomew, Clinton R.; Bassham, Diane C.; Bast, Robert C.; Batoko, Henri; Bay, Boon-Huat; Beau, Isabelle; Béchet, Daniel M.; Begley, Thomas J.; Behl, Christian; Behrends, Christian; Bekri, Soumeya; Bellaire, Bryan; Bendall, Linda J.; Benetti, Luca; Berliocchi, Laura; Bernardi, Henri; Bernassola, Francesca; Besteiro, Sébastien; Bhatia-Kissova, Ingrid; Bi, Xiaoning; Biard-Piechaczyk, Martine; Blum, Janice S.; Boise, Lawrence H.; Bonaldo, Paolo; Boone, David L.; Bornhauser, Beat C.; Bortoluci, Karina R.; Bossis, Ioannis; Bost, Frédéric; Bourquin, Jean-Pierre; Boya, Patricia; Boyer-Guittaut, Michaël; Bozhkov, Peter V.; Brady, Nathan R; Brancolini, Claudio; Brech, Andreas; Brenman, Jay E.; Brennand, Ana; Bresnick, Emery H.; Brest, Patrick; Bridges, Dave; Bristol, Molly L.; Brookes, Paul S.; Brown, Eric J.; Brumell, John H.; Brunetti-Pierri, Nicola; Brunk, Ulf T.; Bulman, Dennis E.; Bultman, Scott J.; Bultynck, Geert; Burbulla, Lena F.; Bursch, Wilfried; Butchar, Jonathan P.; Buzgariu, Wanda; Bydlowski, Sergio P.; Cadwell, Ken; Cahová, Monika; Cai, Dongsheng; Cai, Jiyang; Cai, Qian; Calabretta, Bruno; Calvo-Garrido, Javier; Camougrand, Nadine; Campanella, Michelangelo; Campos-Salinas, Jenny; Candi, Eleonora; Cao, Lizhi; Caplan, Allan B.; Carding, Simon R.; Cardoso, Sandra M.; Carew, Jennifer S.; Carlin, Cathleen R.; Carmignac, Virginie; Carneiro, Leticia A.M.; Carra, Serena; Caruso, Rosario A.; Casari, Giorgio; Casas, Caty; Castino, Roberta; Cebollero, Eduardo; Cecconi, Francesco; Celli, Jean; Chaachouay, Hassan; Chae, Han-Jung; Chai, Chee-Yin; Chan, David C.; Chan, Edmond Y.; Chang, Raymond Chuen-Chung; Che, Chi-Ming; Chen, Ching-Chow; Chen, Guang-Chao; Chen, Guo-Qiang; Chen, Min; Chen, Quan; Chen, Steve S.-L.; Chen, WenLi; Chen, Xi; Chen, Xiangmei; Chen, Xiequn; Chen, Ye-Guang; Chen, Yingyu; Chen, Yongqiang; Chen, Yu-Jen; Chen, Zhixiang; Cheng, Alan; Cheng, Christopher H.K.; Cheng, Yan; Cheong, Heesun; Cheong, Jae-Ho; Cherry, Sara; Chess-Williams, Russ; Cheung, Zelda H.; Chevet, Eric; Chiang, Hui-Ling; Chiarelli, Roberto; Chiba, Tomoki; Chin, Lih-Shen; Chiou, Shih-Hwa; Chisari, Francis V.; Cho, Chi Hin; Cho, Dong-Hyung; Choi, Augustine M.K.; Choi, DooSeok; Choi, Kyeong Sook; Choi, Mary E.; Chouaib, Salem; Choubey, Divaker; Choubey, Vinay; Chu, Charleen T.; Chuang, Tsung-Hsien; Chueh, Sheau-Huei; Chun, Taehoon; Chwae, Yong-Joon; Chye, Mee-Len; Ciarcia, Roberto; Ciriolo, Maria R.; Clague, Michael J.; Clark, Robert S.B.; Clarke, Peter G.H.; Clarke, Robert; Codogno, Patrice; Coller, Hilary A.; Colombo, María I.; Comincini, Sergio; Condello, Maria; Condorelli, Fabrizio; Cookson, Mark R.; Coombs, Graham H.; Coppens, Isabelle; Corbalan, Ramon; Cossart, Pascale; Costelli, Paola; Costes, Safia; Coto-Montes, Ana; Couve, Eduardo; Coxon, Fraser P.; Cregg, James M.; Crespo, José L.; Cronjé, Marianne J.; Cuervo, Ana Maria; Cullen, Joseph J.; Czaja, Mark J.; D'Amelio, Marcello; Darfeuille-Michaud, Arlette; Davids, Lester M.; Davies, Faith E.; De Felici, Massimo; de Groot, John F.; de Haan, Cornelis A.M.; De Martino, Luisa; De Milito, Angelo; De Tata, Vincenzo; Debnath, Jayanta; Degterev, Alexei; Dehay, Benjamin; Delbridge, Lea M.D.; Demarchi, Francesca; Deng, Yi Zhen; Dengjel, Jörn; Dent, Paul; Denton, Donna; Deretic, Vojo; Desai, Shyamal D.; Devenish, Rodney J.; Di Gioacchino, Mario; Di Paolo, Gilbert; Di Pietro, Chiara; Díaz-Araya, Guillermo; Díaz-Laviada, Inés; Diaz-Meco, Maria T.; Diaz-Nido, Javier; Dikic, Ivan; Dinesh-Kumar, Savithramma P.; Ding, Wen-Xing; Distelhorst, Clark W.; Diwan, Abhinav; Djavaheri-Mergny, Mojgan; Dokudovskaya, Svetlana; Dong, Zheng; Dorsey, Frank C.; Dosenko, Victor; Dowling, James J.; Doxsey, Stephen; Dreux, Marlène; Drew, Mark E.; Duan, Qiuhong; Duchosal, Michel A.; Duff, Karen E.; Dugail, Isabelle; Durbeej, Madeleine; Duszenko, Michael; Edelstein, Charles L.; Edinger, Aimee L.; Egea, Gustavo; Eichinger, Ludwig; Eissa, N. Tony; Ekmekcioglu, Suhendan; El-Deiry, Wafik S.; Elazar, Zvulun; Elgendy, Mohamed; Ellerby, Lisa M.; Eng, Kai Er; Engelbrecht, Anna-Mart; Engelender, Simone; Erenpreisa, Jekaterina; Escalante, Ricardo; Esclatine, Audrey; Eskelinen, Eeva-Liisa; Espert, Lucile; Espina, Virginia; Fan, Huizhou; Fan, Jia; Fan, Qi-Wen; Fan, Zhen; Fang, Shengyun; Fang, Yongqi; Fanto, Manolis; Fanzani, Alessandro; Farkas, Thomas; Farre, Jean-Claude; Faure, Mathias; Fechheimer, Marcus; Feng, Carl G.; Feng, Jian; Feng, Qili; Feng, Youji; Fésüs, László; Feuer, Ralph; Figueiredo-Pereira, Maria E.; Fimia, Gian Maria; Fingar, Diane C.; Finkbeiner, Steven; Finkel, Toren; Finley, Kim D.; Fiorito, Filomena; Fisher, Edward A.; Fisher, Paul B.; Flajolet, Marc; Florez-McClure, Maria L.; Florio, Salvatore; Fon, Edward A.; Fornai, Francesco; Fortunato, Franco; Fotedar, Rati; Fowler, Daniel H.; Fox, Howard S.; Franco, Rodrigo; Frankel, Lisa B.; Fransen, Marc; Fuentes, José M.; Fueyo, Juan; Fujii, Jun; Fujisaki, Kozo; Fujita, Eriko; Fukuda, Mitsunori; Furukawa, Ruth H.; Gaestel, Matthias; Gailly, Philippe; Gajewska, Malgorzata; Galliot, Brigitte; Galy, Vincent; Ganesh, Subramaniam; Ganetzky, Barry; Ganley, Ian G.; Gao, Fen-Biao; Gao, George F.; Gao, Jinming; Garcia, Lorena; Garcia-Manero, Guillermo; Garcia-Marcos, Mikel; Garmyn, Marjan; Gartel, Andrei L.; Gatti, Evelina; Gautel, Mathias; Gawriluk, Thomas R.; Gegg, Matthew E.; Geng, Jiefei; Germain, Marc; Gestwicki, Jason E.; Gewirtz, David A.; Ghavami, Saeid; Ghosh, Pradipta; Giammarioli, Anna M.; Giatromanolaki, Alexandra N.; Gibson, Spencer B.; Gilkerson, Robert W.; Ginger, Michael L.; Ginsberg, Henry N.; Golab, Jakub; Goligorsky, Michael S.; Golstein, Pierre; Gomez-Manzano, Candelaria; Goncu, Ebru; Gongora, Céline; Gonzalez, Claudio D.; Gonzalez, Ramon; González-Estévez, Cristina; González-Polo, Rosa Ana; Gonzalez-Rey, Elena; Gorbunov, Nikolai V.; Gorski, Sharon; Goruppi, Sandro; Gottlieb, Roberta A.; Gozuacik, Devrim; Granato, Giovanna Elvira; Grant, Gary D.; Green, Kim N.; Gregorc, Ales; Gros, Frédéric; Grose, Charles; Grunt, Thomas W.; Gual, Philippe; Guan, Jun-Lin; Guan, Kun-Liang; Guichard, Sylvie M.; Gukovskaya, Anna S.; Gukovsky, Ilya; Gunst, Jan; Gustafsson, Åsa B.; Halayko, Andrew J.; Hale, Amber N.; Halonen, Sandra K.; Hamasaki, Maho; Han, Feng; Han, Ting; Hancock, Michael K.; Hansen, Malene; Harada, Hisashi; Harada, Masaru; Hardt, Stefan E.; Harper, J. Wade; Harris, Adrian L.; Harris, James; Harris, Steven D.; Hashimoto, Makoto; Haspel, Jeffrey A.; Hayashi, Shin-ichiro; Hazelhurst, Lori A.; He, Congcong; He, You-Wen; Hébert, Marie-Josée; Heidenreich, Kim A.; Helfrich, Miep H.; Helgason, Gudmundur V.; Henske, Elizabeth P.; Herman, Brian; Herman, Paul K.; Hetz, Claudio; Hilfiker, Sabine; Hill, Joseph A.; Hocking, Lynne J.; Hofman, Paul; Hofmann, Thomas G.; Höhfeld, Jörg; Holyoake, Tessa L.; Hong, Ming-Huang; Hood, David A.; Hotamisligil, Gökhan S.; Houwerzijl, Ewout J.; Høyer-Hansen, Maria; Hu, Bingren; Hu, Chien-an A.; Hu, Hong-Ming; Hua, Ya; Huang, Canhua; Huang, Ju; Huang, Shengbing; Huang, Wei-Pang; Huber, Tobias B.; Huh, Won-Ki; Hung, Tai-Ho; Hupp, Ted R.; Hur, Gang Min; Hurley, James B.; Hussain, Sabah N.A.; Hussey, Patrick J.; Hwang, Jung Jin; Hwang, Seungmin; Ichihara, Atsuhiro; Ilkhanizadeh, Shirin; Inoki, Ken; Into, Takeshi; Iovane, Valentina; Iovanna, Juan L.; Ip, Nancy Y.; Isaka, Yoshitaka; Ishida, Hiroyuki; Isidoro, Ciro; Isobe, Ken-ichi; Iwasaki, Akiko; Izquierdo, Marta; Izumi, Yotaro; Jaakkola, Panu M.; Jäättelä, Marja; Jackson, George R.; Jackson, William T.; Janji, Bassam; Jendrach, Marina; Jeon, Ju-Hong; Jeung, Eui-Bae; Jiang, Hong; Jiang, Hongchi; Jiang, Jean X.; Jiang, Ming; Jiang, Qing; Jiang, Xuejun; Jiang, Xuejun; Jiménez, Alberto; Jin, Meiyan; Jin, Shengkan V.; Joe, Cheol O.; Johansen, Terje; Johnson, Daniel E.; Johnson, Gail V.W.; Jones, Nicola L.; Joseph, Bertrand; Joseph, Suresh K.; Joubert, Annie M.; Juhász, Gábor; Juillerat-Jeanneret, Lucienne; Jung, Chang Hwa; Jung, Yong-Keun; Kaarniranta, Kai; Kaasik, Allen; Kabuta, Tomohiro; Kadowaki, Motoni; Kågedal, Katarina; Kamada, Yoshiaki; Kaminskyy, Vitaliy O.; Kampinga, Harm H.; Kanamori, Hiromitsu; Kang, Chanhee; Kang, Khong Bee; Kang, Kwang Il; Kang, Rui; Kang, Yoon-A; Kanki, Tomotake; Kanneganti, Thirumala-Devi; Kanno, Haruo; Kanthasamy, Anumantha G.; Kanthasamy, Arthi; Karantza, Vassiliki; Kaushal, Gur P.; Kaushik, Susmita; Kawazoe, Yoshinori; Ke, Po-Yuan; Kehrl, John H.; Kelekar, Ameeta; Kerkhoff, Claus; Kessel, David H.; Khalil, Hany; Kiel, Jan A.K.W.; Kiger, Amy A.; Kihara, Akio; Kim, Deok Ryong; Kim, Do-Hyung; Kim, Dong-Hou; Kim, Eun-Kyoung; Kim, Hyung-Ryong; Kim, Jae-Sung; Kim, Jeong Hun; Kim, Jin Cheon; Kim, John K.; Kim, Peter K.; Kim, Seong Who; Kim, Yong-Sun; Kim, Yonghyun; Kimchi, Adi; Kimmelman, Alec C.; King, Jason S.; Kinsella, Timothy J.; Kirkin, Vladimir; Kirshenbaum, Lorrie A.; Kitamoto, Katsuhiko; Kitazato, Kaio; Klein, Ludger; Klimecki, Walter T.; Klucken, Jochen; Knecht, Erwin; Ko, Ben C.B.; Koch, Jan C.; Koga, Hiroshi; Koh, Jae-Young; Koh, Young Ho; Koike, Masato; Komatsu, Masaaki; Kominami, Eiki; Kong, Hee Jeong; Kong, Wei-Jia; Korolchuk, Viktor I.; Kotake, Yaichiro; Koukourakis, Michael I.; Flores, Juan B. Kouri; Kovács, Attila L.; Kraft, Claudine; Krainc, Dimitri; Krämer, Helmut; Kretz-Remy, Carole; Krichevsky, Anna M.; Kroemer, Guido; Krüger, Rejko; Krut, Oleg; Ktistakis, Nicholas T.; Kuan, Chia-Yi; Kucharczyk, Roza; Kumar, Ashok; Kumar, Raj; Kumar, Sharad; Kundu, Mondira; Kung, Hsing-Jien; Kurz, Tino; Kwon, Ho Jeong; La Spada, Albert R.; Lafont, Frank; Lamark, Trond; Landry, Jacques; Lane, Jon D.; Lapaquette, Pierre; Laporte, Jocelyn F.; László, Lajos; Lavandero, Sergio; Lavoie, Josée N.; Layfield, Robert; Lazo, Pedro A.; Le, Weidong; Le Cam, Laurent; Ledbetter, Daniel J.; Lee, Alvin J.X.; Lee, Byung-Wan; Lee, Gyun Min; Lee, Jongdae; lee, Ju-hyun; Lee, Michael; Lee, Myung-Shik; Lee, Sug Hyung; Leeuwenburgh, Christiaan; Legembre, Patrick; Legouis, Renaud; Lehmann, Michael; Lei, Huan-Yao; Lei, Qun-Ying; Leib, David A.; Leiro, José; Lemasters, John J.; Lemoine, Antoinette; Lesniak, Maciej S.; Lev, Dina; Levenson, Victor V.; Levine, Beth; Levy, Efrat; Li, Faqiang; Li, Jun-Lin; Li, Lian; Li, Sheng; Li, Weijie; Li, Xue-Jun; Li, Yan-Bo; Li, Yi-Ping; Liang, Chengyu; Liang, Qiangrong; Liao, Yung-Feng; Liberski, Pawel P.; Lieberman, Andrew; Lim, Hyunjung J.; Lim, Kah-Leong; Lim, Kyu; Lin, Chiou-Feng; Lin, Fu-Cheng; Lin, Jian; Lin, Jiandie D.; Lin, Kui; Lin, Wan-Wan; Lin, Weei-Chin; Lin, Yi-Ling; Linden, Rafael; Lingor, Paul; Lippincott-Schwartz, Jennifer; Lisanti, Michael P.; Liton, Paloma B.; Liu, Bo; Liu, Chun-Feng; Liu, Kaiyu; Liu, Leyuan; Liu, Qiong A.; Liu, Wei; Liu, Young-Chau; Liu, Yule; Lockshin, Richard A.; Lok, Chun-Nam; Lonial, Sagar; Loos, Benjamin; Lopez-Berestein, Gabriel; López-Otín, Carlos; Lossi, Laura; Lotze, Michael T.; Low, Peter; Lu, Binfeng; Lu, Bingwei; Lu, Bo; Lu, Zhen; Luciano, Fréderic; Lukacs, Nicholas W.; Lund, Anders H.; Lynch-Day, Melinda A.; Ma, Yong; Macian, Fernando; MacKeigan, Jeff P.; Macleod, Kay F.; Madeo, Frank; Maiuri, Luigi; Maiuri, Maria Chiara; Malagoli, Davide; Malicdan, May Christine V.; Malorni, Walter; Man, Na; Mandelkow, Eva-Maria; Manon, Stephen; Manov, Irena; Mao, Kai; Mao, Xiang; Mao, Zixu; Marambaud, Philippe; Marazziti, Daniela; Marcel, Yves L.; Marchbank, Katie; Marchetti, Piero; Marciniak, Stefan J.; Marcondes, Mateus; Mardi, Mohsen; Marfe, Gabriella; Mariño, Guillermo; Markaki, Maria; Marten, Mark R.; Martin, Seamus J.; Martinand-Mari, Camille; Martinet, Wim; Martinez-Vicente, Marta; Masini, Matilde; Matarrese, Paola; Matsuo, Saburo; Matteoni, Raffaele; Mayer, Andreas; Mazure, Nathalie M.; McConkey, David J.; McConnell, Melanie J.; McDermott, Catherine; McDonald, Christine; McInerney, Gerald M.; McKenna, Sharon L.; McLaughlin, BethAnn; McLean, Pamela J.; McMaster, Christopher R.; McQuibban, G. Angus; Meijer, Alfred J.; Meisler, Miriam H.; Meléndez, Alicia; Melia, Thomas J.; Melino, Gerry; Mena, Maria A.; Menendez, Javier A.; Menna-Barreto, Rubem F. S.; Menon, Manoj B.; Menzies, Fiona M.; Mercer, Carol A.; Merighi, Adalberto; Merry, Diane E.; Meschini, Stefania; Meyer, Christian G.; Meyer, Thomas F.; Miao, Chao-Yu; Miao, Jun-Ying; Michels, Paul A.M.; Michiels, Carine; Mijaljica, Dalibor; Milojkovic, Ana; Minucci, Saverio; Miracco, Clelia; Miranti, Cindy K.; Mitroulis, Ioannis; Miyazawa, Keisuke; Mizushima, Noboru; Mograbi, Baharia; Mohseni, Simin; Molero, Xavier; Mollereau, Bertrand; Mollinedo, Faustino; Momoi, Takashi; Monastyrska, Iryna; Monick, Martha M.; Monteiro, Mervyn J.; Moore, Michael N.; Mora, Rodrigo; Moreau, Kevin; Moreira, Paula I.; Moriyasu, Yuji; Moscat, Jorge; Mostowy, Serge; Mottram, Jeremy C.; Motyl, Tomasz; Moussa, Charbel E.-H.; Müller, Sylke; Muller, Sylviane; Münger, Karl; Münz, Christian; Murphy, Leon O.; Murphy, Maureen E.; Musarò, Antonio; Mysorekar, Indira; Nagata, Eiichiro; Nagata, Kazuhiro; Nahimana, Aimable; Nair, Usha; Nakagawa, Toshiyuki; Nakahira, Kiichi; Nakano, Hiroyasu; Nakatogawa, Hitoshi; Nanjundan, Meera; Naqvi, Naweed I.; Narendra, Derek P.; Narita, Masashi; Navarro, Miguel; Nawrocki, Steffan T.; Nazarko, Taras Y.; Nemchenko, Andriy; Netea, Mihai G.; Neufeld, Thomas P.; Ney, Paul A.; Nezis, Ioannis P.; Nguyen, Huu Phuc; Nie, Daotai; Nishino, Ichizo; Nislow, Corey; Nixon, Ralph A.; Noda, Takeshi; Noegel, Angelika A.; Nogalska, Anna; Noguchi, Satoru; Notterpek, Lucia; Novak, Ivana; Nozaki, Tomoyoshi; Nukina, Nobuyuki; Nürnberger, Thorsten; Nyfeler, Beat; Obara, Keisuke; Oberley, Terry D.; Oddo, Salvatore; Ogawa, Michinaga; Ohashi, Toya; Okamoto, Koji; Oleinick, Nancy L.; Oliver, F. Javier; Olsen, Laura J.; Olsson, Stefan; Opota, Onya; Osborne, Timothy F.; Ostrander, Gary K.; Otsu, Kinya; Ou, Jing-hsiung James; Ouimet, Mireille; Overholtzer, Michael; Ozpolat, Bulent; Paganetti, Paolo; Pagnini, Ugo; Pallet, Nicolas; Palmer, Glen E.; Palumbo, Camilla; Pan, Tianhong; Panaretakis, Theocharis; Pandey, Udai Bhan; Papackova, Zuzana; Papassideri, Issidora; Paris, Irmgard; Park, Junsoo; Park, Ohkmae K.; Parys, Jan B.; Parzych, Katherine R.; Patschan, Susann; Patterson, Cam; Pattingre, Sophie; Pawelek, John M.; Peng, Jianxin; Perlmutter, David H.; Perrotta, Ida; Perry, George; Pervaiz, Shazib; Peter, Matthias; Peters, Godefridus J.; Petersen, Morten; Petrovski, Goran; Phang, James M.; Piacentini, Mauro; Pierre, Philippe; Pierrefite-Carle, Valérie; Pierron, Gérard; Pinkas-Kramarski, Ronit; Piras, Antonio; Piri, Natik; Platanias, Leonidas C.; Pöggeler, Stefanie; Poirot, Marc; Poletti, Angelo; Poüs, Christian; Pozuelo-Rubio, Mercedes; Prætorius-Ibba, Mette; Prasad, Anil; Prescott, Mark; Priault, Muriel; Produit-Zengaffinen, Nathalie; Progulske-Fox, Ann; Proikas-Cezanne, Tassula; Przedborski, Serge; Przyklenk, Karin; Puertollano, Rosa; Puyal, Julien; Qian, Shu-Bing; Qin, Liang; Qin, Zheng-Hong; Quaggin, Susan E.; Raben, Nina; Rabinowich, Hannah; Rabkin, Simon W.; Rahman, Irfan; Rami, Abdelhaq; Ramm, Georg; Randall, Glenn; Randow, Felix; Rao, V. Ashutosh; Rathmell, Jeffrey C.; Ravikumar, Brinda; Ray, Swapan K.; Reed, Bruce H.; Reed, John C.; Reggiori, Fulvio; Régnier-Vigouroux, Anne; Reichert, Andreas S.; Reiners, John J.; Reiter, Russel J.; Ren, Jun; Revuelta, José L.; Rhodes, Christopher J.; Ritis, Konstantinos; Rizzo, Elizete; Robbins, Jeffrey; Roberge, Michel; Roca, Hernan; Roccheri, Maria C.; Rocchi, Stephane; Rodemann, H. Peter; Rodríguez de Córdoba, Santiago; Rohrer, Bärbel; Roninson, Igor B.; Rosen, Kirill; Rost-Roszkowska, Magdalena M.; Rouis, Mustapha; Rouschop, Kasper M.A.; Rovetta, Francesca; Rubin, Brian P.; Rubinsztein, David C.; Ruckdeschel, Klaus; Rucker, Edmund B.; Rudich, Assaf; Rudolf, Emil; Ruiz-Opazo, Nelson; Russo, Rossella; Rusten, Tor Erik; Ryan, Kevin M.; Ryter, Stefan W.; Sabatini, David M.; Sadoshima, Junichi; Saha, Tapas; Saitoh, Tatsuya; Sakagami, Hiroshi; Sakai, Yasuyoshi; Salekdeh, Ghasem Hoseini; Salomoni, Paolo; Salvaterra, Paul M.; Salvesen, Guy; Salvioli, Rosa; Sanchez, Anthony M.J.; Sánchez-Alcázar, José A.; Sánchez-Prieto, Ricardo; Sandri, Marco; Sankar, Uma; Sansanwal, Poonam; Santambrogio, Laura; Saran, Shweta; Sarkar, Sovan; Sarwal, Minnie; Sasakawa, Chihiro; Sasnauskiene, Ausra; Sass, Miklós; Sato, Ken; Sato, Miyuki; Schapira, Anthony H.V.; Scharl, Michael; Schätzl, Hermann M.; Scheper, Wiep; Schiaffino, Stefano; Schneider, Claudio; Schneider, Marion E.; Schneider-Stock, Regine; Schoenlein, Patricia V.; Schorderet, Daniel F.; Schüller, Christoph; Schwartz, Gary K.; Scorrano, Luca; Sealy, Linda; Seglen, Per O.; Segura-Aguilar, Juan; Seiliez, Iban; Seleverstov, Oleksandr; Sell, Christian; Seo, Jong Bok; Separovic, Duska; Setaluri, Vijayasaradhi; Setoguchi, Takao; Settembre, Carmine; Shacka, John J.; Shanmugam, Mala; Shapiro, Irving M.; Shaulian, Eitan; Shaw, Reuben J.; Shelhamer, James H.; Shen, Han-Ming; Shen, Wei-Chiang; Sheng, Zu-Hang; Shi, Yang; Shibuya, Kenichi; Shidoji, Yoshihiro; Shieh, Jeng-Jer; Shih, Chwen-Ming; Shimada, Yohta; Shimizu, Shigeomi; Shintani, Takahiro; Shirihai, Orian S.; Shore, Gordon C.; Sibirny, Andriy A.; Sidhu, Stan B.; Sikorska, Beata; Silva-Zacarin, Elaine C.M.; Simmons, Alison; Simon, Anna Katharina; Simon, Hans-Uwe; Simone, Cristiano; Simonsen, Anne; Sinclair, David A.; Singh, Rajat; Sinha, Debasish; Sinicrope, Frank A.; Sirko, Agnieszka; Siu, Parco M.; Sivridis, Efthimios; Skop, Vojtech; Skulachev, Vladimir P.; Slack, Ruth S.; Smaili, Soraya S.; Smith, Duncan R.; Soengas, Maria S.; Soldati, Thierry; Song, Xueqin; Sood, Anil K.; Soong, Tuck Wah; Sotgia, Federica; Spector, Stephen A.; Spies, Claudia D.; Springer, Wolfdieter; Srinivasula, Srinivasa M.; Stefanis, Leonidas; Steffan, Joan S.; Stendel, Ruediger; Stenmark, Harald; Stephanou, Anastasis; Stern, Stephan T.; Sternberg, Cinthya; Stork, Björn; Strålfors, Peter; Subauste, Carlos S.; Sui, Xinbing; Sulzer, David; Sun, Jiaren; Sun, Shi-Yong; Sun, Zhi-Jun; Sung, Joseph J.Y.; Suzuki, Kuninori; Suzuki, Toshihiko; Swanson, Michele S.; Swanton, Charles; Sweeney, Sean T.; Sy, Lai-King; Szabadkai, György; Tabas, Ira; Taegtmeyer, Heinrich; Tafani, Marco; Takács-Vellai, Krisztina; Takano, Yoshitaka; Takegawa, Kaoru; Takemura, Genzou; Takeshita, Fumihiko; Talbot, Nicholas J.; Tan, Kevin S.W.; Tanaka, Keiji; Tanaka, Kozo; Tang, Daolin; Tang, Dingzhong; Tanida, Isei; Tannous, Bakhos A.; Tavernarakis, Nektarios; Taylor, Graham S.; Taylor, Gregory A.; Taylor, J. Paul; Terada, Lance S.; Terman, Alexei; Tettamanti, Gianluca; Thevissen, Karin; Thompson, Craig B.; Thorburn, Andrew; Thumm, Michael; Tian, FengFeng; Tian, Yuan; Tocchini-Valentini, Glauco; Tolkovsky, Aviva M.; Tomino, Yasuhiko; Tönges, Lars; Tooze, Sharon A.; Tournier, Cathy; Tower, John; Towns, Roberto; Trajkovic, Vladimir; Travassos, Leonardo H.; Tsai, Ting-Fen; Tschan, Mario P.; Tsubata, Takeshi; Tsung, Allan; Turk, Boris; Turner, Lorianne S.; Tyagi, Suresh C.; Uchiyama, Yasuo; Ueno, Takashi; Umekawa, Midori; Umemiya-Shirafuji, Rika; Unni, Vivek K.; Vaccaro, Maria I.; Valente, Enza Maria; Van den Berghe, Greet; van der Klei, Ida J.; van Doorn, Wouter G.; van Dyk, Linda F.; van Egmond, Marjolein; van Grunsven, Leo A.; Vandenabeele, Peter; Vandenberghe, Wim P.; Vanhorebeek, Ilse; Vaquero, Eva C.; Velasco, Guillermo; Vellai, Tibor; Vicencio, José Miguel; Vierstra, Richard D.; Vila, Miquel; Vindis, Cécile; Viola, Giampietro; Viscomi, Maria Teresa; Voitsekhovskaja, Olga V.; von Haefen, Clarissa; Votruba, Marcela; Wada, Keiji; Wade-Martins, Richard; Walker, Cheryl L.; Walsh, Craig M.; Walter, Jochen; Wan, Xiang-Bo; Wang, Aimin; Wang, Chenguang; Wang, Dawei; Wang, Fan; Wang, Fen; Wang, Guanghui; Wang, Haichao; Wang, Hong-Gang; Wang, Horng-Dar; Wang, Jin; Wang, Ke; Wang, Mei; Wang, Richard C.; Wang, Xinglong; Wang, Xiujie J.; Wang, Ying-Jan; Wang, Yipeng; Wang, Zhen-Bo; Wang, Zhigang Charles; Wang, Zhinong; Wansink, Derick G.; Ward, Diane M.; Watada, Hirotaka; Waters, Sarah L.; Webster, Paul; Wei, Lixin; Weihl, Conrad C.; Weiss, William A.; Welford, Scott M.; Wen, Long-Ping; Whitehouse, Caroline A.; Whitton, J. Lindsay; Whitworth, Alexander J.; Wileman, Tom; Wiley, John W.; Wilkinson, Simon; Willbold, Dieter; Williams, Roger L.; Williamson, Peter R.; Wouters, Bradly G.; Wu, Chenghan; Wu, Dao-Cheng; Wu, William K.K.; Wyttenbach, Andreas; Xavier, Ramnik J.; Xi, Zhijun; Xia, Pu; Xiao, Gengfu; Xie, Zhiping; Xie, Zhonglin; Xu, Da-zhi; Xu, Jianzhen; Xu, Liang; Xu, Xiaolei; Yamamoto, Ai; Yamamoto, Akitsugu; Yamashina, Shunhei; Yamashita, Michiaki; Yan, Xianghua; Yanagida, Mitsuhiro; Yang, Dun-Sheng; Yang, Elizabeth; Yang, Jin-Ming; Yang, Shi Yu; Yang, Wannian; Yang, Wei Yuan; Yang, Zhifen; Yao, Meng-Chao; Yao, Tso-Pang; Yeganeh, Behzad; Yen, Wei-Lien; Yin, Jia-Jing; Yin, Xiao-Ming; Yoo, Ook-Joon; Yoon, Gyesoon; Yoon, Seung-Yong; Yorimitsu, Tomohiro; Yoshikawa, Yuko; Yoshimori, Tamotsu; Yoshimoto, Kohki; You, Ho Jin; Youle, Richard J.; Younes, Anas; Yu, Li; Yu, Long; Yu, Seong-Woon; Yu, Wai Haung; Yuan, Zhi-Min; Yue, Zhenyu; Yun, Cheol-Heui; Yuzaki, Michisuke; Zabirnyk, Olga; Silva-Zacarin, Elaine; Zacks, David; Zacksenhaus, Eldad; Zaffaroni, Nadia; Zakeri, Zahra; Zeh, III, Herbert J.; Zeitlin, Scott O.; Zhang, Hong; Zhang, Hui-Ling; Zhang, Jianhua; Zhang, Jing-Pu; Zhang, Lin; Zhang, Long; Zhang, Ming-Yong; Zhang, Xu Dong; Zhao, Mantong; Zhao, Yi-Fang; Zhao, Ying; Zhao, Zhizhuang J.; Zheng, Xiaoxiang; Zhivotovsky, Boris; Zhong, Qing; Zhou, Cong-Zhao; Zhu, Changlian; Zhu, Wei-Guo; Zhu, Xiao-Feng; Zhu, Xiongwei; Zhu, Yuangang; Zoladek, Teresa; Zong, Wei-Xing; Zorzano, Antonio; Zschocke, Jürgen; Zuckerbraun, Brian

2012-01-01

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. A key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process vs. those that measure flux through the autophagy pathway (i.e., the complete process); thus, a block in macroautophagy that results in autophagosome accumulation needs to be differentiated from stimuli that result in increased autophagic activity, defined as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (in most higher eukaryotes and some protists such as Dictyostelium) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the field understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused

Post-prostatectomy radiation therapy: Consensus guidelines of the Australian and New Zealand Radiation Oncology Genito-Urinary Group

International Nuclear Information System (INIS)

Sidhom, Mark A.; Kneebone, Andrew B.; Lehman, Margot; Wiltshire, Kirsty L.; Millar, Jeremy L.; Mukherjee, Rahul K.; Shakespeare, Thomas P.; Tai, Keen-Hun

2008-01-01

Background and purpose: Three randomised trials have demonstrated the benefit of adjuvant post-prostatectomy radiotherapy (PPRT) for high risk patients. Data also documents the effectiveness of salvage radiotherapy following a biochemical relapse post-prostatectomy. The Radiation Oncology Genito-Urinary Group recognised the need to develop consensus guidelines on to whom, when and how to deliver PPRT. Materials and methods: Draft guidelines were developed and refined at a consensus conference in June 2006 attended by 63 delegates where urological, radiotherapy and diagnostic imaging experts spoke on aspects of PPRT. Unresolved issues were further developed by working parties and redistributed until consensus was reached. Results: Central to the recommendations is that patients with positive surgical margins, seminal vesicle invasion and/or extracapsular extension have a high risk of residual local disease and should be informed of the options of either immediate adjuvant radiotherapy or active surveillance with early salvage in the event of biochemical recurrence. Salvage radiotherapy should be instituted at the earliest confirmation of biochemical recurrence. Detailed contouring guidelines have been developed, defining the regions at risk of residual microscopic disease which should be included in the clinical target volume. The recommended doses are 60-64 Gy for adjuvant, and 60-66 Gy for salvage radiotherapy. The role of hormone therapy in conjunction with PPRT is yet to be defined. Conclusions: These consensus guidelines have been developed to give clinical and technical guidance to radiation oncologists and urologists in the management of high risk post-prostatectomy patients

National guidelines for the use of antibiotics in hospitalised adult patients: the SWAB guidelines revisited

NARCIS (Netherlands)

Prins, J. M.; Kullberg, B. J.; Gyssens, I. C.

2005-01-01

Since 1996, the Dutch Working Party on Antibiotic Policy (Stichting Werkgroep AntibioticaBeleid, SWAB) has been developing national guidelines for the use of antibiotics in hospitalised adult patients. As a result of both an inventory of the wishes of the users of these guidelines and the recently

Methodological guidelines

Energy Technology Data Exchange (ETDEWEB)

Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

1999-04-01

The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs.

Methodological guidelines

International Nuclear Information System (INIS)

Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

1999-01-01

The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs

Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis

Directory of Open Access Journals (Sweden)

Samir Gupta

2016-01-01

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

40 CFR 60.31d - Emissions guidelines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Emissions guidelines. 60.31d Section 60...) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emissions Guidelines and Compliance Times for Sulfuric Acid Production Units § 60.31d Emissions guidelines. Sulfuric acid production units. The emission...

40 CFR 60.36e - Inspection guidelines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Inspection guidelines. 60.36e Section...) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines and Compliance Times for Hospital/Medical/Infectious Waste Incinerators § 60.36e Inspection guidelines. (a) For approval, a State plan shall...

41 CFR 101-39.301 - Utilization guidelines.

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2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Utilization guidelines... § 101-39.301 Utilization guidelines. An agency must be able to justify a full-time vehicle assignment. The following guidelines may be employed by an agency requesting GSA Interagency Fleet Management...

76 FR 22342 - National Standard 10 Guidelines

Science.gov (United States)

2011-04-21

.... 110218147-1199-01] RIN 0648-BA74 National Standard 10 Guidelines AGENCY: National Marine Fisheries Service... comment on potential adjustments to the National Standard 10 Guidelines. DATES: Written comments regarding... advisory guidelines (which shall not have the force and effect of law), based on the national standards to...

41 CFR 101-27.102-2 - Guidelines.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Guidelines. 101-27.102-2 Section 101-27.102-2 Public Contracts and Property Management Federal Property Management Regulations... Replenishment § 101-27.102-2 Guidelines. Guidelines for implementing the EOQ principle of stock replenishment...

Journal of Wildlife Management guidelines

Science.gov (United States)

William M. Block; Frank R. Thompson; Dawn Hanseder; Allison Cox; Anna Knipps

2011-01-01

These Guidelines apply to all Journal of Wildlife Management (JWM, The Journal) submissions. Publishing a professional manuscript proceeds most smoothly if authors understand the policy, procedures, format, and style of the outlet to which they are submitting a manuscript. These instructions supersede all previous guidelines. Manuscripts that clearly deviate from this...

Technical summary of groundwater quality protection program at Savannah River Plant. Volume 1. Site geohydrology, and solid and hazardous wastes

International Nuclear Information System (INIS)

Christensen, E.J.; Gordon, D.E.

1983-12-01

The program for protecting the quality of groundwater underlying the Savannah River Plant (SRP) is described in this technical summary report. The report is divided into two volumes. Volume I contains a discussion of the general site geohydrology and of both active and inactive sites used for disposal of solid and hazardous wastes. Volume II includes a discussion of radioactive waste disposal. Most information contained in these two volumes is current as of December 1983. The groundwater quality protection program has several elements which, taken collectively, are designed to achieve three major goals. These goals are to evaluate the impact on groundwater quality as a result of SRP operations, to restore or protect groundwater quality by taking corrective action as necessary, and to ensure disposal of waste materials in accordance with regulatory guidelines

Guidelines for bone scintigraphy in children

International Nuclear Information System (INIS)

Hahn, K.; Fischer, S.; Gordon, I.; Mann, M.; Piepsz, A.; Olivier, P.; Sixt, R.; Velzen, J. van

2000-01-01

The guidelines are intended to help nuclear medical teams in their daily routine. The guidelines give information relating to indications, performance of examinations, analysis and interpretation of the diagnostic results. The guidelines should be applied in the context of adopted basic quality criteria in nuclear medicine, requirements of the German radiation protection ordinance, as well as the regulatory codes for radiation protection in the medical field. The guidelines express the opinions of the Paediatric Committee of the EANM and hence focus on compliance with the relevant European standards in nuclear medicine. In order to enhance the specificity of results obtained with a bone scintigraphy, the interpretation of the results should be based on combined analysis with information drawn from X-rays. (orig./CB) [de

Guidelines for Developing Competency-Based Curriculum.

Science.gov (United States)

Goodson, Ludy

1979-01-01

Presents guidelines for the development of competency-based curriculum formulated as a result of an automotive mechanics curriculum workshop. Listed are specific guidelines for content development, writing style, and illustration. (LRA)

40 CFR 60.33e - Emissions guidelines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Emissions guidelines. 60.33e Section 60...) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines and Compliance Times for Hospital/Medical/Infectious Waste Incinerators § 60.33e Emissions guidelines. (a) For approval, a State plan shall...

Systematic review of recent dementia practice guidelines.

Science.gov (United States)

Ngo, Jennifer; Holroyd-Leduc, Jayna M

2015-01-01

dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Clinical and anatomical guidelines in pelvic cancer contouring for radiotherapy treatment planning; Definition de regles simples anatomocliniques dans la determination du volume cible des tumeurs pelviennes pour le planning radiotherapeutique

Energy Technology Data Exchange (ETDEWEB)

Portaluri, M.; Bambace, S.; Giuliano, G.; Pili, G.; Didonna, V. [General Hospital Di Summa-Perrino, Dept. of Radiation Oncology, Medical Physics, Brindisi (Italy); Perez, C.; Angone, G.; Alloro, E. [General Hospital Di Summa-Perrino, Dept. of Radiology, Medical Physics, Brindisi (Italy); Scialpi, M. [General Hospital SS. Annunziata, Dept. of Radiology, Taranto (Italy)

2004-08-01

Background and purpose. Many observations on potential inadequate coverage of tumour volume at risk in advanced cervical cancer (CC) when conventional radiation fields are used, have further substantiated by investigators using MRI, CT or lymph-angiographic imaging. This work tries to obtain three dimensional margins by observing enlarged nodes in CT scans in order to improve pelvic nodal chains clinical target volumes (CTVs) drawing, and by looking for corroborative evidence in the literature for a better delineation of tumour CTV. Method. Eleven consecutive patients (seven males, four females, mean age 62 years, range 43 8) with CT diagnosis of nodal involvement caused by pathologically proved carcinoma of the cervix (n = 2), carcinoma of the rectum (n = 2), carcinoma of the prostate (n = 2), non-Hodgkin lymphoma (n 2), Hodgkin lymphoma (n = 1), carcinoma of the penis (n = 1) and carcinoma of the corpus uteri (n = 1) were retrospectively reviewed. Sixty CT scans with 67 enlarged pelvic nodes were reviewed in order to record the more proximal structures (muscle, bone, vessels, cutis or sub-cutis and other organs) to each enlarged node or group of nodes according to the four surfaces (anterior, lateral, posterior and medial) in a clockwise direction. Results. summary of the observations of each nodal chain and the number of occurrences of every marginal structure on axial CT slices is presented. Finally, simple guidelines are proposed. Conclusions. Tumour CTV should be based on individual tumour anatomy mainly for lateral beams as it results from sagittal T2 weighted MRI images. Boundaries of pelvic nodes CTVs can be derived from observations of enlarged lymph nodes in CT scans. (author)

Guideline for primary care management of headache in adults

Science.gov (United States)

Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

2015-01-01

Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

National and international guidelines for rectal cancer

DEFF Research Database (Denmark)

Nielsen, Liv Bjerre Juul; Wille-Jørgensen, P

2014-01-01

, this might not be the case between guidelines. No formal evaluation of the contrasting guidance has been reported. METHOD: A systematic search for national and international guidelines on rectal cancer was performed. Eleven guidelines were identified for further analysis. RESULTS: There was no consensus...... concerning the definition of rectal cancer. Ten of the 11 guidelines use the TNM staging system and there was general agreement regarding the recommendation of MRI and CT in rectal cancer. There was consensus concerning a multidisciplinary approach, preoperative chemoradiotherapy (CRT) and total mesorectal...

78 FR 9743 - Event Reporting Guidelines

Science.gov (United States)

2013-02-11

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0237] Event Reporting Guidelines AGENCY: Nuclear... Regulatory Commission (NRC) has issued NUREG- 1022, Revision 3, ``Event Reporting Guidelines: 10 CFR 50.72 and 50.73.'' [[Page 9744

Belgian guidelines for economic evaluations: second edition.

Science.gov (United States)

Thiry, Nancy; Neyt, Mattias; Van De Sande, Stefaan; Cleemput, Irina

2014-12-01

The aim of this study was to present the updated methodological guidelines for economic evaluations of healthcare interventions (drugs, medical devices, and other interventions) in Belgium. The update of the guidelines was performed by three Belgian health economists following feedback from users of the former guidelines and personal experience. The updated guidelines were discussed with a multidisciplinary team consisting of other health economists, assessors of reimbursement request files, representatives of Belgian databases and representatives of the drugs and medical devices industry. The final document was validated by three external validators that were not involved in the previous discussions. The guidelines give methodological guidance for the following components of an economic evaluation: literature review, perspective of the evaluation, definition of the target population, choice of the comparator, analytic technique and study design, calculation of costs, valuation of outcomes, definition of the time horizon, modeling, handling uncertainty and discounting. We present a reference case that can be considered as the minimal requirement for Belgian economic evaluations of health interventions. These guidelines will improve the methodological quality, transparency and uniformity of the economic evaluations performed in Belgium. The guidelines will also provide support to the researchers and assessors performing or evaluating economic evaluations.

Clinical algorithms to aid osteoarthritis guideline dissemination.

Science.gov (United States)

Meneses, S R F; Goode, A P; Nelson, A E; Lin, J; Jordan, J M; Allen, K D; Bennell, K L; Lohmander, L S; Fernandes, L; Hochberg, M C; Underwood, M; Conaghan, P G; Liu, S; McAlindon, T E; Golightly, Y M; Hunter, D J

2016-09-01

Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Small-Volume Injections: Evaluation of Volume Administration Deviation From Intended Injection Volumes.

Science.gov (United States)

Muffly, Matthew K; Chen, Michael I; Claure, Rebecca E; Drover, David R; Efron, Bradley; Fitch, William L; Hammer, Gregory B

2017-10-01

In the perioperative period, anesthesiologists and postanesthesia care unit (PACU) nurses routinely prepare and administer small-volume IV injections, yet the accuracy of delivered medication volumes in this setting has not been described. In this ex vivo study, we sought to characterize the degree to which small-volume injections (≤0.5 mL) deviated from the intended injection volumes among a group of pediatric anesthesiologists and pediatric postanesthesia care unit (PACU) nurses. We hypothesized that as the intended injection volumes decreased, the deviation from those intended injection volumes would increase. Ten attending pediatric anesthesiologists and 10 pediatric PACU nurses each performed a series of 10 injections into a simulated patient IV setup. Practitioners used separate 1-mL tuberculin syringes with removable 18-gauge needles (Becton-Dickinson & Company, Franklin Lakes, NJ) to aspirate 5 different volumes (0.025, 0.05, 0.1, 0.25, and 0.5 mL) of 0.25 mM Lucifer Yellow (LY) fluorescent dye constituted in saline (Sigma Aldrich, St. Louis, MO) from a rubber-stoppered vial. Each participant then injected the specified volume of LY fluorescent dye via a 3-way stopcock into IV tubing with free-flowing 0.9% sodium chloride (10 mL/min). The injected volume of LY fluorescent dye and 0.9% sodium chloride then drained into a collection vial for laboratory analysis. Microplate fluorescence wavelength detection (Infinite M1000; Tecan, Mannedorf, Switzerland) was used to measure the fluorescence of the collected fluid. Administered injection volumes were calculated based on the fluorescence of the collected fluid using a calibration curve of known LY volumes and associated fluorescence.To determine whether deviation of the administered volumes from the intended injection volumes increased at lower injection volumes, we compared the proportional injection volume error (loge [administered volume/intended volume]) for each of the 5 injection volumes using a linear

50 CFR 510.9 - Uniform pay guidelines.

Science.gov (United States)

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Uniform pay guidelines. 510.9 Section 510... ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the... accordance with guidelines established by the Director of the Office of Management and Budget pursuant to...

Physicians' preferences for asthma guidelines implementation.

Science.gov (United States)

Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

2010-10-01

Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

Author Guidelines

Directory of Open Access Journals (Sweden)

Yunisrina Qismullah Yusuf

2016-03-01

://www.teachingenglish.org.uk/think/articles/group-work-v-whole-class-activities Journal: Yusuf, Y. Q., Pillai, S., & Mohd. Ali, N.T.A. (2013. Speaking Acehnese in Malaysia. Language and Communication, 33(1: 50-60. Chapter in an edited volume: Lee, E. M., & Lim, L. (2000. Diphthongs in Singaporean English: Their realizations across different formality levels, and some attitudes of listeners towards them. In A. Brown, D. Deterding & E. L. Low (Eds. The English language in Singapore: Research on pronunciation (pp. 101-111. Singapore: Singapore Association for Applied Linguistics. Conference proceedings publications: Al-Tamimi, J., & Ferragne, E. (2005. Does vowel space size depend on language vowel inventories? Evidence from two Arabic dialects and French. Proceedings of Interspeech (pp. 2465-2468. Lisbon, Portugal. Published dissertation: Asyik. A. G. (1987. A contextual grammar of Acehnese sentences. (Doctoral dissertation. University of Michigan, Ann Arbor. Retrieved February 4, 2014 from http://www.acehbooks.org/pdf/00402.pdf. (Order number: 8720237 Unpublished thesis/dissertation: Yasin, B. (2004. Sistem informasi manajemen pendidikan: Studi pengembangan model sistem informasi manajemen bidang adminsitrasi akademik dan kemahasiswaan pada FKIP Unsyiah. (Unpublished doctoral dissertation. Universitas Negeri Malang Malang.   Unpublished paper presented at a conference: Yasin, B. (2007, December. Membangun masa depan pendidikan Aceh Barat: Strategi dan kebijakan. Paper presented at the Seminar Pembangunan Pendidikan Kabupaten Aceh Barat, Universitas Syiah Kuala, Banda Aceh, Indonesia. Mass media/newspaper: Akmal, S. (2011, March 13. Nasib Bahsa Aceh di tengah euforia nasionalisme Keacehan. Serambi Indonesia, p. Opini column. For in-text citations, use the name of the author(s followed by the year of publication. Submit the article to sielejournal@gmail.com, with the subject: SUBMISSION TO SiELE. For further information on the submission guideline, please visit our page at http://www.jurnal.unsyiah.ac.id/SiELE. Once your article is accepted, the

Author Guidelines

Directory of Open Access Journals (Sweden)

Yunisrina Qismullah Yusuf

2015-10-01

http://www.teachingenglish.org.uk/think/articles/group-work-v-whole-class-activities Journal: Yusuf, Y. Q., Pillai, S., & Mohd. Ali, N.T.A. (2013. Speaking Acehnese in Malaysia. Language and Communication, 33(1: 50-60. Chapter in an edited volume: Lee, E. M., & Lim, L. (2000. Diphthongs in Singaporean English: Their realizations across different formality levels, and some attitudes of listeners towards them. In A. Brown, D. Deterding & E. L. Low (Eds. The English language in Singapore: Research on pronunciation (pp. 101-111. Singapore: Singapore Association for Applied Linguistics. Conference proceedings publications: Al-Tamimi, J., & Ferragne, E. (2005. Does vowel space size depend on language vowel inventories? Evidence from two Arabic dialects and French. Proceedings of Interspeech (pp. 2465-2468. Lisbon, Portugal. Published dissertation: Asyik. A. G. (1987. A contextual grammar of Acehnese sentences. (Doctoral dissertation. University of Michigan, Ann Arbor. Retrieved February 4, 2014 from http://www.acehbooks.org/pdf/00402.pdf. (Order number: 8720237 Unpublished thesis/dissertation: Yasin, B. (2004. Sistem informasi manajemen pendidikan: Studi pengembangan model sistem informasi manajemen bidang adminsitrasi akademik dan kemahasiswaan pada FKIP Unsyiah. (Unpublished doctoral dissertation. Universitas Negeri Malang Malang.   Unpublished paper presented at a conference: Yasin, B. (2007, December. Membangun masa depan pendidikan Aceh Barat: Strategi dan kebijakan. Paper presented at the Seminar Pembangunan Pendidikan Kabupaten Aceh Barat, Universitas Syiah Kuala, Banda Aceh, Indonesia. Mass media/newspaper: Akmal, S. (2011, March 13. Nasib Bahsa Aceh di tengah euforia nasionalisme Keacehan. Serambi Indonesia, p. Opini column.   For in-text citations, use the name of the author(s followed by the year of publication.  Submit the article to sielejournal@gmail.com, with the subject: SUBMISSION TO SiELE. For further information on the submission guideline, please visit

Author Guidelines

Directory of Open Access Journals (Sweden)

Yunisrina Qismullah Yusuf

2014-03-01

http://www.teachingenglish.org.uk/think/articles/group-work-v-whole-class-activities Journal: Yusuf, Y. Q., Pillai, S., & Mohd. Ali, N.T.A. (2013. Speaking Acehnese in Malaysia. Language and Communication, 33(1: 50-60. Chapter in an edited volume: Lee, E. M., & Lim, L. (2000. Diphthongs in Singaporean English: Their realizations across different formality levels, and some attitudes of listeners towards them. In A. Brown, D. Deterding & E. L. Low (Eds. The English language in Singapore: Research on pronunciation (pp. 101-111. Singapore: Singapore Association for Applied Linguistics. Conference proceedings publications: Al-Tamimi, J., & Ferragne, E. (2005. Does vowel space size depend on language vowel inventories? Evidence from two Arabic dialects and French. Proceedings of Interspeech (pp. 2465-2468. Lisbon, Portugal. Published dissertation: Asyik. A. G. (1987. A contextual grammar of Acehnese sentences. (Doctoral dissertation. University of Michigan, Ann Arbor. Retrieved February 4, 2014 from http://www.acehbooks.org/pdf/00402.pdf. (Order number: 8720237 Unpublished thesis/dissertation: Yasin, B. (2004. Sistem informasi manajemen pendidikan: Studi pengembangan model sistem informasi manajemen bidang adminsitrasi akademik dan kemahasiswaan pada FKIP Unsyiah. (Unpublished doctoral dissertation. Universitas Negeri Malang Malang.   Unpublished paper presented at a conference: Yasin, B. (2007, December. Membangun masa depan pendidikan Aceh Barat: Strategi dan kebijakan. Paper presented at the Seminar Pembangunan Pendidikan Kabupaten Aceh Barat, Universitas Syiah Kuala, Banda Aceh, Indonesia. Mass media/newspaper: Akmal, S. (2011, March 13. Nasib Bahsa Aceh di tengah euforia nasionalisme Keacehan. Serambi Indonesia, p. Opini column.   For in-text citations, use the name of the author(s followed by the year of publication.  Submit the article to sielejournal@gmail.com, with the subject: SUBMISSION TO SiELE. For further information on the submission guideline, please visit

Author Guidelines

Directory of Open Access Journals (Sweden)

Yunisrina Qismullah Yusuf

2014-09-01

http://www.teachingenglish.org.uk/think/articles/group-work-v-whole-class-activities Journal: Yusuf, Y. Q., Pillai, S., & Mohd. Ali, N.T.A. (2013. Speaking Acehnese in Malaysia. Language and Communication, 33(1: 50-60. Chapter in an edited volume: Lee, E. M., & Lim, L. (2000. Diphthongs in Singaporean English: Their realizations across different formality levels, and some attitudes of listeners towards them. In A. Brown, D. Deterding & E. L. Low (Eds. The English language in Singapore: Research on pronunciation (pp. 101-111. Singapore: Singapore Association for Applied Linguistics. Conference proceedings publications: Al-Tamimi, J., & Ferragne, E. (2005. Does vowel space size depend on language vowel inventories? Evidence from two Arabic dialects and French. Proceedings of Interspeech (pp. 2465-2468. Lisbon, Portugal. Published dissertation: Asyik. A. G. (1987. A contextual grammar of Acehnese sentences. (Doctoral dissertation. University of Michigan, Ann Arbor. Retrieved February 4, 2014 from http://www.acehbooks.org/pdf/00402.pdf. (Order number: 8720237 Unpublished thesis/dissertation: Yasin, B. (2004. Sistem informasi manajemen pendidikan: Studi pengembangan model sistem informasi manajemen bidang adminsitrasi akademik dan kemahasiswaan pada FKIP Unsyiah. (Unpublished doctoral dissertation. Universitas Negeri Malang Malang.   Unpublished paper presented at a conference: Yasin, B. (2007, December. Membangun masa depan pendidikan Aceh Barat: Strategi dan kebijakan. Paper presented at the Seminar Pembangunan Pendidikan Kabupaten Aceh Barat, Universitas Syiah Kuala, Banda Aceh, Indonesia. Mass media/newspaper: Akmal, S. (2011, March 13. Nasib Bahsa Aceh di tengah euforia nasionalisme Keacehan. Serambi Indonesia, p. Opini column.   For in-text citations, use the name of the author(s followed by the year of publication.  Submit the article to sielejournal@gmail.com, with the subject: SUBMISSION TO SiELE. For further information on the submission guideline, please visit

National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening.

Science.gov (United States)

Halpern, Joshua A; Shoag, Jonathan E; Artis, Amanda S; Ballman, Karla V; Sedrakyan, Art; Hershman, Dawn L; Wright, Jason D; Shih, Ya Chen Tina; Hu, Jim C

2017-02-01

Studies demonstrate that use of prostate-specific antigen screening decreased significantly following the US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen screening in 2012. To determine downstream effects on practice patterns in prostate cancer diagnosis and treatment following the 2012 USPSTF recommendation. Procedural volumes of certifying and recertifying urologists from 2009 through 2016 were evaluated for variation in prostate biopsy and radical prostatectomy (RP) volume. Trends were confirmed using the New York Statewide Planning and Research Cooperative System and Nationwide Inpatient Sample. The study included a representative sample of urologists across practice settings and nationally representative sample of all RP discharges. We obtained operative case logs from the American Board of Urology and identified urologists performing at least 1 prostate biopsy (n = 5173) or RP (n = 3748), respectively. The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening. Change in median biopsy and RP volume per urologist and national procedural volume. Following the USPSTF recommendation, median biopsy volume per urologist decreased from 29 to 21 (interquartile range [IQR}, 12-34; P prostate biopsy and RP volumes decreased significantly. A panoramic vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation.

Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines

International Nuclear Information System (INIS)

Verhoeven, Karolien; Weltens, Caroline; Remouchamps, Vincent; Mahjoubi, Khalil; Veldeman, Liv; Lengele, Benoit; Hortobagyi, Eszter; Kirkove, Carine

2015-01-01

Objective: A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy. Methods: The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast. Results: The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5 mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes. Conclusion: With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based

American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature.

Science.gov (United States)

Acharya, Jayant N; Hani, Abeer; Cheek, Janna; Thirumala, Partha; Tsuchida, Tammy N

2016-08-01

This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 5. While the 10-10 system of electrode position nomenclature has been accepted internationally for almost two decades, it has not been used universally. The reasons for this and clinical scenarios when the 10-10 system provides additional localizing information are discussed in this revision. In addition, situations in which AF1/2, AF5/6, PO1/2 and PO5/6 electrode positions may be utilized for EEG recording are discussed.

[The German program for disease management guidelines: type 2 diabetes--diabetic retinopathy/maculopathy guideline 2006. Short review].

Science.gov (United States)

Ollenschläger, Günter; Kopp, Ina; Thole, Henning; Lelgemann, Monika

2007-02-15

In Germany, the first national consensus between six medical scientific associations on evidence-based recommendations for prevention and therapy of retinopathy/maculopathy in type 2 diabetes was reached in fall 2006. The recommendations' main sources are the NICE Retinopathy Guideline 2002, and existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Type 2 Diabetes-Retinopathy/Maculopathy 2006 (www.diabetes.versorgungsleitlinien.de).

Vehicle recovery and towing guideline

Energy Technology Data Exchange (ETDEWEB)

NONE

2010-01-15

This guideline was developed to provide light and medium duty vehicles operators in the oil and gas industry with a set of best practices for avoiding injury and damage during the recovery of stuck vehicles. The aim of the guideline was to increase awareness of safety issues and promote the safe usage of the vehicles by personnel throughout the petroleum industry and to establish minimum standards of practice for vehicle recovery. The guideline included a step-by-step guide for pulling out a vehicle with a recovery strap as well as vehicle-mounted winch procedures. Pre-job checklists for both procedures were provided. Issues related to the strength rating of vehicle tow hooks and hitch receivers were discussed, as well as some of the hazards associated with steep terrains and heavy mud. The guideline also included recommendations for a vehicle recovery kit with instructions on vehicle recovery, a recovery strap, a recovery hitch and shackle, a collapsible shovel, traffic cones and reflector flares, and a heavy blanket and gloves. 7 refs., 2 tabs., 13 figs.

Intention to Purchase Products under Volume Discount Scheme: A Conceptual Model and Research Propositions

Directory of Open Access Journals (Sweden)

Mohammad Iranmanesh

2014-12-01

Full Text Available Many standard brands sell products under the volume discount scheme (VDS as more and more consumers are fond of purchasing products under this scheme. Despite volume discount being commonly practiced, there is a dearth of research, both conceptual and empirical, focusing on purchase characteristics factors and consumer internal evaluation concerning the purchase of products under VDS. To attempt to fill this void, this article develops a conceptual model on VDS with the intention of delineating the influence of the purchase characteristics factors on the consumer intention to purchase products under VDS and provides an explanation of their effects through consumer internal evaluation. Finally, the authors discuss the managerial implications of their research and offer guidelines for future empirical research.

Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD

Directory of Open Access Journals (Sweden)

Louis-Philippe Boulet

2006-01-01

Full Text Available The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue, the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals.

Demarcating Mobile Phone Interface Design Guidelines to Expedite Selection

Directory of Open Access Journals (Sweden)

Karen Vera Renaud

2017-12-01

Full Text Available Guidelines are recommended as a tool for informing user interface design. Despite a proliferation of guidelines in the research literature, there is little evidence of their use in industry, nor their influence in academic literature. In this paper, we explore the research literature related to mobile phone design guidelines to find out why this should be so. We commenced by carrying out a scoping literature review of the mobile phone design guideline literature to gain insight into the maturity of the field. The question we wanted to explore was: “Are researchers building on each others’ guidelines, or is the research field still in the foundational stage?” We discovered a poorly structured field, with many researchers proposing new guidelines, but little incremental refinement of extant guidelines. It also became clear that the current reporting of guidelines did not explicitly communicate their multi-dimensionality or deployment context. This leaves designers without a clear way of discriminating between guidelines, and could contribute to the lack of deployment we observed. We conducted a thematic analysis of papers identified by means of a systematic literature review to identify a set of dimensions of mobile phone interface design guidelines. The final dimensions provide a mechanism for differentiating guidelines and expediting choice.

Overview of guidelines on breast screening

DEFF Research Database (Denmark)

Juhl Jørgensen, Karsten; Kalager, Mette; Barratt, Alexandra

2017-01-01

Updated guidelines on breast cancer screening have been published by several major organisations over the past five years. Recommendations vary regarding both age range, screening interval, and even on whether breast screening should be offered at all. The variation between recommendations reflects....... The estimates vary according to the methodology of the randomised trials, and the design of the observational studies. Guideline recommendations reflect the choice of evidence informing them. While there are well-developed tools to deal with randomised trials in guideline work, these are not always used......, or they may not be followed as recommended. Further, results of trials performed decades ago may no longer be applicable. For observational studies, the framework for inclusion in guidelines is not similarly well-developed and there are methodological concerns specific to screening interventions...

Japanese guidelines for allergic rhinitis 2017

Directory of Open Access Journals (Sweden)

Kimihiro Okubo

2017-04-01

To incorporate evidence based medicine (EBM introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2016. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA, this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

Guidelines for the verification and validation of expert system software and conventional software: Survey and documentation of expert system verification and validation methodologies. Volume 3

International Nuclear Information System (INIS)

Groundwater, E.H.; Miller, L.A.; Mirsky, S.M.

1995-03-01

This report is the third volume in the final report for the Expert System Verification and Validation (V ampersand V) project which was jointly sponsored by the Nuclear Regulatory Commission and the Electric Power Research Institute. The ultimate objective is the formulation of guidelines for the V ampersand V of expert systems for use in nuclear power applications. The purpose of this activity was to survey and document techniques presently in use for expert system V ampersand V. The survey effort included an extensive telephone interviewing program, site visits, and a thorough bibliographic search and compilation. The major finding was that V ampersand V of expert systems is not nearly as established or prevalent as V ampersand V of conventional software systems. When V ampersand V was used for expert systems, it was almost always at the system validation stage after full implementation and integration usually employing the non-systematic dynamic method of open-quotes ad hoc testing.close quotes There were few examples of employing V ampersand V in the early phases of development and only weak sporadic mention of the possibilities in the literature. There is, however, a very active research area concerning the development of methods and tools to detect problems with, particularly, rule-based expert systems. Four such static-testing methods were identified which were not discovered in a comprehensive review of conventional V ampersand V methods in an earlier task

Treatment Guidelines of Atrial Fibrillation (AFib or AF)

Science.gov (United States)

... Artery Disease Venous Thromboembolism Aortic Aneurysm More Treatment Guidelines of Atrial Fibrillation (AFib or AF) Updated:Jun 28,2017 What are the treatment guidelines for atrial fibrillation? Medical guidelines are written by ...

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery.

Science.gov (United States)

Struijk-Mulder, M C; Ettema, H B; Verheyen, C C; Büller, H R

2010-04-01

Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. We aimed to compare (inter)national guidelines and analyse differences. MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments. Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery. Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly.

Time to detoxify medical literature from guideline overdose

Institute of Scientific and Technical Information of China (English)

Dinesh Vyas; Arpita K Vyas

2012-01-01

The current financial turmoil in the United States has been attributed to multiple reasons including healthcare expenditure.Health care spending has increased from 5.7 percent of the gross domestic product (GDP)in 1965 to 16 percent of the GDP in 2004.Healthcare is driven with a goal to provide best possible care available at that period of time.Guidelines are generally assumed to have the high level of certainty and security as conclusions generated by the conventional scientific method leading many clinicians to use guidelines as the final arbiters of care.To provide the standard of care,physicians follow guidelines,proposed by either groups of physicians or various medical societies or government organizations like National Comprehensive Cancer Network.This has lead to multiple tests for the patient and has not survived the test of time.This independence leads to lacunae in the standardization of guidelines,hence flooding of literature with multiple guidelines and confusion to patients and physicians and eventually overtreatment,inefficiency,and patient inconvenience.There is an urgent need to restrict articles with Guidelines and develop some strategy like have an intermediate stage of pre-guidelines and after 5-10 years of trials,a systematic launch of the Guidelines.There can be better ways than this for putting together guidelines as has been suggested by multiple authors and researchers.

OSART guidelines. 1992 edition

International Nuclear Information System (INIS)

1992-01-01

The IAEA Operational Safety Review Team (OSART) Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as a guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness. Additional guidance and reference material has been prepared by the IAEA to complement the expertise of the OSART members

12 CFR 708a.13 - Voting guidelines.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Voting guidelines. 708a.13 Section 708a.13... INSURED CREDIT UNIONS TO MUTUAL SAVINGS BANKS § 708a.13 Voting guidelines. A converting credit union must conduct its member vote on conversion in a fair and legal manner. NCUA provides the following guidelines...

Oak Regeneration Guidelines for the Central Appalachians

Science.gov (United States)

Kim C. Steiner; James C. Finley; Peter J. Gould; Songlin Fei; Marc McDill

2008-01-01

This article presents the first explicit guidelines for regenerating oaks in the central Appalachians. The objectives of this paper are (1) to describe the research foundation on which the guidelines are based and (2) to provide users with the instructions, data collection forms, supplementary tables, and decision charts needed to apply the guidelines in the field. The...

No. 354-Canadian HIV Pregnancy Planning Guidelines.

Science.gov (United States)

Loutfy, Mona; Kennedy, V Logan; Poliquin, Vanessa; Dzineku, Frederick; Dean, Nicola L; Margolese, Shari; Symington, Alison; Money, Deborah M; Hamilton, Scot; Conway, Tracey; Khan, Sarah; Yudin, Mark H

2018-01-01

The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Hypertension guidelines and their effects on the health system

Directory of Open Access Journals (Sweden)

Konta, Brigitte

2005-12-01

Full Text Available Introduction: Hypertension guidelines, which have existed for many years and primarily used in the USA, Canada and Great Britain, are now becoming an issue in Germany. Strong efforts are presently underway for a German version comparable to the guidelines developed for the mentioned countries. The development of guidelines is a part of the implementation system of guidelines in Germany. It covers the mode of operation of the AWMF (work community of the scientific medical subject companies with the clearinghouse for guidelines (CLA and the cooperation with the centre for medical quality (ÄZQ. In the HTA report the real use of the hypertension guidelines shall be investigated for Germany from the development trends and further possibilities of use according to a medical applicability. Economic issues and an optimisation of use are also discussed. Question: The following questions shall be answered in particular: 1. How much are the guidelines used concerning hypertension? 2. Can effects (or their influence be established on the medical procedures? 3. Are there statements available about costs and cost effectiveness? 4. Are there recommendations for further use? Methodology: To answer these questions, a comprehensive literature search was done. No empirical investigation was carried out. From this enquiry 206 articles were checked in detail but not all of them were available in full text. Only those publications which directly dealt with high blood pressure guidelines or articles with a direct reference to the topic have been considered in the HTA report. Publications concerning screening or methods of prevention, medical studies of the hypertension syndrome without a direct reference to guidelines and publications concerned with putting guidelines into action were excluded. Results: After an analysis of the selected literature addressing the topic of hypertension guidelines, it was evident that the use of these guidelines cannot be gathered from

Cancer related fatigue: implementing guidelines for optimal management.

Science.gov (United States)

Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

2017-07-18

Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may

European Society of Veterinary Cardiology screening guidelines for dilated cardiomyopathy in Doberman Pinschers.

Science.gov (United States)

Wess, G; Domenech, O; Dukes-McEwan, J; Häggström, J; Gordon, S

2017-10-01

Dilated cardiomyopathy (DCM) is the most common cardiac disease in large breed dogs and is inherited in Doberman Pinschers with a high prevalence (58%). The European Society for Veterinary Cardiology convened a task force to formulate screening guidelines for DCM in Dobermans. Screening for occult DCM in Dobermans should start at three years of age and use both Holter monitoring and echocardiography. Yearly screening over the life of the dog is recommended, as a one-time screening is not sufficient to rule out future development of DCM. The preferred echocardiographic method is the measurement of the left ventricular volume by Simpson's method of discs (SMOD). Less than 50 single ventricular premature complexes (VPCs) in 24 h are considered to be normal in Dobermans, although detection of any number of VPCs is cause for concern. Greater than 300 VPCs in 24 h or two subsequent recordings within a year showing between 50 and 300 VPCs in 24 h is considered diagnostic of occult DCM in Dobermans regardless of the concurrent echocardiographic findings. The guidelines also provide recommendations concerning ancillary tests, that are not included in the standard screening protocol, but which may have some utility when recommended tests are not available or financially untenable on an annual basis. These tests include assay of cardiac biomarkers (Troponin I and N-Terminal pro-B-type Natriuretic Peptide) as well as a 5-min resting electrocardiogram (ECG). The current guidelines should help to establish an early diagnosis of DCM in Dobermans. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

A survey of psychiatrists' attitudes toward treatment guidelines.

Science.gov (United States)

Healy, Daniel J; Goldman, Mona; Florence, Timothy; Milner, Karen K

2004-04-01

We developed a survey to look at psychiatrists' attitudes toward psychotropic prescribing guidelines, specifically the Texas Medication Algorithm Project (TMAP) algorithms. The 22-page survey was distributed to 24 psychiatrists working in 4 CMHC's; 13 completed the survey. 90% agreed that guidelines should be general and flexible. The majority also agreed that guidelines should define how to measure response to a specific agent; fewer agreed guidelines should specify dosage, side effect management, or augmentation strategies. Psychiatrists were familiar with TMAP; none referred to it in their practice. In spite of this, psychiatrists' medication preferences were similar to those suggested by guidelines.

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

Science.gov (United States)

Colan, Steven D

2015-08-01

imaging, and strain and strain rate were either novel or non-existent and have now moved into the main stream. Cardiac magnetic resonance imaging (MRI) had very limited availability, and since that time imaging and assessment of myocardial iron content, delayed gadolinium enhancement, and extracellular volume have moved into the mainstream. The only devices discussed in the International Society for Heart and Lung Transplantation guidelines were extracorporeal membrane oxygenators, pacemakers, and defibrillators. Since that time, ventricular assist devices have become mainstream. Despite the relative lack of randomised controlled trials in paediatric heart failure, advances continue to occur. These advances warrant implementation of an update and review process, something that is best done under the auspices of the national and international cardiology societies. A joint activity that includes the International Society for Heart and Lung Transplantation, American College of Cardiology/American Heart Association, the Association for European Paediatric and Congenital Cardiology (AEPC), European Society of Cardiology, Canadian Cardiovascular Society, and others will have more credibility than independent efforts by any of these organisations.

Guideline Implementation: Hand Hygiene.

Science.gov (United States)

Goldberg, Judith L

2017-02-01

Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Medicare depreciation; useful life guidelines--HCFA. Proposed rule.

Science.gov (United States)

1982-09-30

We are proposing to amend Medicare regulations to clarify which useful life guidelines providers of health care services may use to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize HHS useful life guidelines or, if none have been published by HHS, the American Hospital Association (AHA) useful life guidelines of 1973 or IRS guidelines. We are proposing to eliminate the reference to IRS guidelines because those previously acceptable for Medicare purposes are outdated and have been made obsolete by the IRS or by statutory change. We would also delete the specific reference to the 1973 AHA guidelines. In addition, we intend this amendment to clarify that certain tax legislation on accelerated depreciation, recently passed by Congress, does not apply to the Medicare program.

Revised dietary guidelines for Koreans.

Science.gov (United States)

Jang, Young Ai; Lee, Haeng Shin; Kim, Bok Hee; Lee, Yoonna; Lee, Hae Jeung; Moon, Jae Jin; Kim, Cho-il

2008-01-01

With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.

[Target volume margins for lung cancer: internal target volume/clinical target volume].

Science.gov (United States)

Jouin, A; Pourel, N

2013-10-01

The aim of this study was to carry out a review of margins that should be used for the delineation of target volumes in lung cancer, with a focus on margins from gross tumour volume (GTV) to clinical target volume (CTV) and internal target volume (ITV) delineation. Our review was based on a PubMed literature search with, as a cornerstone, the 2010 European Organisation for Research and Treatment of Cancer (EORTC) recommandations by De Ruysscher et al. The keywords used for the search were: radiotherapy, lung cancer, clinical target volume, internal target volume. The relevant information was categorized under the following headings: gross tumour volume definition (GTV), CTV-GTV margin (first tumoural CTV then nodal CTV definition), in field versus elective nodal irradiation, metabolic imaging role through the input of the PET scanner for tumour target volume and limitations of PET-CT imaging for nodal target volume definition, postoperative radiotherapy target volume definition, delineation of target volumes after induction chemotherapy; then the internal target volume is specified as well as tumoural mobility for lung cancer and respiratory gating techniques. Finally, a chapter is dedicated to planning target volume definition and another to small cell lung cancer. For each heading, the most relevant and recent clinical trials and publications are mentioned. Copyright © 2013. Published by Elsevier SAS.

Managing Ulcerative Colitis – The Guidelines and Beyond

Directory of Open Access Journals (Sweden)

Mitchell RKL Lie

2013-11-01

Full Text Available Management guidelines offer clinicians clear, evidence-based and often succinct treatment advice. For ulcerative colitis these guidelines describe the use of 5-ASA, corticosteroids, thiopurines, cyclosporine, and anti-TNFα therapies. However, guidelines do have some drawbacks, mainly a lack of concrete advice concerning patients resistant to these aforementioned therapies. This review gives a short overview of current guidelines and addresses treatment alternatives for conventional therapies.

Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Science.gov (United States)

Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie; Friese, Randall; Guillamondegui, Oscar; Jawa, Randeep; Maung, Adrian; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin; Seamon, Mark; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew

2012-11-01

During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be

Cancer screening guidelines.

Science.gov (United States)

Zoorob, R; Anderson, R; Cefalu, C; Sidani, M

2001-03-15

Numerous medical organizations have developed cancer screening guidelines. Faced with the broad, and sometimes conflicting, range of recommendations for cancer screening, family physicians must determine the most reasonable and up-to-date method of screening. Major medical organizations have generally achieved consensus on screening guidelines for breast, cervical and colorectal cancer. For breast cancer screening in women ages 50 to 70, clinical breast examination and mammography are generally recommended every one or two years, depending on the medical organization. For cervical cancer screening, most organizations recommend a Papanicolaou test and pelvic examination at least every three years in patients between 20 and 65 years of age. Annual fecal occult blood testing along with flexible sigmoidoscopy at five-year to 10-year intervals is the standard recommendation for colorectal cancer screening in patients older than 50 years. Screening for prostate cancer remains a matter of debate. Some organizations recommend digital rectal examination and a serum prostate-specific antigen test for men older than 50 years, while others do not. In the absence of compelling evidence to indicate a high risk of endometrial cancer, lung cancer, oral cancer and ovarian cancer, almost no medical organizations have developed cancer screening guidelines for these types of cancer.

Periodontics and the new CDC guidelines.

Science.gov (United States)

Basquill, Linda C; Basquill, Patrick J

2004-07-01

On December 19, 2003, the Centers for Disease Control and Prevention released the Guidelines for Infection Control in Dental Health-Care Settings--2003. The publication was the first comprehensive dental infection control update since 1993. Although the guidelines are not directed toward a particular dental specialty, some recommendations may have a significant impact on the practice of periodontics because of the nature of the procedures that are considered routine to the specialty. This article deals with some of the issues addressed in the guidelines, highlighting topics of special interest to periodontists.

Empirical influence of the multicultural guidelines: A brief report.

Science.gov (United States)

Fouad, Nadya A; Santana, Mercedes; Ghosh, Arpita

2017-10-01

In 2002, the American Psychological Association (APA) Council of Representatives approved the "Guidelines for Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists." The Guidelines have been downloaded 64,153 times from the APA website from 2007 to 2013, and have been cited nearly 900 times. This suggests that the Guidelines have influenced education, training, research, and practice in psychology. However, it is unclear how the Guidelines have influenced these domains. We conducted a comprehensive literature review to examine how the Guidelines have influenced the field. Articles were coded for several criteria, including whether the Guidelines were cited, the type of research that was conducted, study findings, limitations, and future directions of research. The data for this study consisted of 895 empirical articles published since the 2003 publication of the Guidelines. A literature review using the keywords APA and multicultural guidelines were searched in PsycINFO and ERIC databases. Articles were then coded by the research team. Findings from the literature review suggested that although there were a total of 895 articles and books that cited the Guidelines, only 34 met our coding criteria. Our findings suggest that most of the articles that cited the Guidelines used the citation as a way to document that culture is important to consider. In some cases, other professions cited the Guidelines to argue that their discipline should also attend to culture. However, very few articles focused on framing an investigation around a specific guideline. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Heat exchanger performance monitoring guidelines

International Nuclear Information System (INIS)

Stambaugh, N.; Closser, W. Jr.; Mollerus, F.J.

1991-12-01

Fouling can occur in many heat exchanger applications in a way that impedes heat transfer and fluid flow and reduces the heat transfer or performance capability of the heat exchanger. Fouling may be significant for heat exchanger surfaces and flow paths in contact with plant service water. This report presents guidelines for performance monitoring of heat exchangers subject to fouling. Guidelines include selection of heat exchangers to monitor based on system function, safety function and system configuration. Five monitoring methods are discussed: the heat transfer, temperature monitoring, temperature effectiveness, delta P and periodic maintenance methods. Guidelines are included for selecting the appropriate monitoring methods and for implementing the selected methods. The report also includes a bibliography, example calculations, and technical notes applicable to the heat transfer method

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

Science.gov (United States)

Remington, Gary; Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-09-01

The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

77 FR 13585 - Electricity Subsector Cybersecurity Risk Management Process Guideline

Science.gov (United States)

2012-03-07

... DEPARTMENT OF ENERGY Electricity Subsector Cybersecurity Risk Management Process Guideline AGENCY... Electricity Subsector Cybersecurity Risk Management Process guideline. The guideline describes a risk... Cybersecurity Risk Management Process Guideline. The primary goal of this guideline is to describe a risk...

Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

Energy Technology Data Exchange (ETDEWEB)

Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

2014-07-15

The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

Condensate polishing guidelines for PWR and BWR plants

International Nuclear Information System (INIS)

Robbins, P.; Crinigan, P.; Graham, B.; Kohlmann, R.; Crosby, C.; Seager, J.; Bosold, R.; Gillen, J.; Kristensen, J.; McKeen, A.; Jones, V.; Sawochka, S.; Siegwarth, D.; Keeling, D.; Polidoroff, T.; Morgan, D.; Rickertsen, D.; Dyson, A.; Mills, W.; Coleman, L.

1993-03-01

Under EPRI sponsorship, an industry committee, similar in form and operation to other guideline committees, was created to develop Condensate Polishing Guidelines for both PWR and BWR systems. The committee reviewed the available utility and water treatment industry experience on system design and performance and incorporated operational and state-of-the-art information into document. These guidelines help utilities to optimize present condensate polisher designs as well as be a resource for retrofits or new construction. These guidelines present information that has not previously been presented in any consensus industry document. The committee generated guidelines that cover both deep bed and powdered resin systems as an integral part of the chemistry of PWR and BWR plants. The guidelines are separated into sections that deal with the basis for condensate polishing, system design, resin design and application, data management and performance and management responsibilities

75 FR 48934 - Coral Reef Conservation Program Implementation Guidelines

Science.gov (United States)

2010-08-12

...-01] RIN 0648-ZC19 Coral Reef Conservation Program Implementation Guidelines AGENCY: National Oceanic... Guidelines (Guidelines) for the Coral Reef Conservation Program (CRCP or Program) under the Coral Reef... assistance for coral reef conservation projects under the Act. NOAA revised the Implementation Guidelines for...

Colorectal Cancer Screening: A Guide to the Guidelines

Directory of Open Access Journals (Sweden)

Douglas K Rex

1999-01-01

Full Text Available The two most recent guidelines for colorectal cancer screening are those of the Agency for Healthcare Policy and Research, and the American Cancer Society. The guidelines are similar in many regards and reflect current literature, consensus opinion and compromise between members of multidisciplinary panels. The emphasis of both guidelines is to increase the options available for colorectal cancer screening. Increasing choice should expand the attractiveness of colorectal cancer screening to more patients and physicians, and the development of guidelines should help compel payers to provide reimbursement for colorectal cancer screening. These guidelines are summarized and evaluated as they pertain to colorectal cancer screening.

Development of human factors design review guidelines

International Nuclear Information System (INIS)

Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul

1997-10-01

The Objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, Human factors engineering program review model' and '26, Review criteria for human actors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides be ing performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents of NUREG-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we well update the guidelines by reviewing the literature related to alarm design published after 1994

Development of human factors design review guidelines

Energy Technology Data Exchange (ETDEWEB)

Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul [Korea Atomic Energy Research Institute, Taejon (Korea)

1997-10-01

The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: 25. Human Factors Engineering Program Review Model and 26. Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation, which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents of NUREG-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994. (author). 12 refs., 5 figs., 2 tabs.

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

NARCIS (Netherlands)

Struijk-Mulder, M. C.; Ettema, H. B.; Verheyen, C. C.; Büller, H. R.

2010-01-01

BACKGROUND: Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. OBJECTIVES: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the

48 CFR 1603.7002 - Additional guidelines.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Additional guidelines. 1603.7002 Section 1603.7002 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL... OF INTEREST Misleading, Deceptive, or Unfair Advertising 1603.7002 Additional guidelines. Any...

Soft tissue sarcoma - Compliance with guidelines

NARCIS (Netherlands)

Nijhuis, PHA; Schaapveld, M; Otter, R; Hoekstra, HJ

2001-01-01

BACKGROUND. Because soft tissue sarcomas (STS) are rare, guidelines for the diagnosis and treatment of patients with STS were developed. Because the diagnostic management is essential for definitive treatment, adherence to these guidelines is important. METHODS. Primary STS registered by the

Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality

Directory of Open Access Journals (Sweden)

Joslyn S. Kirby

2015-01-01

Full Text Available Actinic keratosis (AK is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document.

The siting guidelines, 10 CFR Part 960

International Nuclear Information System (INIS)

Hanlon, C.L.

1991-01-01

The Siting Guidelines, 10 CFR Part 960, have played a major role in the U.S. Department of Energy's (the Department) Office of Civilian Radioactive Waste Management siting program since their development and implementation in response to the Nuclear Waste Policy Act of 1982. According to the Act, the Siting Guidelines were applicable to the selection of sites for characterization. The Nuclear Waste Policy Amendments Act of 1987 (the Amendments Act) has selected the Yucca Mountain, Nevada, site for characterization from among those nominated according to the Siting Guidelines. Thus, the Amendments Act has taken the repository program beyond the phase of Siting Guidelines applicability, making the U.S. Nuclear Regulatory Commission's 10 CFR Part 60 the applicable regulation. However, the Department has chosen to make use of aspects of the Siting Guidelines in the Site Characterization Plan for the Yucca Mountain Site. (author) 4 figs., 11 refs

Estimating the cost-per-result of a national reflexed Cryptococcal antigenaemia screening program: Forecasting the impact of potential HIV guideline changes and treatment goals.

Science.gov (United States)

Cassim, Naseem; Coetzee, Lindi Marie; Schnippel, Kathryn; Glencross, Deborah Kim

2017-01-01

During 2016, the National Health Laboratory Service (NHLS) introduced laboratory-based reflexed Cryptococcal antigen (CrAg) screening to detect early Cryptococcal disease in immunosuppressed HIV+ patients with a confirmed CD4 count of 100 cells/μl or less. The aim of this study was to assess cost-per-result of a national screening program across different tiers of laboratory service, with variable daily CrAg test volumes. The impact of potential ART treatment guideline and treatment target changes on CrAg volumes, platform choice and laboratory workflow are considered. CD4 data (with counts per-result was calculated for four scenarios, including the existing service status quo (Scenario-I), and three other settings (as Scenarios II-IV) which were based on information from recent antiretroviral (ART) guidelines, District Health Information System (DHIS) data and UNAIDS 90/90/90 HIV/AIDS treatment targets. Scenario-II forecast CD4 testing offered only to new ART initiates recorded at DHIS. Scenario-III projected all patients notified as HIV+, but not yet on ART (recorded at DHIS) and Scenario-IV forecast CrAg screening in 90% of estimated HIV+ patients across South Africa (also DHIS). Stata was used to assess daily CrAg volumes at the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles across 52 CD4-laboratories. Daily volumes were used to determine technical effort/ operator staff costs (% full time equivalent) and cost-per-result for all scenarios. Daily volumes ranged between 3 and 64 samples for Scenario-I at the 5th and 95th percentile. Similarly, daily volumes ranges of 1-12, 2-45 and 5-100 CrAg-directed samples were noted for Scenario's II, III and IV respectively. A cut-off of 30 CrAg tests per day defined use of either LFA or EIA platform. LFA cost-per-result ranged from $8.24 to $5.44 and EIA cost-per-result between $5.58 and $4.88 across the range of test volumes. The technical effort across scenarios ranged from 3.2-27.6% depending on test volumes and

Guidelines for prevention in psychology.

Science.gov (United States)

2014-04-01

The effectiveness of prevention to enhance human functioning and reduce psychological distress has been demonstrated. From infancy through adulthood, access to preventive services and interventions is important to improve the quality of life and human functioning and reduce illness and premature death. The importance of prevention is consistent with the Patient Protection and Affordable Care Act of 2010. Even with the increased focus on prevention, psychology training programs rarely require specific courses on prevention. In particular, conceptualizations about best practices in prevention, particularly at the environmental level, are lacking. Therefore, psychologists engaged in prevention can benefit from a set of guidelines that address and inform prevention practices. Accordingly, the Guidelines for Prevention in Psychology are intended to "inform psychologists, the public, and other interested parties regarding desirable professional practices" in prevention. The Prevention Guidelines are recommended based on their potential benefits to the public and the professional practice of psychology. They support prevention as an important area of practice, research, and training for psychologists. The Guidelines give increased attention to prevention within APA, encouraging psychologists to become involved with preventive activities relevant to their area of practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis : an electronic guideline implementability appraisal

NARCIS (Netherlands)

van Dijk, Lotte J. E. W.; Nelen, Willianne L. D. M.; D'Hooghe, Thomas M.; Dunselman, Gerard A. J.; Hermens, Rosella P. M. G.; Bergh, Christina; Nygren, Karl G.; Simons, Arnold H. M.; de Sutter, Petra; Marshall, Catherine; Burgers, Jako S.; Kremer, Jan A. M.

2011-01-01

Background: Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological

Strategy Guideline: Demonstration Home

Energy Technology Data Exchange (ETDEWEB)

Savage, C.; Hunt, A.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

Strategy Guideline. Demonstration Home

Energy Technology Data Exchange (ETDEWEB)

Hunt, A.; Savage, C.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

Recombinant human erythropoietin and blood transfusion in low-birth weight preterm infants under restrictive transfusion guidelines

International Nuclear Information System (INIS)

Badiee, Z.; Pourmirzaiee, Mohmmad A.; Naseri, F.; Kelishadi, R.

2006-01-01

To compare the number and volume of red blood cell transfusions (RBCTs) in very low birth weight infants under restrictive red blood cell transfusion guidelines with and without erythropoietin administration. In a controlled clinical trial conducted at the neonatal intensive care unit of Alzahra Hospital, Isfahan, Iran, between April 2002 to April 2004, 60 premature infants with gestational age up to 34 weeks, birth weight up to 1500 g, and postnatal age between 8 and 14 days were included. The newborns were randomized into 2 groups: Group 1 received 3 doses of 400 IU/kg erythropoietin per week for 6 weeks, and Group 2 received no treatment aside from their conventional medications. The 2 groups did not differ significantly with respect to their mean gestational age, birth weight and hematocrit at the study entry. Fewer transfusions were administered to those receiving erythropoietin (26.7% versus 50%, p=0.03), but there was no statistically significant difference between groups with respect to volume of transfusion. Compared with the placebo group, the infants receiving erythropoietin had a higher mean hematocrit (34% +/- 4.3 versus 29% +/- 5.9, p<0.001) and absolute reticulocyte count (57 +/- 19 versus 10 +/- 4.8 x 106, p<0.001) at the end of the study. We found no significant difference in the incidence of thrombocytopenia and leukopenia between the 2 groups. We conclude that when the restrictive RBCT guidelines were followed, treatment with erythropoietin can be useful in reduction of the number of RBCTs. (author)

48 CFR 13.202 - Purchase guidelines.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase guidelines. 13.202 Section 13.202 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING... Threshold 13.202 Purchase guidelines. (a) Solicitation, evaluation of quotations, and award. (1) To the...

Do guidelines on first impression make sense? Implementation of a chest pain guideline in primary care: a systematic evaluation of acceptance and feasibility

Directory of Open Access Journals (Sweden)

Kramer Lena

2011-11-01

Full Text Available Abstract Background Most guidelines concentrate on investigations, treatment, and monitoring instead of patient history and clinical examination. We developed a guideline that dealt with the different aetiologies of chest pain by emphasizing the patient's history and physical signs. The objective of this study was to evaluate the guideline's acceptance and feasibility in the context of a practice test. Methods The evaluation study was nested in a diagnostic cross-sectional study with 56 General Practitioners (GPs and 862 consecutively recruited patients with chest pain. The evaluation of the guideline was conducted in a mixed method design on a sub-sample of 17 GPs and 282 patients. Physicians' evaluation of the guideline was assessed via standardized questionnaires and case record forms. Additionally, practice nursing staff and selected patients were asked for their evaluation of specific guideline modules. Quantitative data was analyzed descriptively for frequencies, means, and standard deviations. In addition, two focus groups with a total of 10 GPs were held to gain further insights in the guideline implementation process. The data analysis and interpretation followed the standards of the qualitative content analysis. Results The overall evaluation of the GPs participating in the evaluation study regarding the recommendations made in the chest pain guideline was positive. A total of 14 GPs were convinced that there was a need for this kind of guideline and perceived the guideline recommendations as useful. While the long version was partially criticized for a perceived lack of clarity, the short version of the chest pain guideline and the heart score were especially appreciated by the GPs. However, change of clinical behaviour as consequence of the guideline was inconsistent. While on a concrete patient related level, GPs indicated to have behaved as the guideline recommended, the feedback on a more general level was heterogeneous. Several

76 FR 17064 - Shared Use Path Accessibility Guidelines

Science.gov (United States)

2011-03-28

...] RIN 3014-AA41 Shared Use Path Accessibility Guidelines AGENCY: Architectural and Transportation... (ANPRM) to develop accessibility guidelines for shared use paths. Shared use paths are designed for both... users. The guidelines will include technical provisions for making newly constructed and altered shared...

Sustainable design guidelines to support the Washington State ferries terminal design manual : design guideline application and refinement.

Science.gov (United States)

2013-08-01

The Sustainable Design Guidelines were developed in Phase I of this research program (WA-RD : 816.1). Here we are reporting on the Phase II effort that beta-tested the Phase I Guidelines on : example ferry terminal designs and refinements made ...

Guideline implementation strategies for specialist mental healthcare.

Science.gov (United States)

Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Koesters, Markus

2013-07-01

Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

Introducing guidelines into clinical practice.

Science.gov (United States)

Fowkes, F G; Roberts, C J

1984-04-01

The impetus for guidelines of practice has been accelerated by a worldwide trend towards insurance based systems of health care. In the past it has been the tradition for the clinician to order all the diagnostic procedures that conceivably might help to clarify what is wrong with a patient, or what course of treatment should be followed. This traditional view ignores the stubborn economic reality that resources are finite and that it is no longer possible to be both endlessly generous and continually fair. Making judgements about the need for, and value of, services now forms an important part of coping with this problem. Clinical practice has to strive to be as safe as possible and to produce a given benefit at a socially acceptable cost. Guidelines are recommendations, preferably developed by clinicians themselves, which describe how and when individual clinical activities should be offered in order to achieve these objectives. Utilisation review of current practice is a valuable source of information for the development of guidelines. In the United Kingdom the Royal College of Radiologists attempted to do this in connection with the use of pre-operative chest X-rays. In 1979 they published the findings of a multicentre review of 10,619 consecutive cases of elective non-cardiopulmonary surgery undertaken in 8 centres throughout the United Kingdom. Substantial variations were found in national practice. Use of pre-operative chest X-rays varied from 11.5% of patients in one centre to 54.2% of patients in another centre. The study also found that the chest X-ray report did not seem to have much influence on the decision to operate nor on the decision to use inhalation anaesthesia. The College study failed to find "any evidence at all for the effectiveness of pre-operative chest X-ray when used routinely" and it was estimated that even if the procedure was 10% effective the costs of avoiding one death would be approximately 1 million pounds. These findings provided

Risk management guidelines for petroleum storage tank sites

Energy Technology Data Exchange (ETDEWEB)

NONE

2001-10-01

These guidelines provide a site management process designed particularly for soil and groundwater pollution originating from existing or former petroleum storage tank (PST) facilities and provide uniform standards for the remediation of polluted PST sites in Alberta. The numerical criteria, risk management objectives and technical information described in this document were compiled from four documents including Remediation Guidelines for Petroleum Storage Tank Sites 1994, the Canada-Wide Standards for Petroleum Hydrocarbons in Soil, Alberta Soil and Water Quality Guidelines for Hydrocarbons at Upstream Oil and Gas Facilities, and Guidelines for Managing Risks at Contaminated Sites in Alberta. The changes in these updated guidelines reflect new remediation criteria and provide a process for determining alternate site-specific management objectives for more petroleum storage tank sites. The guidelines were developed using a risk-based approach that ensures the protection of human health, safety and the environment. The guidelines apply to aboveground and underground storage tank facilities that contain gasoline, diesel, heating oil, and aviation fuel. The guidelines specify requirements by Alberta Environment and the Alberta Fire Code. The chapter on risk management process included information on site investigation, determination of soil type, pollution source removal, land use assessment, selection of exposure pathways, depth of remediation, human inhalation and groundwater protection pathways, and verification of remediation. figs, 4 tabs., 2 appendices.

EPRI PWR primary water chemistry guidelines revision

International Nuclear Information System (INIS)

McElrath, Joel; Fruzzetti, Keith

2014-01-01

EPRI periodically updates the PWR Primary Water Chemistry Guidelines as new information becomes available and as required by NEI 97-06 (Steam Generator Program Guidelines) and NEI 03-08 (Guideline for the Management of Materials Issues). The last revision of the PWR water chemistry guidelines identified an optimum primary water chemistry program based on then-current understanding of research and field information. This new revision provides further details with regard to primary water stress corrosion cracking (PWSCC), fuel integrity, and shutdown dose rates. A committee of industry experts, including utility specialists, nuclear steam supply system (NSSS) and fuel vendor representatives, Institute of Nuclear Power Operations (INPO) representatives, consultants, and EPRI staff collaborated in reviewing the available data on primary water chemistry, reactor water coolant system materials issues, fuel integrity and performance issues, and radiation dose rate issues. From the data, the committee updated the water chemistry guidelines that all PWR nuclear plants should adopt. The committee revised guidance with regard to optimization to reflect industry experience gained since the publication of Revision 6. Among the changes, the technical information regarding the impact of zinc injection on PWSCC initiation and dose rate reduction has been updated to reflect the current level of knowledge within the industry. Similarly, industry experience with elevated lithium concentrations with regard to fuel performance and radiation dose rates has been updated to reflect data collected to date. Recognizing that each nuclear plant owner has a unique set of design, operating, and corporate concerns, the guidelines committee has retained a method for plant-specific optimization. Revision 7 of the Pressurized Water Reactor Primary Water Chemistry Guidelines provides guidance for PWR primary systems of all manufacture and design. The guidelines continue to emphasize plant

41 CFR 109-38.502 - Guidelines.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Guidelines. 109-38.502 Section 109-38.502 Public Contracts and Property Management Federal Property Management Regulations System... 38-MOTOR EQUIPMENT MANAGEMENT 38.5-Scheduled Maintenance § 109-38.502 Guidelines. ...

48 CFR 813.202 - Purchase guidelines.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase guidelines. 813.202 Section 813.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS CONTRACTING... Threshold 813.202 Purchase guidelines. Open market micro-purchases shall be equitably distributed among all...

Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.

Science.gov (United States)

Shahangian, Shahram; Alspach, Todd D; Astles, J Rex; Yesupriya, Ajay; Dettwyler, William K

2014-02-01

changes in reimbursement volumes may be explained by disease prevalence and severity, patterns of drug use, clinical or laboratory practices, and testing recommendations and guidelines, among others. These data may be useful to policy makers, health systems researchers, laboratory directors, and industry scientists to understand, address, and anticipate trends in laboratory testing in the Medicare population.

Development application guidelines : Newfoundland offshore area

Energy Technology Data Exchange (ETDEWEB)

NONE

1988-12-01

The Canada-Newfoundland Offshore Petroleum Board has created a set of guidelines which describe the information needed by the Board to process a development application by a proponent of an offshore hydrocarbon development project. The guidelines also describe the review process that will be followed in considering a proponent`s application. Proponents must also refer to the Canada-Newfoundland Atlantic Accord Implementation Act and the Canada-Newfoundland Atlantic Accord Implementation (Newfoundland) Act. These guidelines also describe the requirements for the Canada-Newfoundland benefits plan, the environmental impact statement, the socio-economic impact statement, the safety plan, and the environmental protection plan.

Japanese guidelines for childhood asthma 2017.

Science.gov (United States)

Arakawa, Hirokazu; Hamasaki, Yuhei; Kohno, Yoichi; Ebisawa, Motohiro; Kondo, Naomi; Nishima, Sankei; Nishimuta, Toshiyuki; Morikawa, Akihiro

2017-04-01

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0-15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists). Copyright © 2016 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

The development of evidence-based guidelines in dentistry.

Science.gov (United States)

Faggion, C M

2013-02-01

Use of guidelines is an important means of reducing the gap between research and clinical practice. Sound and unbiased information should be available to enable dental professionals to provide better clinical treatment for their patients. The development of clinical guidelines in dentistry should follow standard and transparent methodology. The purpose of this article is to propose important steps for developing evidence-based clinical recommendations in dentistry. Initially, dental guidelines should be extensively sought and assessed to answer focused clinical questions. If there is a paucity of guidelines or if existing guidelines are not of good methodological quality, systematic reviews should be searched or conducted to serve as a basis for the development of evidence-based guidelines. When systematic reviews are produced, they should be rigorous in order to provide the best evidence possible. In the last phase of the process, the overall quality of evidence should be scrutinized and assessed, together with other factors (balance between treatment effects and side effects, patients' values, and cost-effectiveness of therapy) to determine the strength of recommendations. It is expected this approach will result in the development of sound clinical guidelines and consequent improvement of dental treatment.

ACC/AHA guidelines superior to ESC/EAS guidelines for primary prevention with statins in non-diabetic Europeans

DEFF Research Database (Denmark)

Mortensen, Martin Bødtker; Nordestgaard, Børge G; Afzal, Shoaib

2017-01-01

Aim We compared the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and the 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on prevention of atherosclerotic cardiovascular disease (ASCVD) using different risk prediction models [US......-calibrated around decision thresholds for statin therapy. For a Class I recommendation, 42% of individuals qualified for statins using the ACC/AHA guidelines vs. 6% with the ESC/EAS guidelines. Using ACC/AHA- vs. ESC/EAS-defined statin eligibility led to a substantial gain in sensitivity (+62% for any ASCVD and+76......% for fatal ASCVD) with a smaller loss in specificity (-35% for any ASCVD and -36% for fatal ASCVD). Similar differences between the ACC/AHA and ESC/EAS guidelines were found for men and women separately, and for Class IIa recommendations. The sensitivity and specificity of a US-PCE risk of 5% were similar...

Flexible manufacturing system handbook. Volume 1: Executive summary

Science.gov (United States)