WorldWideScience

Sample records for recommended practices overview

  1. Recommended practices in elevated temperature design: A compendium of breeder reactor experiences (1970-1986): An overview

    International Nuclear Information System (INIS)

    Wei, B.C.; Cooper, W.L. Jr.; Dhalla, A.K.

    1987-09-01

    Significant experiences have been accumulated in the establishment of design methods and criteria applicable to the design of Liquid Metal Fast Breeder Reactor (LMFBR) components. The Subcommittee of the Elevated Temperature Design under the Pressure Vessel Research Council (PVRC) has undertaken to collect, on an international basis, design experience gained, and the lessons learned, to provide guidelines for next generation advanced reactor designs. This paper shall present an overview and describe the highlights of the work

  2. Clinical practice recommendations for depression.

    Science.gov (United States)

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

    2009-01-01

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

  3. Overview of human health in the Arctic: conclusions and recommendations.

    Science.gov (United States)

    Donaldson, Shawn; Adlard, Bryan; Odland, Jon Øyvind

    2016-01-01

    This article is intended to provide an overview of the key conclusions, knowledge gaps and key recommendations based on the recent 2015 Arctic human health assessment under the Arctic Monitoring and Assessment Program. This assessment was based primarily on data from human health monitoring and research studies and peer-reviewed literature published since the last assessment in 2009.

  4. Training Research: Practical Recommendations for Maximum Impact

    Science.gov (United States)

    Beidas, Rinad S.; Koerner, Kelly; Weingardt, Kenneth R.; Kendall, Philip C.

    2011-01-01

    This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations. PMID:21380792

  5. Clinical practice recommendations for bipolar disorder.

    Science.gov (United States)

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

    2009-01-01

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

  6. Radiation protection: Philosophy, recommendations and practice

    International Nuclear Information System (INIS)

    Woodhead, D.S.

    1997-01-01

    The philosophy developed by the International Commission on Radiological Protection for the control of human radiation exposure will be described. The application of the ICRP recommendations to the authorization and control of the disposal of radioactive wastes to the sea will be discussed in the context of the practice in the United Kingdom. (author)

  7. [Nutrition recommendations for children who practice sports].

    Science.gov (United States)

    Sánchez-Valverde Visus, F; Moráis López, A; Ibáñez, J; Dalmau Serra, J

    2014-08-01

    Several health benefits have been attributed to sports practice, and an adequate nutrition status helps to maintain an optimal performance. Children most frequently practice non-competitive and non-endurance activities in a school setting. The dietary intake of children who practice sports should be similar to the general population, properly meeting their energy and nutrient requirements. During the activity performance, correct hydration should be aimed for, with water appearing to be an adequate source in most cases. General calorie and micronutrient supplementation should not be commonly recommended in children. Paediatricians must control nutritional status and dietary habits of children who practice sports, especially in those cases when weight-loss is aimed for, as well as take into account the psychological implications of competitive sports practice. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  8. Parenting Coordinators' Practices Recommendations: A Qualitative Study

    OpenAIRE

    Hirsch, Barbara Phyllis

    2016-01-01

    This qualitative study used a phenomenological approach to understand the experiences of seven parenting coordinators in using parenting coordination practices that they have found to be effective and would recommend to other parenting coordinators to achieve the following goals: educating parents, increasing the quality of parenting and co-parenting, managing conflict, and involving children and other family members in the process of parenting coordination. Data were collected with semi-str...

  9. Subsea leak detection systems - recommended practice

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Kristin Nergaard

    2010-07-01

    It is known in the industry that occasional leakages occur in subsea production systems. In spite of efforts to apply subsea leak detectors, the experience is that most leakages are either detected by ROV during routine inspections or interventions or as oil slicks on the surface . Operators and authority awareness towards the environmental impact of oil and gas production is increasing. The regulatory bodies in Norway, EU and USA specify requirements for detection of acute pollution. This paper presents the development of a Recommended Practice (RP) sponsored by OLF (The Norwegian Oil Industry Association). The JIP includes several major oil and gas operators. The objective of the RP is to serve as a technical and practical reference in the field of subsea leak detection. (Author)

  10. Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

    Science.gov (United States)

    Smith, Kirsten V; Thew, Graham R

    2017-09-01

    The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

  11. Practical recommendations for breathing-adapted radiotherapy

    International Nuclear Information System (INIS)

    Simon, L.; Giraud, P.; Rosenwald, J.C.; Dumas, J.L.; Lorchel, F.; Marre, D.; Dupont, S.; Varmenot, N.; Ginestet, C.; Caron, J.; Marchesi, V.; Ferreira, I.; Garcia, R.

    2007-01-01

    Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. (authors)

  12. Recommendable Practices for Effective Nuclear Crisis Communication

    International Nuclear Information System (INIS)

    Lee, Chang Ju; Hah, Yeon Hee

    2011-01-01

    'Crisis communication' refers one of the activities done by the Nuclear Regulatory Organizations (NROs) in order to protect the public and the environment from the possible harmful effects. As denoted by the BMU, German NRO, crisis communication is not only 'public information' or 'information for the public', but also communication between authorities in order to guarantee that public information is consistent. This study proposes some recommendable practices for developing a guideline of well-prepared nuclear crisis communication system, including its management framework, and for introducing good insights, based on the study of international aspects provided by relevant OECD/NEA WPGC (Working Group on Public Communication for Nuclear Regulatory Organizations)i working group

  13. Recommended Screening Practices for Launch Collision Aviodance

    Science.gov (United States)

    Beaver, Brian A.; Hametz, Mark E.; Ollivierre, Jarmaine C.; Newman, Lauri K.; Hejduk, Matthew D.

    2015-01-01

    The objective of this document is to assess the value of launch collision avoidance (COLA) practices and provide recommendations regarding its implementation for NASA robotic missions. The scope of this effort is limited to launch COLA screens against catalog objects that are either spacecraft or debris. No modifications to manned safety COLA practices are considered in this effort. An assessment of the value of launch COLA can be broken down into two fundamental questions: 1) Does collision during launch represent a significant risk to either the payload being launched or the space environment? 2) Can launch collision mitigation be performed in a manner that provides meaningful risk reduction at an acceptable level of operational impact? While it has been possible to piece together partial answers to these questions for some time, the first attempt to comprehensively address them is documented in reference (a), Launch COLA Operations: an Examination of Data Products, Procedures, and Thresholds, Revision A. This report is the product of an extensive study that addressed fundamental technical questions surrounding launch collision avoidance analysis and practice. The results provided in reference (a) will be cited throughout this document as these two questions are addressed. The premise of this assessment is that in order to conclude that launch COLA is a value-added activity, the answer to both of these questions must be affirmative. A "no" answer to either of these questions points toward the conclusion that launch COLA provides little or no risk mitigation benefit. The remainder of this assessment will focus on addressing these two questions.

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

    OpenAIRE

    Knowles, C. H.; Grossi, U.; Horrocks, E. J.; Pares, D.; Vollebregt, P. F.; Chapman, M.; Brown, S.; Mercer-Jones, M.; Williams, A. B.; Yiannakou, Y.; Hooper, R. J.; Stevens, N.; Mason, James; HASH(0x55897e1f8d68); HASH(0x55897e16c5e8)

    2017-01-01

    Aim\\ud \\ud This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR).\\ud Methods\\ud \\ud Summary of review data, development of GPR and future research recommendations as outlined in detail in the ‘introduction and methods’ paper.\\ud Results\\ud \\ud The overall quality of d...

  15. Farmers' Characteristics and Adoption' of Recommended Practices ...

    African Journals Online (AJOL)

    into cooperatives and increased agricultural extension education to enhance communication were recommended. ,. Key words: ... I Further actions by the Federal government to fully utilize the ... by constructing tube wells, wash bore, purchase.

  16. Overview of nuclear power plant equipment qualification issues and practices

    International Nuclear Information System (INIS)

    Torr, K.G.

    1989-01-01

    This report presents a view of and commentary on the current status of equipment qualification (EQ) in nuclear industries of the major western nations. The introductory chapters discuss the concepts of EQ, the elements of EQ process and highlight some of the key issues in EQ. A brief review of industry practices and some of the prevalent industrial standards is presented, followed by an overview of current regulatory positions in the USA, France, Germany and Sweden. A summary and commentary on the latest research findings on issues relating to accident simulation, to aging simulation and some special topics related to EQ, has been contributed by Franklin Research Centre of Philadelphia. The last part of the report deals with equipment qualification in Canada and gives recommendations on EQ for new plants as well as currently operational CANDU nuclear power plants

  17. Energy efficiency in Europe. Overview of policies and good practices

    International Nuclear Information System (INIS)

    Sebi, Carine; Mairet, Nicolas; Pollier, Karine; Lapillonne, Bruno; Dyevre, Nicolas; Bolinches, Christine

    2014-01-01

    As part of its Presidency of the Club EnR, a network of 24 national energy management agencies in Europe, ADEME drew up a brochure in 2014 on policies and best practices for energy efficiency in the countries of the European Union. An overview of the actions and programmes of 'neighbouring countries' is also given in this brochure. This action is a concrete part of the knowledge-sharing approach that encourages wide dissemination of proven or particularly promising policies. After an introductory chapter on the key figures and general objectives of the EU, the document is structured into 10 consumer industries and supplemented by a chapter on cross-industry measures. The conclusion draws lessons and makes recommendations to improve the results of future actions

  18. Recommended practice for process sampling for partial pressure analysis

    International Nuclear Information System (INIS)

    Blessing, James E.; Ellefson, Robert E.; Raby, Bruce A.; Brucker, Gerardo A.; Waits, Robert K.

    2007-01-01

    This Recommended Practice describes and recommends various procedures and types of apparatus for obtaining representative samples of process gases from >10 -2 Pa (10 -4 Torr) for partial pressure analysis using a mass spectrometer. The document was prepared by a subcommittee of the Recommended Practices Committee of the American Vacuum Society. The subcommittee was comprised of vacuum users and manufacturers of mass spectrometer partial pressure analyzers who have practical experience in the sampling of process gas atmospheres

  19. Overview of ICRP Committee 4: application of the Commission's recommendations.

    Science.gov (United States)

    Cool, D A

    2016-06-01

    Committee 4 develops principles and recommendations on radiological protection of people in all exposure situations. The committee meeting in 2014 was hosted by GE Healthcare in Arlington Heights, IL, USA on 27 July-1 August 2014. The programme of work of Committee 4 encompasses several broad areas, including a series of reports covering various aspects of existing exposure situations, leading the efforts of the International Commission on Radiological Protection (ICRP) to update and elaborate recommendations in light of the accident at Fukushima Daiichi nuclear power plant for emergencies and living in contaminated areas, elaborating the underpinnings of the system of radiological protection, and developing focussed reports on specific topic areas in consultation with ICRP's special liaison organisations. Committee 4 has six active Task Groups working on naturally occurring radioactive material; cosmic radiation in aviation; updates of ICRP Publications 109 and 111; ethics of radiological protection; surface and near-surface disposal of solid radioactive waste; and exposures resulting from contaminated sites from past industrial, military, and nuclear activities. In addition, there is a Working Party on tolerability of risk, and ongoing work with the various special liaison organisations of ICRP. © The International Society for Prosthetics and Orthotics.

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

    Science.gov (United States)

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

    2017-09-01

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

  1. Farmers\\' Characteristics And Adoption Of Recommended Practices ...

    African Journals Online (AJOL)

    The study focused on farmers under the fadama project scheme in Edo State, Nigeria with emphasis on the relationship between farmers\\' characteristics and adoption of recommended technologies. Analyses of data obtained from a random sample of 80 respondents reveals that fadama farming was dominated by females ...

  2. farmer's characteristics and adoption of recommended practices ...

    African Journals Online (AJOL)

    Prof. Ekwueme

    80 respondents reveals that fadama farming was dominated by females ... determinants of respondents' adoption of fadama-related technologies, accounting for about 39% of .... of male adoption of improved practices could be related to the.

  3. Practical Recommendations on Supplemental Feeding Introduction

    Directory of Open Access Journals (Sweden)

    S. G. Makarova

    2015-01-01

    Full Text Available Despite the availability of a national consensus document describing in detail modern approaches to feeding infants, pediatricians keep on giving most diverse recommendations on the time of supplemental feeding introduction. The article presents a brief historical review, as well the modern view on the issue of introduction of supplemental feeding to children. In the previous century, it was common both in Russia and most European countries to introduce supplemental feeding to children at the age of 2 or even 1.5 months. In 2002, the World Health Organization put forward an initiative in support of breastfeeding and recommended not to introduce supplemental feeding before the age of 6 months. A certain “golden mean” has apparently been achieved on the basis of results of studies and a longterm discussion among the specialists in feeding from different countries — all scientific communities and national recommendations of most countries define the optimal age for supplemental feeding introduction as “from 4 (completed months to 6 (completed months” with certain individual approach. 

  4. The Practice of Campus-Based Threat Assessment: An Overview

    Science.gov (United States)

    Pollard, Jeffrey W.; Nolan, Jeffrey J.; Deisinger, Eugene R. D.

    2012-01-01

    This article provides an overview of threat assessment and management as implemented on campuses of higher education. Standards of practice and state calls for implementation are cited. An overview of some of the basic principles for threat assessment and management implementation is accompanied by examples of how they are utilized. Pitfalls…

  5. Feasability study for waterway infrastructure: International overview and methodological recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Santos Fontes Pereira, L. dos; Brandão, R.; Yamashita, Y.; Guilherme de Aragão, J.J.

    2016-07-01

    The context in which the waterway transportation is in Brazil makes clear the development need of specific methodologies for the sector planning. This paper aims to compare the methods of analysis of technical, economic and environmental viability, adopted in Europe, United States and Brazil, listing the best practices and possible improvements of the method adopted in Brazil. The analysis of the documents was based on comparative method, seeking the common elements from its attributes. Each document was analysed in terms of: its structure; type of impacts; required indicators on each impact analysis; reference values for classification of indicators; and the form of integrated analysis of different impacts. The study suggests the inclusion of certain changes in the methodology of calculation and in its combination of tools and parameters used in the measurement of fiscal impacts on the comparative analysis of standard models usually adopted in the United States, Europe and the World Bank. (Author)

  6. Best practices and recommendations on policy packaging

    DEFF Research Database (Denmark)

    Fearnley, Nils; Longva, Frode; Ramjerdi, Farideh

    2011-01-01

    . This report gives practical and general advice for each of these stages: 1. Define objectives and targets 2. Create an inventory of measures, identify potential primary measures and detect causal relationships 3. Assess policy package 4. Modify package 5. Package implementation 6. Evaluate effects, introduce...

  7. Adoption of Recommended Rice Production Practices among ...

    African Journals Online (AJOL)

    User

    rice production practices by women farmers in Nasarawa State. A total of 203 women rice farmers were selected for the study using multi- ... RRPPs were unavailability of credit facilities, poor marketing system and ... economy which provides employment opportunity for about 70-80 percent of the total ..... shown in Table 1.

  8. Practical nutritional recommendations for the athlete.

    Science.gov (United States)

    Maughan, Ronald J; Burke, Louise M

    2011-01-01

    The aim of training is to achieve optimum performance on the day of competition via three processes or paradigms; training hard to create the required training stimulus, training smart to maximize adaptations to the training stimulus, and training specifically to fine- turn the behaviors or physiology needed for competition strategies. Dietary strategies for competition must target the factors that would otherwise cause fatigue during the event, promoting an enhancement of performance by reducing or delaying the onset of these factors. In some cases, the nutritional strategies needed to achieve these various paradigms are different, and even opposite to each other, so athletes need to periodize their nutrition, just as they periodize their training program. The evolution of new knowledge from sports nutrition research, such as presented in this book, usually starts with a stark concept that must be further refined; to move from individual nutrients to food, from 'one size fits all' to the individual needs and practices of different athletes, and from single issues to an integrated picture of sports nutrition. The translation from science to practice usually requires a large body of follow-up studies as well as experimentation in the field. Copyright © 2011 S. Karger AG, Basel.

  9. Four simple recommendations to encourage best practices in research software.

    Science.gov (United States)

    Jiménez, Rafael C; Kuzak, Mateusz; Alhamdoosh, Monther; Barker, Michelle; Batut, Bérénice; Borg, Mikael; Capella-Gutierrez, Salvador; Chue Hong, Neil; Cook, Martin; Corpas, Manuel; Flannery, Madison; Garcia, Leyla; Gelpí, Josep Ll; Gladman, Simon; Goble, Carole; González Ferreiro, Montserrat; Gonzalez-Beltran, Alejandra; Griffin, Philippa C; Grüning, Björn; Hagberg, Jonas; Holub, Petr; Hooft, Rob; Ison, Jon; Katz, Daniel S; Leskošek, Brane; López Gómez, Federico; Oliveira, Luis J; Mellor, David; Mosbergen, Rowland; Mulder, Nicola; Perez-Riverol, Yasset; Pergl, Robert; Pichler, Horst; Pope, Bernard; Sanz, Ferran; Schneider, Maria V; Stodden, Victoria; Suchecki, Radosław; Svobodová Vařeková, Radka; Talvik, Harry-Anton; Todorov, Ilian; Treloar, Andrew; Tyagi, Sonika; van Gompel, Maarten; Vaughan, Daniel; Via, Allegra; Wang, Xiaochuan; Watson-Haigh, Nathan S; Crouch, Steve

    2017-01-01

    Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations.

  10. Overview of Performance Based Practical Design

    Science.gov (United States)

    2018-03-01

    DOI: https://doi.org/10.13023/KTC.RR.2018.03 State transportation agencies (STAs) have increasingly turned to practical design and performance based practical design(PBPD) to inform project development and implementation and to reduce project cos...

  11. Welfare issues of horses: an overview and practical recommendations

    Directory of Open Access Journals (Sweden)

    Elisabetta Canali

    2010-01-01

    Full Text Available The largest proportion of the world’s horses are still used for work in agriculture and traction, however in the western countries they are increasingly kept for recreational and social purposes, breeding, sport and competition. It is often assumed that horses enjoys better farming conditions than other species, yet they have specific needs which should be fulfilled in order to have a proper welfare. This paper will review the main welfare issues of horses and the following aspects will be considered: nutrition, housing and management, clinical problems, behaviour problems, training and riding, transportation, measuring welfare. Horses are social animals that live in groups in close contact with conspecifics. They spend most of their waking hours moving at walk, grazing and eating grass. Some of the constraints imposed on horses during the last centuries conflict to their naturally evolved behaviour. Effective and humane handling of horses positively affects many important aspects like the safety of man, the performance level and the welfare of horses. It is an essential condition for keeping horses that handlers, riders, trainers, farriers and veterinarians have proper knowledge of the behaviour of the horse in order to fulfil their natural needs and guarantee their welfare.

  12. Recommended practice for the neutron radiography of nuclear fuels

    International Nuclear Information System (INIS)

    Matfield, R.S.

    1983-01-01

    The document is part of a Neutron Radiography Handbook being prepared by a Neutron Radiography Working Party of the European Community. It commences with a description of the information that should be provided by a user of neutron radiography services and then gives recommendations on the equipment to be used. This is followed by two sections on the techniques to be used for detecting discontinuities and the making of measurements on nuclear fuel. This is then followed by recommended safety practices and then sections on film handling, film processing, viewing of radiographs, references, radiographs, storage and records. Recommendations on training and certification are being prepared. It does not include any technical justification for the practices which are recommended. (Auth.)

  13. Four simple recommendations to encourage best practices in research software

    DEFF Research Database (Denmark)

    Jiménez, Rafael C.; Kuzak, Mateusz; Alhamdoosh, Monther

    2017-01-01

    Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage...... the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute...... to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption...

  14. Solar Ready: An Overview of Implementation Practices

    Energy Technology Data Exchange (ETDEWEB)

    Watson, A.; Guidice, L.; Lisell, L.; Doris, L.; Busche, S.

    2012-01-01

    This report explores three mechanisms for encouraging solar ready building design and construction: solar ready legislation, certification programs for solar ready design and construction, and stakeholder education. These methods are not mutually exclusive, and all, if implemented well, could contribute to more solar ready construction. Solar ready itself does not reduce energy use or create clean energy. Nevertheless, solar ready building practices are needed to reach the full potential of solar deployment. Without forethought on incorporating solar into design, buildings may be incompatible with solar due to roof structure or excessive shading. In these cases, retrofitting the roof or removing shading elements is cost prohibitive. Furthermore, higher up-front costs due to structural adaptations and production losses caused by less than optimal roof orientation, roof equipment, or shading will lengthen payback periods, making solar more expensive. With millions of new buildings constructed each year in the United States, solar ready can remove installation barriers and increase the potential for widespread solar adoption. There are many approaches to promoting solar ready, including solar ready legislation, certification programs, and education of stakeholders. Federal, state, and local governments have the potential to implement programs that encourage solar ready and in turn reduce barriers to solar deployment. With the guidance in this document and the examples of jurisdictions and organizations already working to promote solar ready building practices, federal, state, and local governments can guide the market toward solar ready implementation.

  15. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

  16. Renal cystic disease: A practical overview

    International Nuclear Information System (INIS)

    Hartman, D.S.

    1987-01-01

    Renal cystic disease includes a group of lesions with extremely diverse clinical, radiographic, and pathologic findings. The recent development of multiple imaging systems to study renal cystic disease has resulted in considerable interest in correlating the images obtained by different modalities with each other and with the underlying gross pathology. A thorough knowledge of the disturbed morphology and natural history of these diseases will lead to a better understanding of their appearance on radiologic imaging. This refresher course correlates disturbed morphology with appearances on diagnostic imaging, urography, US, angiography, CT, and MR imaging. The advantages and limitations of each imaging method are detailed. A practical classification emphasizing differential features is presented. The presentation is divided into two parts. In the first part typical and atypical cystic masses, including acquired cystic disease (from dialysis), Von Hippel-Lindau disease, and the cystic disease of tuberous sclerosis are discussed. In the second part, polycystic kidney disease (dominant and recessive), medullary cystic disease, medullary sponge kidney, multicycle-dysplastic kidney, renal sinus cysts (peripelvic), and pluricystic kidney disease are discussed

  17. International short-term medical missions: a systematic review of recommended practices.

    Science.gov (United States)

    Roche, Stephanie D; Ketheeswaran, Pavinarmatha; Wirtz, Veronika J

    2017-01-01

    To identify practices for conducting international short-term medical missions (STMMs) recommended in the literature and examine how these link STMMs to recipient countries' existing health systems. Systematic review of PubMed-indexed articles on STMMs and their bibliographies using preferred reporting items for systematic reviews and meta-analyses guidelines. Recommendations were organized using the World Health Organization Health Systems Framework. In 92 publications, 67 % offered at least one recommendation that would link STMMs to the recipient country's health system. Among these recommendations, most focused on service delivery and few on health financing and governance. There is a lack of consensus around a proper standard of care, patient selection, and trip duration. Comprehensive global standards are needed for STMM work to ensure that services are beneficial both to patients and to the broader healthcare systems of recipient countries. By providing an overview of the current recommendations and important gaps where practice recommendations are needed, this study can provide relevant input into the development of global standards for STMMs.

  18. Practical Recommendations for the Preliminary Design Analysis of ...

    African Journals Online (AJOL)

    Interior-to-exterior shear ratios for equal and unequal bay frames, as well as column inflection points were obtained to serve as practical aids for preliminary analysis/design of fixed-feet multistory sway frames. Equal and unequal bay five story frames were analysed to show the validity of the recommended design ...

  19. Adoption Level of IFAD Project Recommended Farming Practices ...

    African Journals Online (AJOL)

    E M IGBOKWE

    the respondents respectively identified low counterpart funding, untimely disbursement of funds and inadequate mobility of extension staff as the major constraints to the effective implementation of the programme. Generally, there was a high level of adoption of the recommended farming practices among the participating.

  20. Recommendations on practice of conditioned pain modulation (CPM) testing.

    Science.gov (United States)

    Yarnitsky, D; Bouhassira, D; Drewes, A M; Fillingim, R B; Granot, M; Hansson, P; Landau, R; Marchand, S; Matre, D; Nilsen, K B; Stubhaug, A; Treede, R D; Wilder-Smith, O H G

    2015-07-01

    Protocols for testing conditioned pain modulation (CPM) vary between different labs/clinics. In order to promote research and clinical application of this tool, we summarize the recommendations of interested researchers consensus meeting regarding the practice of CPM and report of its results. © 2014 European Pain Federation - EFIC®

  1. TU-E-BRB-03: Overview of Proposed TG-132 Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Brock, K. [University of Michigan (United States)

    2015-06-15

    Deformable image registration (DIR) is developing rapidly and is poised to substantially improve dose fusion accuracy for adaptive and retreatment planning and motion management and PET fusion to enhance contour delineation for treatment planning. However, DIR dose warping accuracy is difficult to quantify, in general, and particularly difficult to do so on a patient-specific basis. As clinical DIR options become more widely available, there is an increased need to understand the implications of incorporating DIR into clinical workflow. Several groups have assessed DIR accuracy in clinically relevant scenarios, but no comprehensive review material is yet available. This session will also discuss aspects of the AAPM Task Group 132 on the Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning official report, which provides recommendations for DIR clinical use. We will summarize and compare various commercial DIR software options, outline successful clinical techniques, show specific examples with discussion of appropriate and inappropriate applications of DIR, discuss the clinical implications of DIR, provide an overview of current DIR error analysis research, review QA options and research phantom development and present TG-132 recommendations. Learning Objectives: Compare/contrast commercial DIR software and QA options Overview clinical DIR workflow for retreatment To understand uncertainties introduced by DIR Review TG-132 proposed recommendations.

  2. Personalized Approach to Nutrition of Children Athletes: Practical Recommendations

    Directory of Open Access Journals (Sweden)

    S. G. Makarova

    2016-01-01

    Full Text Available Adequate nutrition is the most important factor of children’s health, affecting not only his/her state of health, but also physical activity indicators. Children athletes, for compensating the energy cost, anabolic processes activation, and operability recovery, need an optimum diet with adequate protein, fats, carbohydrates, minerals and vitamins to cover the development and growth needs, as well as to recover from the physical and neuro-psychological stress. There are also certain requirements to food and drinking regime, especially during periods of intense training and competitions. Recommendations for the composition of diets for children athletes are developed and presented in a number of guidelines; however, studies show that the actual nutrition of almost half of the specialized children and youth Olympic reserve schools’ students does not meet the recommended standards. The article presents an overview of modern approaches to young athletes’ nutrition organization, and gives recommendations for personified diet correction and nutritive support depending on sports specialization, nature of physical activity, stage of training process, and individual features of a child.

  3. Recommended Practices Guide Securing WLANs using 802.11i

    Energy Technology Data Exchange (ETDEWEB)

    Masica, K

    2006-10-16

    This paper addresses design principles and best practices regarding the implementation and operation of Wireless LAN (WLAN) communication networks based on the 802.11i security standard. First, a general overview of WLAN technology and standards is provided in order to ground the discussion in the evolution of WLAN standards and security approaches. This is followed by a detailed explanation of the 802.11i standard for securing WLAN networks. Principles for designing secure WLAN networks are then presented, followed by a list of specific best practices that can be used as a guideline for organizations considering the deployment of WLAN networks for non-critical control and monitoring applications. Finally, a section on technical issues and considerations for deploying WLAN networks in critical environments is presented.

  4. Compliance With Recommended Food Safety Practices in Television Cooking Shows.

    Science.gov (United States)

    Cohen, Nancy L; Olson, Rita Brennan

    Examine compliance with recommended food safety practices in television cooking shows. Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows. Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned. There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  5. Doctors’ Knowledge of Hypertension Guidelines Recommendations Reflected in Their Practice

    Directory of Open Access Journals (Sweden)

    Nafees Ahmad

    2018-01-01

    Full Text Available Aim. To evaluate doctors’ knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008. Methods. Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors’ knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor. SPSS 17 was used for data analysis. Results. Nineteen doctors (73.07% had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines’ recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15±1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5–20. Statistically significant correlation (rs = 0.635, P<0.001 was observed between doctors’ knowledge and practice scores. A total of 349 (67.1% prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P=0.008, left ventricular hypertrophy (OR = 0.091, P=0.001 and heart failure (OR = 1.923, P=0.039 were significantly associated with guidelines adherence. Conclusion. Doctors’ knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.

  6. First aid in the dental practice: an overview.

    Science.gov (United States)

    Jevon, P

    2016-06-24

    First aid encompasses a wide range of scenarios ranging from simple reassurance following a minor mishap to dealing with a life-threatening emergency. Dentists may need to provide first aid in their dental practice to a patient, relative or member of staff. This article provides an overview to first aid in the dental practice, including priorities, responsibilities when providing first aid, assessment of the environment and the casualty (primary survey &secondary survey). The new A3 'First Aid in the Workplace' poster is now available and is included as an insert in this issue (BDJ Vol. 220, Issue 12).

  7. A methodology for practical implementation of ICRP recommendations for optimization

    International Nuclear Information System (INIS)

    Webb, G.A.M.; Clarke, R.H.

    1979-01-01

    The system of dose limitation recommended by the Commission has been restated in its most recent recommendations with the requirements implying cost benefit analysis elevated to pride of place. The main subject of this paper is discussion of the problems involved in carrying out differential cost benefit analysis (optimization) studies. The various quantities such as Effective Dose Equivalent and Collective Effective Dose Equivalent Commitment needed to carry out these studies are discussed, their strengths and weaknesses identified and suggestions made as to how they should be used in practice. In particular the implications underlying the use of the collective quantities as the independent variable in these studies are clarified and examined. The need for the maximum realism in calculational models and parameters used in the calculation of collective quantities for optimization studies is stressed, with the corollary of conservative calculations for comparison with dose limits. The methods for calculating costs are examined, both for the plant or equipment installed to reduce doses and for the cost associated with the consequent reduction in health detriment. Some practical problems are cited in both the theory and practice of optimization. It is concluded that optimization is not yet sufficiently developed in either basic formalism or practical application. Some areas are identified where further work is needed. (author)

  8. Practice implications and recommendations for managing codeine misuse and dependence

    Directory of Open Access Journals (Sweden)

    Bergin Michael

    2015-12-01

    Full Text Available Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O’Malley’s framework (1. Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

  9. Infection control practices across Canada: do dentists follow the recommendations?

    Science.gov (United States)

    McCarthy, G M; Koval, J J; John, M A; MacDonald, J K

    1999-10-01

    This study investigated provincial and territorial differences in dentists' compliance with recommended infection control practices in Canada (1995). Questionnaires were mailed to a stratified random sample of 6,444 dentists, of whom 66.4% responded. Weighted analyses included Pearson's chi-square test and multiple logistic regression. Significant provincial and territorial differences included testing for immune response after hepatitis B virus (HBV) vaccination, HBV vaccination for all clinical staff, use of infection control manuals and post-exposure protocols, biological monitoring of heat sterilizers, handwashing before treating patients, using gloves and changing them after each patient, heat-sterilizing handpieces between patients, and using masks and uniforms to protect against splatter of blood and saliva. Excellent compliance (compliance with a combination of 18 recommended infection control procedures) ranged from 0% to 10%; the best predictors were more hours of continuing education on infection control in the last two years, practice location in larger cities (> 500,000) and sex (female). Clearly, improvements in infection control are desirable for dentists in all provinces and territories. Extending mandatory continuing education initiatives to include infection control may promote better compliance with current recommendations.

  10. Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence.

    Science.gov (United States)

    Gillespie, David C; Bowen, Audrey; Chung, Charlie S; Cockburn, Janet; Knapp, Peter; Pollock, Alex

    2015-02-01

    Although cognitive impairments are common following stroke, there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life. Indeed, a recent project to identify priorities for research into life after stroke determined that the top priority for patients, carers and health professionals was how to improve cognitive impairments. To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base. Evidence was synthesised for the six Cochrane reviews relating to rehabilitation for post-stroke cognitive impairment and any subsequently published randomized controlled trials to February 2012. Data arising from 44 trials involving over 1500 patients was identified. Though there was support for the effectiveness of cognitive rehabilitation for some cognitive impairments, significant gaps were found in the current evidence base. All of the Cochrane reviews identified major limitations within the evidence they identified. There is currently insufficient research evidence, or evidence of insufficient quality, to support clear recommendations for clinical practice. Recommendations are made as to the research required to strengthen the evidence base, and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke. © The Author(s) 2014.

  11. Scientific Software - the role of best practices and recommendations

    Science.gov (United States)

    Fritzsch, Bernadette; Bernstein, Erik; Castell, Wolfgang zu; Diesmann, Markus; Haas, Holger; Hammitzsch, Martin; Konrad, Uwe; Lähnemann, David; McHardy, Alice; Pampel, Heinz; Scheliga, Kaja; Schreiber, Andreas; Steglich, Dirk

    2017-04-01

    In Geosciences - like in most other communities - scientific work strongly depends on software. For big data analysis, existing (closed or open source) program packages are often mixed with newly developed codes. Different versions of software components and varying configurations can influence the result of data analysis. This often makes reproducibility of results and reuse of codes very difficult. Policies for publication and documentation of used and newly developed software, along with best practices, can help tackle this problem. Within the Helmholtz Association a Task Group "Access to and Re-use of scientific software" was implemented by the Open Science Working Group in 2016. The aim of the Task Group is to foster the discussion about scientific software in the Open Science context and to formulate recommendations for the production and publication of scientific software, ensuring open access to it. As a first step, a workshop gathered interested scientists from institutions across Germany. The workshop brought together various existing initiatives from different scientific communities to analyse current problems, share established best practices and come up with possible solutions. The subjects in the working groups covered a broad range of themes, including technical infrastructures, standards and quality assurance, citation of software and reproducibility. Initial recommendations are presented and discussed in the talk. They are the foundation for further discussions in the Helmholtz Association and the Priority Initiative "Digital Information" of the Alliance of Science Organisations in Germany. The talk aims to inform about the activities and to link with other initiatives on the national or international level.

  12. Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1.

    Science.gov (United States)

    Caro, J Jaime; Briggs, Andrew H; Siebert, Uwe; Kuntz, Karen M

    2012-01-01

    Models--mathematical frameworks that facilitate estimation of the consequences of health care decisions--have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR Modeling Task Force reported in 2003 has led to a new Task Force, jointly convened with the Society for Medical Decision Making, and this series of seven articles presents the updated recommendations for best practices in conceptualizing models; implementing state-transition approaches, discrete event simulations, or dynamic transmission models; and dealing with uncertainty and validating and reporting models transparently. This overview article introduces the work of the Task Force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these articles includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1.

    Science.gov (United States)

    Caro, J Jaime; Briggs, Andrew H; Siebert, Uwe; Kuntz, Karen M

    2012-01-01

    Models-mathematical frameworks that facilitate estimation of the consequences of health care decisions-have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR modeling task force reported in 2003 has led to a new task force, jointly convened with the Society for Medical Decision Making, and this series of seven papers presents the updated recommendations for best practices in conceptualizing models; implementing state-transition approaches, discrete event simulations, or dynamic transmission models; dealing with uncertainty; and validating and reporting models transparently. This overview introduces the work of the task force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these papers includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making.

  14. A manual of recommended practices for hydrogen energy systems

    Energy Technology Data Exchange (ETDEWEB)

    Hoagland, W.; Leach, S. [W. Hoagland and Associates, Boulder, CO (United States)

    1997-12-31

    Technologies for the production, distribution, and use of hydrogen are rapidly maturing and the number and size of demonstration programs designed to showcase emerging hydrogen energy systems is expanding. The success of these programs is key to hydrogen commercialization. Currently there is no comprehensive set of widely-accepted codes or standards covering the installation and operation of hydrogen energy systems. This lack of codes or standards is a major obstacle to future hydrogen demonstrations in obtaining the requisite licenses, permits, insurance, and public acceptance. In a project begun in late 1996 to address this problem, W. Hoagland and Associates has been developing a Manual of Recommended Practices for Hydrogen Systems intended to serve as an interim document for the design and operation of hydrogen demonstration projects. It will also serve as a starting point for some of the needed standard-setting processes. The Manual will include design guidelines for hydrogen procedures, case studies of experience at existing hydrogen demonstration projects, a bibliography of information sources, and a compilation of suppliers of hydrogen equipment and hardware. Following extensive professional review, final publication will occur later in 1997. The primary goal is to develop a draft document in the shortest possible time frame. To accomplish this, the input and guidance of technology developers, industrial organizations, government R and D and regulatory organizations and others will be sought to define the organization and content of the draft Manual, gather and evaluate available information, develop a draft document, coordinate reviews and revisions, and develop recommendations for publication, distribution, and update of the final document. The workshop, Development of a Manual of Recommended Practices for Hydrogen Energy Systems, conducted on March 11, 1997 in Alexandria, Virginia, was a first step.

  15. Nutritional practices of national female soccer players: analysis and recommendations.

    Science.gov (United States)

    Martin, Louise; Lambeth, Anneliese; Scott, Dawn

    2006-01-01

    The aim of the study was to establish the nutritional practices and activity patterns of elite female soccer players. The nutritional intake of 16 female England Soccer players was self-reported over a seven-day period. Participants were provided with written and verbal guidelines for the completion of the diaries. Training details were also recorded, and used in combination with BMR predictions to calculate daily energy expenditure. Energy, macronutrient and micronutrient intakes were determined using DietMaster 4.0 software. Results suggest that energy intake was low (1904 ± 366.3 kcal) in relation to previous recommendations for soccer players. Energy expenditure (2153.5 ± 596.2 kcal) was not significantly different (p > 0.05) from intake, suggesting energy balance was achieved. Carbohydrate (53.8 ± 6.8%), protein (16.8 ± 2.1%) and fat (28.8 ± 6.6%) intakes were in line with recommendations. Fluid intake (2466 ± 1350.5ml·day(-1)) was sufficient to meet baseline recommendations, but would need to be higher to meet the additional requirement of training and competition. With the exception of vitamin A and iron, all micronutrient intakes were higher than the DRI. In conclusion, recommendations for female soccer players are to encourage consumption of carbohydrate-electrolyte beverages to enhance carbohydrate intake and increase fluid intake, and ensure sufficient iron rich foods are included in the diet to meet the DRI. Key pointsFemale soccer players demonstrate a low energy intake in relation to predicted requirements, but were in energy balance in this study.Increased carbohydrate intake may be beneficial to both training and competition performance of elite female soccer playersFluid requirements should be addressed on an individual basis and matched to player requirements.The iron status of female soccer players may be compromised due to insufficient dietary intake to meet the DRV.

  16. Nutritional Practices of National Female Soccer Players: Analysis and Recommendations

    Science.gov (United States)

    Martin, Louise; Lambeth, Anneliese; Scott, Dawn

    2006-01-01

    The aim of the study was to establish the nutritional practices and activity patterns of elite female soccer players. The nutritional intake of 16 female England Soccer players was self-reported over a seven-day period. Participants were provided with written and verbal guidelines for the completion of the diaries. Training details were also recorded, and used in combination with BMR predictions to calculate daily energy expenditure. Energy, macronutrient and micronutrient intakes were determined using DietMaster 4.0 software. Results suggest that energy intake was low (1904 ± 366.3 kcal) in relation to previous recommendations for soccer players. Energy expenditure (2153.5 ± 596.2 kcal) was not significantly different (p > 0.05) from intake, suggesting energy balance was achieved. Carbohydrate (53.8 ± 6.8%), protein (16.8 ± 2.1%) and fat (28.8 ± 6.6%) intakes were in line with recommendations. Fluid intake (2466 ± 1350.5ml·day-1) was sufficient to meet baseline recommendations, but would need to be higher to meet the additional requirement of training and competition. With the exception of vitamin A and iron, all micronutrient intakes were higher than the DRI. In conclusion, recommendations for female soccer players are to encourage consumption of carbohydrate-electrolyte beverages to enhance carbohydrate intake and increase fluid intake, and ensure sufficient iron rich foods are included in the diet to meet the DRI. Key points Female soccer players demonstrate a low energy intake in relation to predicted requirements, but were in energy balance in this study. Increased carbohydrate intake may be beneficial to both training and competition performance of elite female soccer players Fluid requirements should be addressed on an individual basis and matched to player requirements. The iron status of female soccer players may be compromised due to insufficient dietary intake to meet the DRV. PMID:24198690

  17. Recommended Practice for Patch Management of Control Systems

    Energy Technology Data Exchange (ETDEWEB)

    Steven Tom; Dale Christiansen; Dan Berrett

    2008-12-01

    A key component in protecting a nation’s critical infrastructure and key resources is the security of control systems. The term industrial control system refers to supervisory control and data acquisition, process control, distributed control, and any other systems that control, monitor, and manage the nation’s critical infrastructure. Critical Infrastructure and Key Resources (CIKR) consists of electric power generators, transmission systems, transportation systems, dam and water systems, communication systems, chemical and petroleum systems, and other critical systems that cannot tolerate sudden interruptions in service. Simply stated, a control system gathers information and then performs a function based on its established parameters and the information it receives. The patch management of industrial control systems software used in CIKR is inconsistent at best and nonexistent at worst. Patches are important to resolve security vulnerabilities and functional issues. This report recommends patch management practices for consideration and deployment by industrial control systems owners.

  18. Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

    Science.gov (United States)

    Alotaibi, Fawaz S

    2012-10-01

    This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

  19. A Heart-Healthy Diet: Recent Insights and Practical Recommendations.

    Science.gov (United States)

    Dinu, Monica; Pagliai, Giuditta; Sofi, Francesco

    2017-08-24

    The purpose of this study is to review the current evidence on the relationship between diet and heart, giving practical recommendations for cardiovascular prevention. A heart-healthy diet should maximize the consumption of whole grains, vegetables, fruit, and legumes and discourage the consumption of meat and meat products as well as refined and processed foods. Plant-based diets fully meet these criteria, and the evidence supporting the protective effect of these dietary patterns evolved rapidly in recent years. Among plant-based diets, the Mediterranean and vegetarian diets gained the greater interest, having been associated with numerous health benefits such as reduced levels of traditional and novel risk factors and lower risk of cardiovascular disease. These positive effects may be explained by their high content of dietary fiber, complex carbohydrate, vitamins, minerals, polyunsaturated fatty acids, and phytochemicals. Current evidence suggests that both Mediterranean and vegetarian diets are consistently beneficial with respect to cardiovascular disease.

  20. Practical recommendations for the evaluation of improvement initiatives

    Science.gov (United States)

    Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

    2018-01-01

    Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

  1. MANAGERIAL AND COST ACCOUNTING PRACTICES - A ROMANIAN OVERVIEW

    Directory of Open Access Journals (Sweden)

    CARDOS ILDIKO REKA

    2011-12-01

    for management in the decision making process but these information are produced using traditional managerial accounting practices, tools and techniques are preferred by Romanian organizations in the detriment of modern practices like activity based-costing or target costing. Implications - The results of our study represents a reference point for both researchers and practitioners who are willing to carry on future research in the field of managerial accounting. Originality/Value - This paper tries to fill a gap in the literature related to the Romanian managerial accounting systems and practices. Moreover, it present an overview of managerial accounting practices within Romanian companies giving the possibility to formulate suggestions and proposals for its future development and evolution.

  2. Climate change and mountain water resources: overview and recommendations for research, management and policy

    Directory of Open Access Journals (Sweden)

    D. Viviroli

    2011-02-01

    Full Text Available Mountains are essential sources of freshwater for our world, but their role in global water resources could well be significantly altered by climate change. How well do we understand these potential changes today, and what are implications for water resources management, climate change adaptation, and evolving water policy? To answer above questions, we have examined 11 case study regions with the goal of providing a global overview, identifying research gaps and formulating recommendations for research, management and policy.

    After setting the scene regarding water stress, water management capacity and scientific capacity in our case study regions, we examine the state of knowledge in water resources from a highland-lowland viewpoint, focusing on mountain areas on the one hand and the adjacent lowland areas on the other hand. Based on this review, research priorities are identified, including precipitation, snow water equivalent, soil parameters, evapotranspiration and sublimation, groundwater as well as enhanced warming and feedback mechanisms. In addition, the importance of environmental monitoring at high altitudes is highlighted. We then make recommendations how advancements in the management of mountain water resources under climate change could be achieved in the fields of research, water resources management and policy as well as through better interaction between these fields.

    We conclude that effective management of mountain water resources urgently requires more detailed regional studies and more reliable scenario projections, and that research on mountain water resources must become more integrative by linking relevant disciplines. In addition, the knowledge exchange between managers and researchers must be improved and oriented towards long-term continuous interaction.

  3. Scrum in practice: an overview of Scrum adaptations

    DEFF Research Database (Denmark)

    Hron, Michal; Obwegeser, Nikolaus

    2018-01-01

    Agile software development practices have gained widespread acceptance and application across all industries. Scrum, as one of the most widely used agile methods, has been adopted in countless organizations. However, while there is an understanding that practitioners rarely apply Scrum “by the book......”, only little research addresses the actual adaptations and modifications that are made to fit Scrum to real world requirements: whether it is to solve methodological drawbacks, to fit the method to specific contextual constraints, or to add additional value to the method by augmentation or combination...... with other tools and methods. To get an overview of the proposed adaptations and their implications, this study presents a systematic review of literature reporting on challenges and motivations that lead to modifications of the Scrum method. Based on 31 relevant studies we extract seven distinct motivations...

  4. Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research

    Science.gov (United States)

    Pope, Carley J.; Mazmanian, Dwight

    2016-01-01

    Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature. PMID:27148457

  5. Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research

    Directory of Open Access Journals (Sweden)

    Carley J. Pope

    2016-01-01

    Full Text Available Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1 use standardized assessment protocols; (2 confirm diagnosis through established clinical interview when possible; (3 provide a clear operationalized definition for breastfeeding variables; (4 clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5 be prospective or longitudinal in nature; and (6 take into consideration other potential risk factors identified in the empirical literature.

  6. DNV launches new recommended practice for design of subsea equipment

    Energy Technology Data Exchange (ETDEWEB)

    Toerstad, Elisabeth Heggelund

    2005-07-01

    The application of modern corrosion-resistant alloys to subsea pipelines and components has led to serious problems of hydrogen embrittlement from the corrosion protection system, resulting in cracks and leaks. The most commonly known incidents of this kind are the duplex hubs on Voinhaven, UK and Garn West and the 13% Cr pipelines on Tune and Aasgard, all at the Norwegian shelf. Understanding the nature of this problem has called for a broad multidisciplinary approach, involving expertise on corrosion and metallurgy as well as structural design and integrity. Competence in probabilistic analyses and risk assessments has also been necessary in order to set acceptance criteria and evaluate probability of failure for existing installations. (Det Norske Veritas (DNV) is now about to issues a Recommended Practise (RP) for design of subsea equipment in duplex steels under Cathodic Protection. The RP is based on knowledge gained through failure investigations, qualification pr grams and research work, and a broad industry consortium has contributed with experience and knowledge. Hydrogen Induced Stress Cracking (HISC) due to hydrogen from the Cathodic Protection (CP) system has been one of the most frequent and costly failure modes for subsea equipment and pipelines in the North Sea over the recent years. Today, the international oil business is looking to Norway for assistance in establishing detailed knowledge about and preventive measures against this failure mode. A significant research work is currently being carried out jointly by DNV, SINTEF and TWI (The Welding Institute), supported by a broad industry consortium - aiming at a better understanding of the HISC (Hydrogen Induced Stress Cracking) mechanism and establishment of test methods which reflect the sensitivity to cracking. DNV has also established a Recommended Practice, which will be issued late 2005. It reflects the experience gained from the failure examinations, fitness for purpose evaluations, research

  7. Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management.

    Science.gov (United States)

    Toussaint, Michel; Davidson, Zoe; Bouvoie, Veronique; Evenepoel, Nathalie; Haan, Jurn; Soudon, Philippe

    2016-10-01

    Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population. This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available. Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated. There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population. Implications for Rehabilitation Little guidance is available for the management of dysphagia in Duchenne dystrophy. Food can penetrate the vestibule, accumulate as residue or cause aspiration. We propose recommendations and an algorithm to guide management of dysphagia. Penetration/residue accumulation

  8. Power Testing in Basketball: Current Practice and Future Recommendations.

    Science.gov (United States)

    Wen, Neal; Dalbo, Vincent J; Burgos, Bill; Pyne, David B; Scanlan, Aaron T

    2018-02-01

    Numerous foundational movements performed during basketball are predicated on underlying power-related attributes, including speed, change-of-direction, and jumping. Accordingly, fitness testing batteries for basketball have incorporated an assortment of linear speed tests, change-of-direction tests, and jump tests. However, due to the wide variety of testing options it is difficult for basketball practitioners to select appropriate testing protocols for the assessment of power-related attributes. As a result, there is a need to review the relevant literature to identify game-specific, power-related attributes important in basketball and the most appropriate tests available to assess power-related attributes for basketball practitioners. Therefore, the aims of this review were to: (1) identify essential power-related attributes important in basketball; (2) discuss the suitability of common and novel power-related tests; and (3) provide recommendations for future research and best practice approaches for basketball coaching staff. In this review, we propose a series of novel tests that are more targeted and specific to basketball movements including: (1) 5-m and 10-m linear sprints, (2) Modified Agility T-Test, (3) Change-of-Direction Deficit, (4) lateral bound, (5) Sargent jump, (6) one-step jump, and (7) isometric midthigh pull test. Improved testing of power-related attributes should enable basketball practitioners to develop targeted training plans for enhancing player performance.

  9. Medical Physics Practice Guidelines - the AAPM's minimum practice recommendations for medical physicists.

    Science.gov (United States)

    Mills, Michael D; Chan, Maria F; Prisciandaro, Joann I; Shepard, Jeff; Halvorsen, Per H

    2013-11-04

    The AAPM has long advocated a consistent level of medical physics practice, and has published many recommendations and position statements toward that goal, such as Science Council Task Group reports related to calibration and quality assurance, Education Council and Professional Council Task Group reports related to education, training, and peer review, and Board-approved Position Statements related to the Scope of Practice, physicist qualifications, and other aspects of medical physics practice. Despite these concerted and enduring efforts, the profession does not have clear and concise statements of the acceptable practice guidelines for routine clinical medical physics. As accreditation of clinical practices becomes more common, Medical Physics Practice Guidelines (MPPGs) will be crucial to ensuring a consistent benchmark for accreditation programs. To this end, the AAPM has recently endorsed the development of MPPGs, which may be generated in collaboration with other professional societies. The MPPGs are intended to be freely available to the general public. Accrediting organizations, regulatory agencies, and legislators will be encouraged to reference these MPPGs when defining their respective requirements. MPPGs are intended to provide the medical community with a clear description of the minimum level of medical physics support that the AAPM would consider prudent in clinical practice settings. Support includes, but is not limited to, staffing, equipment, machine access, and training. These MPPGs are not designed to replace extensive Task Group reports or review articles, but rather to describe the recommended minimum level of medical physics support for specific clinical services. This article has described the purpose, scope, and process for the development of MPPGs.

  10. Predicting abuse potential of stimulants and other dopaminergic drugs: overview and recommendations.

    Science.gov (United States)

    Huskinson, Sally L; Naylor, Jennifer E; Rowlett, James K; Freeman, Kevin B

    2014-12-01

    Examination of a drug's abuse potential at multiple levels of analysis (molecular/cellular action, whole-organism behavior, epidemiological data) is an essential component to regulating controlled substances under the Controlled Substances Act (CSA). We reviewed studies that examined several central nervous system (CNS) stimulants, focusing on those with primarily dopaminergic actions, in drug self-administration, drug discrimination, and physical dependence. For drug self-administration and drug discrimination, we distinguished between experiments conducted with rats and nonhuman primates (NHP) to highlight the common and unique attributes of each model in the assessment of abuse potential. Our review of drug self-administration studies suggests that this procedure is important in predicting abuse potential of dopaminergic compounds, but there were many false positives. We recommended that tests to determine how reinforcing a drug is relative to a known drug of abuse may be more predictive of abuse potential than tests that yield a binary, yes-or-no classification. Several false positives also occurred with drug discrimination. With this procedure, we recommended that future research follow a standard decision-tree approach that may require examining the drug being tested for abuse potential as the training stimulus. This approach would also allow several known drugs of abuse to be tested for substitution, and this may reduce false positives. Finally, we reviewed evidence of physical dependence with stimulants and discussed the feasibility of modeling these phenomena in nonhuman animals in a rational and practical fashion. This article is part of the Special Issue entitled 'CNS Stimulants'. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Dosimetry of clinical neutron and proton beams: An overview of recommendations

    International Nuclear Information System (INIS)

    Vynckier, S.

    2004-01-01

    Neutron therapy beams are obtained by accelerating protons or deuterons on Beryllium. These neutron therapy beams present comparable dosimetric characteristics as those for photon beams obtained with linear accelerators; for instance, the penetration of a p(65) + Be neutron beam is comparable with the penetration of an 8 MV photon beam. In order to be competitive with conventional photon beam therapy, the dosimetric characteristics of the neutron beam should therefore not deviate too much from the photon beam characteristics. This paper presents a brief summary of the neutron beams used in radiotherapy. The dosimetry of the clinical neutron beams is described. Finally, recent and future developments in the field of physics for neutron therapy is mentioned. In the last two decades, a considerable number of centres have established radiotherapy treatment facilities using proton beams with energies between 50 and 250 MeV. Clinical applications require a relatively uniform dose to be delivered to the volume to be treated, and for this purpose the proton beam has to be spread out, both laterally and in depth. The technique is called 'beam modulation' and creates a region of high dose uniformity referred to as the 'spread-out Bragg peak'. Meanwhile, reference dosimetry in these beams had to catch up with photon and electron beams for which a much longer tradition of dosimetry exists. Proton beam dosimetry can be performed using different types of dosemeters, such as calorimeters, Faraday cups, track detectors and ionisation chambers. National standard dosimetry laboratories will, however, not provide a standard for the dosimetry of proton beams. To achieve uniformity on an international level, the use of an ionisation chamber should be considered. This paper reviews and summarises the basic principles and recommendations for the absorbed dose determination in a proton beam, utilising ionisation chambers calibrated in terms of absorbed dose to water. These recommendations

  12. Effective implementation of research into practice: an overview of systematic reviews of the health literature

    Directory of Open Access Journals (Sweden)

    Fraser Alec

    2011-06-01

    Full Text Available Abstract Background The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. Findings A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. Conclusions This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials.

  13. Effective implementation of research into practice: an overview of systematic reviews of the health literature.

    Science.gov (United States)

    Boaz, Annette; Baeza, Juan; Fraser, Alec

    2011-06-22

    The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).

  14. Recommended Practice: Creating Cyber Forensics Plans for Control Systems

    Energy Technology Data Exchange (ETDEWEB)

    Eric Cornelius; Mark Fabro

    2008-08-01

    issues and to accommodate for the diversity in both system and architecture types, a framework based in recommended practices to address forensics in the control systems domain is required. This framework must be fully flexible to allow for deployment into any control systems environment regardless of technologies used. Moreover, the framework and practices must provide for direction on the integration of modern network security technologies with traditionally closed systems, the result being a true defense-in-depth strategy for control systems architectures. This document takes the traditional concepts of cyber forensics and forensics engineering and provides direction regarding augmentation for control systems operational environments. The goal is to provide guidance to the reader with specifics relating to the complexity of cyber forensics for control systems, guidance to allow organizations to create a self-sustaining cyber forensics program, and guidance to support the maintenance and evolution of such programs. As the current control systems cyber security community of interest is without any specific direction on how to proceed with forensics in control systems environments, this information product is intended to be a first step.

  15. Coal waste management practices in the USA:an overview

    Institute of Scientific and Technical Information of China (English)

    Yoginder P. Chugh; Paul T. Behum

    2014-01-01

    This paper provides an overview of coal waste management practices with two case studies and an estimate of management cost in 2010 US dollars. Processing of as-mined coal typically results in considerable amount of coarse and fine coal processing wastes because of in-seam and out-of-seam dilution mining. Processing plant clean coal recovery values run typically 50%–80%. Trace metals and sulfur may be present in waste materials that may result in leachate water with corrosive charac-teristics. Water discharges may require special measures such as liner and collection systems, and treatment to neutralize acid drainage and/or water quality for trace elements. The potential for variations in coal waste production and quality depends upon mining or processing, plus the long-term methods of waste placement. The changes in waste generation rates and engineering properties of the coal waste during the life of the facility must be considered. Safe, economical and environmentally acceptable management of coal waste involves consideration of geology, soil and rock mechanics, hydrology, hydraulics, geochemistry, soil science, agronomy and environmental sciences. These support all aspects of the regulatory environment including the design and construction of earth and rock embankments and dams, as well as a wide variety of waste disposal structures. Development of impoundments is critical and require considerations of typical water-impounding dams and additional requirements of coal waste disposal impoundments. The primary purpose of a coal waste disposal facility is to dispose of unusable waste materials from mining. However, at some sites coal waste impoundments serve to provide water storage capacity for processing and flood attenuation.

  16. Internal Quality Control Practices in Coagulation Laboratories: recommendations based on a patterns-of-practice survey.

    Science.gov (United States)

    McFarlane, A; Aslan, B; Raby, A; Moffat, K A; Selby, R; Padmore, R

    2015-12-01

    Internal quality control (IQC) procedures are crucial for ensuring accurate patient test results. The IQMH Centre for Proficiency Testing conducted a web-based survey to gather information on the current IQC practices in coagulation testing. A questionnaire was distributed to 174 Ontario laboratories licensed to perform prothrombin time (PT) and activated partial thromboplastin time (APTT). All laboratories reported using two levels of commercial QC (CQC); 12% incorporate pooled patient plasma into their IQC program; >68% run CQC at the beginning of each shift; 56% following maintenance, with reagent changes, during a shift, or with every repeat sample; 6% only run CQC at the beginning of the day and 25% when the instruments have been idle for a defined period of time. IQC run frequency was determined by manufacturer recommendations (71%) but also influenced by the stability of test (27%), clinical impact of an incorrect test result (25%), and sample's batch number (10%). IQC was monitored using preset limits based on standard deviation (66%), precision goals (46%), or allowable performance limits (36%). 95% use multirules. Failure actions include repeating the IQC (90%) and reporting patient results; if repeat passes, 42% perform repeat analysis of all patient samples from last acceptable IQC. Variability exists in coagulation IQC practices among Ontario clinical laboratories. The recommendations presented here would be useful in encouraging standardized IQC practices. © 2015 John Wiley & Sons Ltd.

  17. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice12

    Science.gov (United States)

    Sherf Dagan, Shiri; Goldenshluger, Ariela; Globus, Inbal; Schweiger, Chaya; Kessler, Yafit; Kowen Sandbank, Galit; Ben-Porat, Tair; Sinai, Tali

    2017-01-01

    Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications. PMID:28298280

  18. Recommended programming practices to facilitate the portability of science computer programs

    International Nuclear Information System (INIS)

    Anon.

    1983-01-01

    This standard recommends programming practices to facilitate the portability of computer programs prepared for scientific and engineering computations. These practices are intended to simplify implementation, conversion, and modification of computer programs

  19. Recommended Practices for the Safe Design and Operation of Flywheels

    Energy Technology Data Exchange (ETDEWEB)

    Bender, Donald Arthur [Sandia National Lab. (SNL-CA), Livermore, CA (United States); Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-12-01

    Flywheel energy storage systems are in use globally in increasing numbers . No codes pertaining specifically to flywheel energy storage exist. A number of industrial incidents have occurred. This protocol recommends a technical basis for safe flywheel de sign and operation for consideration by flywheel developers, users of flywheel systems and standards setting organizations.

  20. Online Student Services: Current Practices and Recommendations for Implementation

    Science.gov (United States)

    Bailey, Tabitha L.; Brown, Abbie

    2016-01-01

    Recommendations for planning and development of online student services based on a review of the literature on research conducted in a variety of college settings. Focus topics include the institutional website, help desks and information centers, student orientation, academic support, and library services.

  1. Overview, comparative assessment and recommendations of forecasting models for short-term water demand prediction

    CSIR Research Space (South Africa)

    Anele, AO

    2017-11-01

    Full Text Available -term water demand (STWD) forecasts. In view of this, an overview of forecasting methods for STWD prediction is presented. Based on that, a comparative assessment of the performance of alternative forecasting models from the different methods is studied. Times...

  2. Allergy-immunology practice parameters and strength of recommendation data: an evolutionary perspective.

    Science.gov (United States)

    Park, Matthew H; Banks, Taylor A; Nelson, Michael R

    2016-03-01

    The practice parameters for allergy and immunology (A/I) are a valuable tool guiding practitioners' clinical practice. The A/I practice parameters have evolved over time in the context of evidence-based medicine milestones. To identify evolutionary trends in the character, scope, and evidence underlying recommendations in the A/I practice parameters. Practice parameters that have guided A/I from 1995 through 2014 were analyzed. Statements and recommendations with strength of recommendation categories A and B were considered to have a basis in evidence from controlled trials. Forty-three publications and updates covering 25 unique topics were identified. There was great variability in the number of recommendations made and the proportion of statements with controlled trial evidence. The mean number of recommendations made per practice parameter has decreased significantly, from 95.8 to a mean of 38.3. There also is a trend toward an increased proportion of recommendations based on controlled trial evidence in practice parameters with fewer recommendations, with a mean of 30.7% in practice parameters with at least 100 recommendations based on controlled trial evidence compared with 48.3% in practice parameters with 30 to 100 recommendations and 51.0% in those with fewer than 30 recommendations. The A/I practice parameters have evolved significantly over time. Encouragingly, greater controlled trial evidence is associated with updated practice parameters and a recent trend of more narrowly focused topics. These findings should only bolster and inspire confidence in the utility of the A/I practice parameters in assisting practitioners to navigate through the uncertainty that is intrinsic to medicine in making informed decisions with patients. Published by Elsevier Inc.

  3. What the recommended practice for setpoint determination methodologies does or does not do. Part 2

    International Nuclear Information System (INIS)

    Beuchel, B.E.; Annon, M.C.

    1991-01-01

    The long-awaited Recommended Practice (RP) to complement ISA S67.04-1987 Setpoints for Nuclear Safety-Related Instrumentation is very close to publication. The RP, entitled Methodologies for the Determination of Setpoints for Nuclear Safety-Related Instrumentation, has been prepared through the efforts of over 50 persons representing over 20 utilities, all four LWR NSSS vendors, three instrument manufacturers, several architectural engineering firms, numerous consulting firms and other individuals. Throughout the period during which the RP was being prepared, it became apparent to the RP Committee members that the scope and approaches outlined in the RP were not fully understood by the general nuclear community. Therefore, the goals of this paper are to enhance the understanding of the RP and facilitate the utilization of the RP by potential users. The primary objective of the paper is to provide a broad overview of the purpose and scope of the RP. This will be achieved by describing the general organization of the RP as well as a brief explanation of the contents of each section. The paper will also discuss the role of the RP in the development of actual setpoint calculations, i.e., and explanation of the need for a user's specific methodology document to customize the RP for a specific user. In addition, the paper identifies, and attempts to clarify, several potential misconceptions by users, as to what the RP does not do

  4. Best practice governance principles in the sports industry: an overview

    African Journals Online (AJOL)

    This overview examines the British and Australian models and codes of corporate governance since South African Company Law as well as Australian Company Law have their roots in British Company Law. From the literature seven pillars of good governance emerged and their applicability to sports governing bodies is ...

  5. Practice-based Research Network Research Good Practices (PRGPs): Summary of Recommendations.

    Science.gov (United States)

    Dolor, Rowena J; Campbell-Voytal, Kimberly; Daly, Jeanette; Nagykaldi, Zsolt J; O'Beirne, Maeve; Sterling, Pamela; Fagnan, Lyle J; Levy, Barcey; Michaels, LeAnn; Louks, Hannah A; Smith, Paul; Aspy, Cheryl B; Patterson, V Beth; Kano, Miria; Sussman, Andrew L; Williams, Robert; Neale, Anne Victoria

    2015-12-01

    Practice-based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity. Network directors and coordinators from seven U.S.-based PBRNs worked with a professional team facilitator during semiannual in-person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization. The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links. The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. © 2015 Wiley Periodicals, Inc.

  6. Bilingual Language Assessment: Contemporary Versus Recommended Practice in American Schools.

    Science.gov (United States)

    Arias, Graciela; Friberg, Jennifer

    2017-01-01

    The purpose of this study was to identify current practices of school-based speech-language pathologists (SLPs) in the United States for bilingual language assessment and compare them to American Speech-Language-Hearing Association (ASHA) best practice guidelines and mandates of the Individuals with Disabilities Education Act (IDEA, 2004). The study was modeled to replicate portions of Caesar and Kohler's (2007) study and expanded to include a nationally representative sample. A total of 166 respondents completed an electronic survey. Results indicated that the majority of respondents have performed bilingual language assessments. Furthermore, the most frequently used informal and standardized assessments were identified. SLPs identified supports, and barriers to assessment, as well as their perceptions of graduate preparation. The findings of this study demonstrated that although SLPs have become more compliant to ASHA and IDEA guidelines, there is room for improvement in terms of adequate training in bilingual language assessment.

  7. Radiation in dental practice: awareness, protection and recommendations.

    Science.gov (United States)

    Praveen, B N; Shubhasini, A R; Bhanushree, R; Sumsum, P S; Sushma, C N

    2013-01-01

    Radiation is the transmission of energy through space and matter. There are several forms of radiation, including ionizing and nonionizing. X-rays are the ionizing radiation used extensively in medical and dental practice. Even though they provide useful information and aid in diagnosis, they also have the potential to cause harmful effects. In dentistry, it is mainly used for diagnostic purposes and in a dental set-up usually the practicing dentist exposes, processes and interprets the radiograph. Even though such exposure is less, it is critical to reduce the exposure to the dental personnel and patients in order to prevent the harmful effects of radiation. Several radiation protection measures have been advocated to ameliorate these effects. A survey conducted in the Bengaluru among practicing dentists revealed that radiation protection awareness was very low and the necessary measures taken to reduce the exposure were not adequate. The aim of the article is to review important parameters that must be taken into consideration in the clinical set-up to reduce radiation exposure to patients and dental personnel.

  8. Research ethics consultation: ethical and professional practice challenges and recommendations.

    Science.gov (United States)

    Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-05-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

  9. Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

    Science.gov (United States)

    Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-01-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

  10. Allergic Rhinitis in Children: Principles of Early Diagnosis and Effective Therapy. Overview of Clinical Recommendations

    Directory of Open Access Journals (Sweden)

    Alexander A. Baranov

    2017-01-01

    Full Text Available The article briefly summarizes the key provisions of the clinical recommendations on medical care delivery for children with allergic rhinitis: modern approaches to diagnosis and therapy. The current document was developed by the professional association of pediatric specialists —the Union of Pediatricians of Russia — together with the leading experts of the Russian Association of Allergists and Clinical Immunologists. The recommendations are regularly updated due to the latest evidence-based results of effectiveness and safety of various medical interventions. The article presents information on the epidemiology of allergic rhinitis in children, specific diagnostic features which provide the opportunity for the timely and correct diagnosis and an effective therapy with personal approach.

  11. Pain in Fabry Disease: Practical Recommendations for Diagnosis and Treatment.

    Science.gov (United States)

    Politei, Juan M; Bouhassira, Didier; Germain, Dominique P; Goizet, Cyril; Guerrero-Sola, Antonio; Hilz, Max J; Hutton, Elspeth J; Karaa, Amel; Liguori, Rocco; Üçeyler, Nurcan; Zeltzer, Lonnie K; Burlina, Alessandro

    2016-07-01

    Patients with Fabry disease (FD) characteristically develop peripheral neuropathy at an early age, with pain being a crucial symptom of underlying pathology. However, the diagnosis of pain is challenging due to the heterogeneous and nonspecific symptoms. Practical guidance on the diagnosis and management of pain in FD is needed. In 2014, experts met to discuss recent advances on this topic and update clinical guidance. Emerging disease-specific tools, including FabryScan, Fabry-specific Pediatric Health and Pain Questionnaire, and Würzburg Fabry Pain Questionnaire, and more general tools like the Total Symptom Score can aid diagnosis, characterization, and monitoring of pain in patients with FD. These tools can be complemented by more objective and quantifiable sensory testing. In male and female patients of any age, pain related to FD can be an early indication to start disease-specific enzyme replacement therapy before potentially irreversible organ damage to the kidneys, heart, or brain occurs. To improve treatment outcomes, pain should be diagnosed early in unrecognized or newly identified FD patients. Treatment should include: (a) enzyme replacement therapy controlling the progression of underlying pathology; (b) adjunctive, symptomatic pain management with analgesics for chronic neuropathic and acute nociceptive, and inflammatory or mixed pain; and (c) lifestyle modifications. © 2016 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.

  12. [Physiotherapy strategies in osteoporosis--recommendations for daily practice].

    Science.gov (United States)

    Uhlemann, C; Lange, U

    2006-09-01

    Physiotherapy in osteoporosis essentially takes the form of stimulatory therapy tailored to the findings and the pathomechanism. The choice of therapy and its dosage depend on the desired result (prevention, cure, rehabilitation). Physical therapy applied in osteoporosis includes electrical, thermic (hydrothermic, high frequency thermic, light thermic) and mechanical (massage, physiotherapy) stimuli, which can be applied regionally, locally or hoistically. To be efficient, a pain therapy requires that the various painful states be differentiated between: whereas, for example, in the case of acute pain physiotherapy fulfils the function of immediate therapy (normally rest and "mild" cold applications), in chronic pain it has to fulfil the function of an adaptive performance therapy of neuronal structures (formative-adaptive physiotherapy, thermic therapy improving trophism, direct current, transcutaneous electric nerve stimulation/TENS). It is necessary and extremely important forday-to-day clinical practice that physiotherapy strategies that are tailored to each patient's needs and also economically justifiable be implemented. The article isintended to contribute to this.

  13. Increasing Glencore's sustainable management performance: recommendation and risks, statements based on literature and best practices

    OpenAIRE

    Gottschall, Arnaud; Maeder, Eric

    2014-01-01

    The main purpose of this report is to provide Glencore with applicable recommendations so that it can improve its sustainable reputation. The second purpose of the work is to present all risks incurred by Glencore’s non-application of sustainable recommendations. Recommendations and risks have been developed based on literature, interviews and companies’ good practices. Sustainability reports of mining companies publicly quoted have been intensively used to grasp the different sustainability ...

  14. Diversity in smallholder farms growing coffee and their use of recommended coffee management practices in Uganda

    NARCIS (Netherlands)

    Bongers, G.; Fleskens, L.; Ven, van de G.W.J.; Mukasa, D.; Giller, K.E.; Asten, van P.

    2015-01-01

    Many smallholder farm systems in Uganda produce coffee as an important cash crop. Yet coffee yields are poor. To increase farmers’ production, a range of agronomic practices have been recommended by national and international agencies. Yet the adoption potential of recommendations differs between

  15. Recommended practices for wind farm data collection and reliability assessment for O&M optimization

    DEFF Research Database (Denmark)

    Hahn, Berthold; Welte, Thomas; Faulstich, Stefan

    2017-01-01

    . The complete results of IEA Wind Task 33 are described in the expert group report on recommended practices for "Wind farm data collection and reliability assessment for O&M optimization" which will be published by IEA Wind in 2017. This paper briefly presents the background of the work, the recommended process...

  16. Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature.

    Science.gov (United States)

    Draper, K; Ley, C; Parsonnet, J

    2017-08-24

    Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for 'general bowel health' or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

  17. A historical overview of traditional medicine practices and policy in ...

    African Journals Online (AJOL)

    Background: Although traditional medicine plays an important role in Ethiopian society, knowledge about the extent and characteristics of traditional healing practices and practitioners is limited and has frequently been ignored in the national health system. Objective: To review history of practices and policies on traditional ...

  18. Four simple recommendations to encourage best practices in research software [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Rafael C. Jiménez

    2017-06-01

    Full Text Available Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations.

  19. Medical Informatics in Clinical Practice: An Overview. | Okoromah ...

    African Journals Online (AJOL)

    Providing a high-quality service to patients involves having the right information at the ... Knowledge and practice and application of computer technology in both ... informatics and to stimulate interest in computer support in health care in our ...

  20. Nuclear Power : The roles, functions and opportunities for research institutes - An overview and recommendations

    International Nuclear Information System (INIS)

    Sheriffah Noor Khamseah Al-Idid Syed Ahmad Idid

    2010-01-01

    Shifting nuclear power from being the Last Option to a new energy mix for Malaysia has significant implications and requires specific actions, responses and support from critical stake holders including Government, Utility, Education Sectors and Research Institutes. This paper aims to briefly outline the roles and functions of these stake holders, but spotlighting on that of research institute. Presently the role of research and development (R and D) within a nuclear power programme is a controversial subject. Opinions range from assigning a continuing priority role in this area, to considering it a somewhat questionable effort at the present state of development of proven reactor types, in particular for countries which have not yet started or are at the earlier stages of the nuclear power programmes. As such Nuclear Malaysia may be facing a similar challenge in its quest to identify the most effective role and function for the agency to undertake for the 1st NPP. Thus it is within this context that his paper aims offer an overview of the activities and work scope required to support a Nuclear Power Programme (NPP) with the view that this will enable management and the scientific and research community to formulate strategies and work plan, in particular in terms of HRD and R and D plans, to further enhance its readiness to support Malaysia's first Nuclear Power programme, earmarked by the Government for the year 2020. Additionally it is hoped that this would contribute to the identification of an effective role, function and opportunities for Nuclear Malaysia in supporting Malaysia's first NPP. (author)

  1. An overview on ethical considerations in stem cell research in Iran and ethical recommendations: A review

    Science.gov (United States)

    Farajkhoda, Tahmineh

    2017-01-01

    Conducting research on the stem cell lines might bring some worthy good to public. Human Stem Cells (hSCs) research has provided opportunities for scientific progresses and new therapies, but some complex ethical matters should be noticed to ensure that stem cell research is carried out in an ethically appropriate manner. The aim of this review article is to discuss the importance of stem cell research, code of ethics for stem cell research in Iran and ethical recommendation. Generation of stem cells for research from human embryo or adult stem cells, saving, maintenance and using of them are the main ethical, legal and jurisprudence concerns in Iran. Concerns regarding human reproduction or human cloning, breach of human dignity, genetic manipulation and probability of tumorogenisity are observed in adult/somatic stem cells. Destruction of embryo to generate stem cell is an important matter in Iran. In this regards, obtaining stem cell from donated frozen embryos through infertility treatment that would be discarded is an acceptable solution in Iran for generation of embryo for research. Ethical, legal, and jurisprudence strategies for using adult/somatic stem cells are determination of ownership of stem cells, trade prohibition of human body, supervision on bio banks and information of Oversight Committee on Stem Cell Research. Recommendations to handle ethical issues for conducting stem cell research are well-designed studies, compliance codes of ethics in biomedical research (specifically codes of ethics on stem cell research, codes of ethics on clinical trials studies and codes of ethics on animals studies), appropriate collaboration with ethics committees and respecting of rights of participants (including both of human and animal rights) in research. In addition, there is a necessity for extending global networks of bioethics for strengthening communications within organizations at both the regional and international level, strengthening legislation systems

  2. An overview on ethical considerations in stem cell research in Iran and ethical recommendations: A review

    Directory of Open Access Journals (Sweden)

    Tahmineh Farajkhoda

    2017-08-01

    Full Text Available Conducting research on the stem cell lines might bring some worthy good to public. Human Stem Cells (hSCs research has provided opportunities for scientific progresses and new therapies, but some complex ethical matters should be noticed to ensure that stem cell research is carried out in an ethically appropriate manner. The aim of this review article is to discuss the importance of stem cell research, code of ethics for stem cell research in Iran and ethical recommendation. Generation of stem cells for research from human embryo or adult stem cells, saving, maintenance and using of them are the main ethical, legal and jurisprudence concerns in Iran. Concerns regarding human reproduction or human cloning, breach of human dignity, genetic manipulation and probability of tumorogenisity are observed in adult/somatic stem cells. Destruction of embryo to generate stem cell is an important matter in Iran. In this regards, obtaining stem cell from donated frozen embryos through infertility treatment that would be discarded is an acceptable solution in Iran for generation of embryo for research. Ethical, legal, and jurisprudence strategies for using adult/somatic stem cells are determination of ownership of stem cells, trade prohibition of human body, supervision on bio banks and information of Oversight Committee on Stem Cell Research. Recommendations to handle ethical issues for conducting stem cell research are well-designed studies, compliance codes of ethics in biomedical research (specifically codes of ethics on stem cell research, codes of ethics on clinical trials studies and codes of ethics on animals studies, appropriate collaboration with ethics committees and respecting of rights of participants (including both of human and animal rights in research. In addition, there is a necessity for extending global networks of bioethics for strengthening communications within organizations at both the regional and international level, strengthening

  3. An overview on ethical considerations in stem cell research in Iran and ethical recommendations: A review.

    Science.gov (United States)

    Farajkhoda, Tahmineh

    2017-02-01

    Conducting research on the stem cell lines might bring some worthy good to public. Human Stem Cells (hSCs) research has provided opportunities for scientific progresses and new therapies, but some complex ethical matters should be noticed to ensure that stem cell research is carried out in an ethically appropriate manner. The aim of this review article is to discuss the importance of stem cell research, code of ethics for stem cell research in Iran and ethical recommendation. Generation of stem cells for research from human embryo or adult stem cells, saving, maintenance and using of them are the main ethical, legal and jurisprudence concerns in Iran. Concerns regarding human reproduction or human cloning, breach of human dignity, genetic manipulation and probability of tumorogenisity are observed in adult/somatic stem cells. Destruction of embryo to generate stem cell is an important matter in Iran. In this regards, obtaining stem cell from donated frozen embryos through infertility treatment that would be discarded is an acceptable solution in Iran for generation of embryo for research. Ethical, legal, and jurisprudence strategies for using adult/somatic stem cells are determination of ownership of stem cells, trade prohibition of human body, supervision on bio banks and information of Oversight Committee on Stem Cell Research. Recommendations to handle ethical issues for conducting stem cell research are well-designed studies, compliance codes of ethics in biomedical research (specifically codes of ethics on stem cell research, codes of ethics on clinical trials studies and codes of ethics on animals studies), appropriate collaboration with ethics committees and respecting of rights of participants (including both of human and animal rights) in research. In addition, there is a necessity for extending global networks of bioethics for strengthening communications within organizations at both the regional and international level, strengthening legislation systems

  4. Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia.

    Science.gov (United States)

    Gagnon, Marie-Pierre; Sánchez, Emília; Pons, Joan M V

    2006-01-01

    Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies. Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors. At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice. This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.

  5. Good practice recommendations - medical-professional control of internal exposure to radionuclides in nuclear base installations

    International Nuclear Information System (INIS)

    Berard, Philippe; Blanchin, Nicolas; Fottorino, Robert; Gonin, Michele; Quesne, Benoit; Agrinier, Anne-Laure; Bourgaut, Laurent; Blanchardon, Eric; Challeton de Vathaire, Cecile; Franck, Didier; Piechowski, Jean; Fritsch, Paul; Poncy, Jean-Luc

    2011-07-01

    The first part of this voluminous report presents the context and method of definition of recommendations for a clinical practice and comprises a literature review of national, European and international recommendations, standards and work-group reports. The second part develops recommendations under four main themes: assessment of the committed effective dose (objectives, implementation, communication, traceability and archiving), control programs, dosimetric estimation based on results, and health risk and taking into care by the occupational physician. The authors adopted the same structure for each sub-theme or issue: target extract of regulatory and standard requirements and international recommendations, analysis of literature and of data from professional practices, opinion of the work-group, and graded recommendations with respect to the proof level

  6. Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.

    Science.gov (United States)

    Academy for Educational Development, Washington, DC.

    The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

  7. Weed management practices in natural ecosystems: a critical overview

    Directory of Open Access Journals (Sweden)

    C.F. Reinhardt

    2000-07-01

    Full Text Available Increasing public pressure against the use of pesticides and other agricultural inputs has placed increased emphasis on the development of ecologically based pest management. One distinct reaction of the Weed Science discipline has been the swing away from herbicide research to increased research on the basic biology and ecology of weeds in hopes of reduced reliance on "technological crutches" such as herbicides and other practices that are potentially harmful to the environment. Biological control is the long-standing alternative to the use of herbicides and interest in the former practice has been boosted by the realization that the use of herbicides may lead to the development of herbicide resistance in weed populations, and that herbicide residues occur in surface and groundwater. Supporters of herbicide use would point out that biological control is generally not effective in crop production systems, and is basically slow-acting. Debates between protagonists for the exclusive use of one or the other weed management practice tend to obscure the benefits that integration of different techniques are likely to have. For natural ecosystems it is proposed that integration of the more subtle practice of biological control with the use of herbicides, which relatively quickly overwhelm a biological system with mortality, is likely to be the most effective weed management tool. Different weed management practices that could be considered in natural ecosystems are discussed in terms of three key performance rating criteria, viz. activity, selec- tivity and persistence In this concise review, general discussion is focussed on the fundamentals of weed management practices, with the view to promote concept-based approaches that are critical for the development of effective weed management strate- gies.

  8. Improving the dependability of research in personality and social psychology: recommendations for research and educational practice.

    Science.gov (United States)

    Funder, David C; Levine, John M; Mackie, Diane M; Morf, Carolyn C; Sansone, Carol; Vazire, Simine; West, Stephen G

    2014-02-01

    In this article, the Society for Personality and Social Psychology (SPSP) Task Force on Publication and Research Practices offers a brief statistical primer and recommendations for improving the dependability of research. Recommendations for research practice include (a) describing and addressing the choice of N (sample size) and consequent issues of statistical power, (b) reporting effect sizes and 95% confidence intervals (CIs), (c) avoiding "questionable research practices" that can inflate the probability of Type I error, (d) making available research materials necessary to replicate reported results, (e) adhering to SPSP's data sharing policy, (f) encouraging publication of high-quality replication studies, and (g) maintaining flexibility and openness to alternative standards and methods. Recommendations for educational practice include (a) encouraging a culture of "getting it right," (b) teaching and encouraging transparency of data reporting, (c) improving methodological instruction, and (d) modeling sound science and supporting junior researchers who seek to "get it right."

  9. Overview of the Global Trend in Private Medical Practice | Afolabi ...

    African Journals Online (AJOL)

    More over, many governments face various constraints that force them to prioritize and restrict government spending. This make it impossible for any government to provide free health care for her ever increasing population. Private medical practice is an alternative to complement government efforts in providing health care ...

  10. An Overview of Research Infrastructures in Europe - and Recommendations to LIBER

    Directory of Open Access Journals (Sweden)

    Norbert Lossau

    2012-04-01

    Full Text Available Research infrastructures (RI include major scientific equipment, scientific collections, archives, structured information and ICT-based infrastructures and services3. They support top-level research and can be organized at the national and regional level, at EU Member State, European and global level. RIs have become a topic of interest and priority for funders, political bodies, and (increasingly institutional decision makers. In Europe the European Commission is a funder of RIs, complementing funding done by EU Member States at the national level. Over the last ten years hundreds of RI-projects have been planned and some received funding for design, extension and improvement of operations and services to scientific communities. The ESFRI4 roadmap for research infrastructures represents a financial volume of approx. 20 billion EUR for ten years to construct 44 RIs. From the perspective of realizing the objectives set for RI, 2012 is an essential milestone, as the discussion of the HORIZON 2020 programmes at the European level will take place as well as consultations with member states. The following overview is by no means complete. It focuses on some RIs majorly influenced by the production and management of scientific information and which have relevance for the European political and funding agenda. RI projects include a variety of typologies, ranging from hard, single-site facilities to distributed, soft facilities relying on networks. Typically they have emerged from discipline-specific or cross-disciplinary requirements. RIs produce, process or manage big and small but heterogeneous volumes of information. They are the so-called ‘scientific data factories’ of the 21st century. They comprise various types of information resources such as publications, digitized collections, learning objects and research data. Key issues on today’s agenda for RIs are their uptake by researchers, and their viability, sustainability and interoperability

  11. The prevention and management of congenital syphilis: an overview and recommendations.

    Science.gov (United States)

    Saloojee, Haroon; Velaphi, Sithembiso; Goga, Yasmin; Afadapa, Nike; Steen, Richard; Lincetto, Ornella

    2004-01-01

    The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant. PMID:15356934

  12. Feeding practices of low-income mothers: how do they compare to current recommendations?

    OpenAIRE

    Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

    2015-01-01

    Background Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Methods Eighty low-income mothers and their preschool children were videotaped a...

  13. MANAGERIAL AND COST ACCOUNTING PRACTICES - A ROMANIAN OVERVIEW

    OpenAIRE

    CARDOS ILDIKO REKA; PETE STEFAN

    2011-01-01

    Research theme - Globalization and technological changes generates complexity both in the business environment and the accounting systems. Under these conditions managerial accounting needs to learn new practices in order to become an active consultant of management. Objectives - The main objective of this paper is to present how managerial accounting changed over the years in Romania. We intend to present how the managerial accounting system is implemented within Romanian organizations, to r...

  14. Blood venous sample collection: Recommendations overview and a checklist to improve quality.

    Science.gov (United States)

    Giavarina, Davide; Lippi, Giuseppe

    2017-07-01

    The extra-analytical phases of the total testing process have substantial impact on managed care, as well as an inherent high risk of vulnerability to errors which is often greater than that of the analytical phase. The collection of biological samples is a crucial preanalytical activity. Problems or errors occurring shortly before, or soon after, this preanalytical step may impair sample quality and characteristics, or else modify the final results of testing. The standardization of fasting requirements, rest, patient position and psychological state of the patient are therefore crucial for mitigating the impact of preanalytical variability. Moreover, the quality of materials used for collecting specimens, along with their compatibility, can guarantee sample quality and persistence of chemical and physical characteristics of the analytes over time, so safeguarding the reliability of testing. Appropriate techniques and sampling procedures are effective to prevent problems such as hemolysis, undue clotting in the blood tube, draw of insufficient sample volume and modification of analyte concentration. An accurate identification of both patient and blood samples is a key priority as for other healthcare activities. Good laboratory practice and appropriate training of operators, by specifically targeting collection of biological samples, blood in particular, may greatly improve this issue, thus lowering the risk of errors and their adverse clinical consequences. The implementation of a simple and rapid check-list, including verification of blood collection devices, patient preparation and sampling techniques, was found to be effective for enhancing sample quality and reducing some preanalytical errors associated with these procedures. The use of this tool, along with implementation of objective and standardized systems for detecting non-conformities related to unsuitable samples, can be helpful for standardizing preanalytical activities and improving the quality of

  15. Best practices in business process redesign: an overview and qualitative evaluation of successful redesign heuristics

    NARCIS (Netherlands)

    Reijers, H.A.; Limam Mansar, S.

    2005-01-01

    To implement business process redesign several best practices can be distinguished. This paper gives an overview of heuristic rules that can support practitioners to develop a business process design that is a radical improvement of a current design. The emphasis is on the mechanics of the process,

  16. Overview of the principles and practice of biodosimetry

    International Nuclear Information System (INIS)

    Swartz, Harold M.; Williams, Benjamin B.; Flood, Ann Barry

    2014-01-01

    The principle of biodosimetry is to utilize changes induced in the individual by ionizing radiation to estimate the dose and, if possible, to predict or reflect the clinically relevant response, i.e., the biological consequences of the dose. Ideally, the changes should be specific for ionizing radiation, and the response should be unaffected by prior medical or physiological variations among subjects, including changes that might be caused by the stress and trauma from a radiation event. There are two basic types of biodosimetry with different and often complementary characteristics: those based on changes in biological parameters such as gene activation or chromosomal abnormalities and those based on physical changes in tissues (detected by techniques such as EPR). In this paper, we consider the applicability of the various techniques for different scenarios: small- and large-scale exposures to levels of radiation that could lead to the acute radiation syndrome and exposures with lower doses that do not need immediate care, but should be followed for evidence of long-term consequences. The development of biodosimetry has been especially stimulated by the needs after a large-scale event where it is essential to have a means to identify those individuals who would benefit from being brought into the medical care system. Analyses of the conventional methods officially recommended for responding to such events indicate that these methods are unlikely to achieve the results needed for timely triage of thousands of victims. Emerging biodosimetric methods can fill this critically important gap. (orig.)

  17. Overview of the principles and practice of biodosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Swartz, Harold M.; Williams, Benjamin B.; Flood, Ann Barry [Geisel School of Medicine at Dartmouth, EPR Center for the Study of Viable Systems, Hanover, NH (United States)

    2014-05-15

    The principle of biodosimetry is to utilize changes induced in the individual by ionizing radiation to estimate the dose and, if possible, to predict or reflect the clinically relevant response, i.e., the biological consequences of the dose. Ideally, the changes should be specific for ionizing radiation, and the response should be unaffected by prior medical or physiological variations among subjects, including changes that might be caused by the stress and trauma from a radiation event. There are two basic types of biodosimetry with different and often complementary characteristics: those based on changes in biological parameters such as gene activation or chromosomal abnormalities and those based on physical changes in tissues (detected by techniques such as EPR). In this paper, we consider the applicability of the various techniques for different scenarios: small- and large-scale exposures to levels of radiation that could lead to the acute radiation syndrome and exposures with lower doses that do not need immediate care, but should be followed for evidence of long-term consequences. The development of biodosimetry has been especially stimulated by the needs after a large-scale event where it is essential to have a means to identify those individuals who would benefit from being brought into the medical care system. Analyses of the conventional methods officially recommended for responding to such events indicate that these methods are unlikely to achieve the results needed for timely triage of thousands of victims. Emerging biodosimetric methods can fill this critically important gap. (orig.)

  18. An Overview of Corporate Governance Practices of Selected Islamic Banks

    Directory of Open Access Journals (Sweden)

    Zainab Belal

    2016-05-01

    Full Text Available Complying with Corporate Governance (CG standards is not mandatory but with collapse of many financial institutions, compliance with high standards of CG in banking operation has become a necessity. This is due to the fact that many banks and companies worldwide collapsed as a result of poor corporate governance practices such as Bank of Credit and Commerce International (BCCI 1991, Barings Bank 1995, Lehman Brothers 2008, Enron 2001, WorldCom 2001, etc. Therefore, the objective of this paper is to examine and ascertain whether present level of CG standards practiced by Islamic banks is adequate to prevent or safeguard the banks from collapsing. The approach of the study is to evaluate the effectiveness of board and the various board committees utilizing data published in financial statement of the selected banks. The methodology used in this paper is analytical descriptive to reach accurate results and as more appropriate approach with this research. The study finds out that the selected banks comply with CG standards adopted; however such compliance does not mean that the board, the board committees will be constantly reliable. Therefore, instilling the Islamic values such as the concepts of ih}sân, honesty, and accountability is paramount to prevent CG failures and protect/safeguard the banks from collapsing.

  19. MOST COMMON TACTICAL ERRORS IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS MANAGEMENT: PRACTICAL RECOMMENDATIONS

    Directory of Open Access Journals (Sweden)

    A. S. Poskrebysheva

    2012-01-01

    Full Text Available Treatment of chronic heart failure (CHF often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

  20. MOST COMMON TACTICAL ERRORS IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS MANAGEMENT: PRACTICAL RECOMMENDATIONS

    Directory of Open Access Journals (Sweden)

    A. S. Poskrebysheva

    2014-07-01

    Full Text Available Treatment of chronic heart failure (CHF often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

  1. Exercise recommendations for childhood cancer survivors exposed to cardiotoxic therapies: an institutional clinical practice initiative.

    Science.gov (United States)

    Okada, Maki; Meeske, Kathleen A; Menteer, Jondavid; Freyer, David R

    2012-01-01

    Childhood cancer survivors who have received treatment with anthracyclines are at risk for developing cardiomyopathy in dose-dependent fashion. Historically, restrictions on certain types of physical activity that were intended to preserve cardiac function have been recommended, based on a mixture of evidence-based and consensus-based recommendations. In the LIFE Cancer Survivorship & Transition Program at Children's Hospital Los Angeles, the authors reevaluated their recommendations for exercise in survivors who were exposed to anthracyclines, with or without irradiation in proximity to the myocardium. The primary goal was to develop consistent, specific, practical, safe, and (where possible) evidence-based recommendations for at-risk survivors in the program. To accomplish this, the authors referred to current exercise guidelines for childhood cancer survivors, consulted recent literature for relevant populations, and obtained input from the program's pediatric cardiology consultant. The resulting risk-based exercise recommendations are designed to complement current published guidelines, maximize safe exercise, and help childhood cancer survivors return to a normal life that emphasizes overall wellness and physical activity. This article describes a single institution's experience in modifying exercise recommendations for at-risk childhood survivors and includes the methods, findings, and current institutional practice recommendations along with sample education materials.

  2. Headache research and medical practice in Brazil: an historical overview.

    Science.gov (United States)

    Valença, Marcelo Moraes; da Silva, Amanda Araújo; Bordini, Carlos Alberto

    2015-02-01

    Since the creation of the Brazilian Headache Society in 1978, substantial developments have taken place in both research and clinical practice in the field of headache medicine in Brazil. The Society now has almost 300 members throughout the country, actively working to improve the health of the general population and, in particular, diagnose and treat headache disorders. In addition, in a few large cities, such as São Paulo, Rio de Janeiro, Recife, Ribeirão Preto, Curitiba, and Porto Alegre, headache specialists have come together to promote research projects and increase knowledge in the field through MSc, PhD, and postdoctoral programs. Furthermore, scientific journals have emerged and books have been published to record and disseminate Brazilian scientific production in headache medicine. In this narrative review, we will briefly describe some important aspects of headache medicine in Brazil from prehistoric times to the present day, discuss the origin of headache medicine as a specialty in Brazil, the principal publications dealing with headache disorders, the use of plants and other unconventional forms of treatment used by faith healers, the main training centers, and the research produced to date by Brazilians. In conclusion, in recent years enormous progress has been made in headache medicine in Brazil stimulating us to review and expand our role in an increasingly international scenario. © 2015 American Headache Society.

  3. Overview of robotic colorectal surgery: Current and future practical developments

    Science.gov (United States)

    Roy, Sudipta; Evans, Charles

    2016-01-01

    Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

  4. An overview of clinical governance policies, practices and initiatives.

    Science.gov (United States)

    Braithwaite, Jeffrey; Travaglia, Joanne F

    2008-02-01

    To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

  5. Practical consensus recommendations regarding the management of hormone receptor positive early breast cancer in elderly women

    Directory of Open Access Journals (Sweden)

    Govind Babu

    2018-01-01

    Full Text Available Breast cancer is a leading cause of death among women, and its incidence increases with age. Currently the treatment of breast cancer in older patients is almost identical to their younger counterparts. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists regarding the management of early breast cancer specifically in elderly women.

  6. MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

    Science.gov (United States)

    Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

    2017-07-01

    The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  7. Overview and comparison of international practices on funding mechanisms

    International Nuclear Information System (INIS)

    Tchapga, Flavien

    2006-01-01

    . Therefore the challenge faced by Funding Mechanisms will be to provide when needed the degree of availability necessary for their effectiveness. But this can be expected only if the risk taken in the investment of funds are properly identified and appropriate measures to cope with identified risks taken. This paper sheds some lights on Funding Mechanisms in OECD countries. First of all, it reviews and evidences the variety of the institutional frameworks of Funding Mechanisms. Despite existing differences, these mechanisms are set up with common objectives which are, 1) the management/control of the funds and, 2) the bearing of one of the back-end liabilities of nuclear power industry. Therefore, the paper addresses the existing relationship between these two objectives. The deregulation of the electricity market has created a new situation where electric utilities including NPP owners have entered a volatile era. This raises a new question concerning the robustness of Funding Mechanisms. That question is: What degree of availability of funds accumulated could be expected from those mechanisms under these new volatile business conditions? In this respect, the paper assesses the merits of current Funding Mechanisms. The paper proceeds as follow: 1) A survey of practices in different countries. The design of Funding Mechanisms is considered and their variety is evidenced; 2) Respective merits of Funding mechanisms regarding the availability of funds in a deregulated electricity context. In this respect, the strength and weakness of current Funding Mechanisms are assessed regarding the protection of funds against financial insecurity. Evaluative criteria related to the design of funds on the one hand and to the deregulated electricity context on the other are considered

  8. Practical Recommendations to Improve the Quality of Training and Methodical Support of Professional Teacher Education

    Science.gov (United States)

    Grebennikov, Valery V.; Grudtsina, Ludmila Yu.; Marchuk, Nikolay N.; Sangadgiev, Badma V.; Kudyashev, Nail K.

    2016-01-01

    The research urgency is caused by the transition to the knowledge society and new demands for training and methodical provision of professional pedagogical education. The purpose of this paper is to develop practical recommendations to improve the quality of training and methodical support of professional pedagogical education. The leading…

  9. Standard recommended practice for examination of fuel element cladding including the determination of the mechanical properties

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    Guidelines are provided for the post-irradiation examination of fuel cladding and to achieve better correlation and interpretation of the data in the field of radiation effects. The recommended practice is applicable to metal cladding of all types of fuel elements. The tests cited are suitable for determining mechanical properties of the fuel elements cladding. Various ASTM standards and test methods are cited

  10. Understanding the Organizational Nature of Student Persistence: Empirically-based Recommendations for Practice.

    Science.gov (United States)

    Berger, Joseph B.

    2002-01-01

    Builds on the assumption that colleges and universities are organizations and subsequently that the organizational perspective provides important insights for improving retention on campuses. A review of existing organizational studies of undergraduate persistence serves as the basis for ten empirically-based recommendations for practice that are…

  11. Recommended industry best management practices for the prevention of Phytophthora ramorum introduction in nursery operations

    Science.gov (United States)

    Karen Suslow

    2008-01-01

    The following industry recommended best management practices (BMPs), designed for growers and/or interstate shippers of host and associated host plants of Phytophthora ramorum, consists of biosecurity guidelines created by and for nursery growers in order to reduce the risks associated with P. ramorum. The control of P....

  12. Application of Recommended Design Practices for Conceptual Nuclear Fusion Space Propulsion Systems

    Science.gov (United States)

    Williams, Craig H.

    2004-01-01

    An AIAA Special Project Report was recently produced by AIAA's Nuclear and Future Flight Propulsion Technical Committee and is currently in peer review. The Report provides recommended design practices for conceptual engineering studies of nuclear fusion space propulsion systems. Discussion and recommendations are made on key topics including design reference missions, degree of technological extrapolation and concomitant risk, thoroughness in calculating mass properties (nominal mass properties, weight-growth contingency and propellant margins, and specific impulse), and thoroughness in calculating power generation and usage (power-flow, power contingencies, specific power). The report represents a general consensus of the nuclear fusion space propulsion system conceptual design community and proposes 15 recommendations. This paper expands on the Report by providing specific examples illustrating how to apply each of the recommendations.

  13. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations

    NARCIS (Netherlands)

    Brożek, J. L.; Akl, E. A.; Compalati, E.; Kreis, J.; Terracciano, L.; Fiocchi, A.; Ueffing, E.; Andrews, J.; Alonso-Coello, P.; Meerpohl, J. J.; Lang, D. M.; Jaeschke, R.; Williams, J. W.; Phillips, B.; Lethaby, A.; Bossuyt, P.; Glasziou, P.; Helfand, M.; Watine, J.; Afilalo, M.; Welch, V.; Montedori, A.; Abraha, I.; Horvath, A. R.; Bousquet, J.; Guyatt, G. H.; Schünemann, H. J.

    2011-01-01

    This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We

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

    Science.gov (United States)

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

    2011-05-01

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

  15. The unusual practices within some Neo-Pentecostal churches in South Africa: Reflections and recommendations

    Directory of Open Access Journals (Sweden)

    Mookgo S. Kgatle

    2017-09-01

    Full Text Available This article reflects and makes recommendations on the recent unusual practices within some Neo-Pentecostal churches in South Africa. Neo-Pentecostal churches in South Africa refer to churches that have crossed denominational boundaries. These churches idolise the miraculous, healing, deliverance and enactment of bizarre church performances often performed by charismatic and highly influential spiritual leaders. There have been unusual practices within some Neo-Pentecostal churches that include, among others, the eating of grass, eating of snakes, drinking of petrol, spraying of Doom on the congregants and other experiences. There are many possible theological, psychological and socio-economic explanations for these unusual practices. Given the facts that many South Africans experience various socio-economic challenges, it is argued here that the socio-economic factor is the main explanation for the support of these unusual practices. The unusual practices within some Neo-Pentecostal churches in South Africa are critically unpacked by looking at various churches where the incidents happened. The possible theological, psychological and socio-economic explanations for such practices are outlined in detail. Recommendations are made based on the scientific findings on the unusual practices.

  16. Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

    International Nuclear Information System (INIS)

    Du, Yong; Carrio, Ignasi; De Vincentis, Giuseppe; Fanti, Stefano; Ilhan, Harun; Mommsen, Caroline; Nitzsche, Egbert; Sundram, Francis; Vogel, Wouter; Oyen, Wim; Lewington, Val

    2017-01-01

    Radium Ra 223 dichloride (radium-223, Xofigo registered) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision. An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined. The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway. These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care. (orig.)

  17. Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Du, Yong [The Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine and PET/CT, London (United Kingdom); Carrio, Ignasi [Hospital Sant Pau, Barcelona (Spain); De Vincentis, Giuseppe [Policlinico Umberto I University Hospital Rome, Rome (Italy); Fanti, Stefano [University Hospital Bologna, Bologna (Italy); Ilhan, Harun [Ludwig-Maximilians-University Hospital, Munich (Germany); Mommsen, Caroline [Praxis fuer diagnostische und therapeutische Nuklearmedizin Berlin, Berlin (Germany); Nitzsche, Egbert [Canton Hospital Aarau, Aarau (Switzerland); Sundram, Francis [University Hospital Southampton NHS Foundation Trust, Southampton (United Kingdom); Vogel, Wouter [The Netherlands Cancer Institute, Amsterdam (Netherlands); Oyen, Wim [The Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine and PET/CT, London (United Kingdom); The Institute of Cancer Research, London (United Kingdom); Lewington, Val [Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom)

    2017-09-15

    Radium Ra 223 dichloride (radium-223, Xofigo registered) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision. An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined. The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway. These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care. (orig.)

  18. Practical recommendations for performing ultrasound scanning in the urological and andrological fields.

    Science.gov (United States)

    Martino, Pasquale; Galosi, Andrea Benedetto; Bitelli, Marco; Consonni, Paolo; Fiorini, Fulvio; Granata, Antonio; Gunelli, Roberta; Liguori, Giovanni; Palazzo, Silvano; Pavan, Nicola; Scattoni, Vincenzo; Virgili, Guido

    2014-03-28

    US scanning has been defined as the urologist's stethoscope. These recommendations have been drawn up with the aim of ensuring minimum standards of excellence for ultrasound imaging in urological and andrological practice. A series of essential recommendations are made, to be followed during ultrasound investigations in kidney, prostate, bladder, scrotal and penile diseases. Members of the Imaging Working Group of the Italian Society of Urology (SIU) in collaboration with the Italian Society of Ultrasound in Urology, Andrology and Nephrology (SIEUN) identified expert Urologists, Andrologists, Nephrologists and Radiologists. The recommendations are based on review of the literature, previously published recommendations, books and the opinions of the experts. The final document was reviewed by national experts, including members of the Italian Society of Radiology. Recommendations are listed in 5 chapters, focused on: kidney, bladder, prostate and seminal vesicles, scrotum and testis, penis, including penile echo-doppler. In each chapter clear definitions are made of: indications, technological standards of the devices, the method of performance of the investigation. The findings to be reported are described and discussed, and examples of final reports for each organ are included. In the tables, the ultrasound features of the principal male uro-genital diseases are summarized. Diagnostic accuracy and second level investigations are considered. Ultrasound is an integral part of the diagnosis and follow-up of diseases of the urinary system and male genitals in patients of all ages, in both the hospital and outpatient setting. These recommendations are dedicated to enhancing communication and evidence-based medicine in an inter- and multi-disciplinary approach. The ability to perform and interpret ultrasound imaging correctly has become an integral part of clinical practice in uro-andrology, but intra and inter-observer variability is a well known limitation. These

  19. Psychosocial care for cancer: a framework to guide practice, and actionable recommendations for Ontario

    Science.gov (United States)

    Turnbull Macdonald, G.C.; Baldassarre, F.; Brown, P.; Hatton–Bauer, J.; Li, M.; Green, E.; Lebel, S.

    2012-01-01

    Objectives We set out to create a psychosocial oncology care framework and a set of relevant recommendations that can be used to improve the quality of comprehensive cancer care for Ontario patients and their families.meet the psychosocial health care needs of cancer patients and their families at both the provider and system levels. Data Sources and Methods The adapte process and the practice guideline development cycle were used to adapt the 10 recommendations from the 2008 U.S. Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs into the psychosocial oncology care framework. In addition, the evidence contained in the original document was used, in combination with the expertise of the working group, to create a set of actionable recommendations. Refinement after formal external review was conducted. Data Extraction and Synthesis The new framework consists of 8 defining domains. Of those 8 domains, 7 were adapted from recommendations in the source document; 1 new domain, to raise awareness about the need for psychosocial support of cancer patients and their families, was added. To ensure high-quality psychosocial care and services, 31 actionable recommendations were created. The document was submitted to an external review process. More than 70% of practitioners rated the quality of the advice document as high and reported that they would recommend its use. Conclusions This advice document advocates for a multidisciplinary approach to cancer care in response to the distress experienced by cancer patients and their families. The recommendations will be useful in future to measure performance, quality of practice, and access to psychosocial services. PMID:22876147

  20. Practical recommendations for performing ultrasound scanning in the urological and andrological fields

    Directory of Open Access Journals (Sweden)

    Pasquale Martino

    2014-03-01

    Full Text Available Aim: US scanning has been defined as the urologist’s stethoscope. These recommendations have been drawn up with the aim of ensuring minimum standards of excellence for ultrasound imaging in urological and andrological practice. A series of essential recommendations are made, to be followed during ultrasound investigations in kidney, prostate, bladder, scrotal and penile diseases. Methods: Members of the Imaging Working Group of the Italian Society of Urology (SIU in collaboration with the Italian Society of Ultrasound in Urology, Andrology and Nephrology (SIEUN identified expert Urologists, Andrologists, Nephrologists and Radiologists. The recommendations are based on review of the literature, previously published recommendations, books and the opinions of the experts. The final document was reviewed by national experts, including members of the Italian Society of Radiology. Results: Recommendations are listed in 5 chapters, focused on: kidney, bladder, prostate and seminal vesicles, scrotum and testis, penis, including penile echo-doppler. In each chapter clear definitions are made of: indications, technological standards of the devices, the method of performance of the investigation. The findings to be reported are described and discussed, and examples of final reports for each organ are included. In the tables, the ultrasound features of the principal male uro-genital diseases are summarized. Diagnostic accuracy and second level investigations are considered. Conclusions: Ultrasound is an integral part of the diagnosis and follow-up of diseases of the urinary system and male genitals in patients of all ages, in both the hospital and outpatient setting. These recommendations are dedicated to enhancing communication and evidence-based medicine in an inter- and multi-disciplinary approach. The ability to perform and interpret ultrasound imaging correctly has become an integral part of clinical practice in uro-andrology, but intra and inter

  1. How to Measure Motivational Interviewing Fidelity in Randomized Controlled Trials: Practical Recommendations.

    Science.gov (United States)

    Jelsma, Judith G M; Mertens, Vera-Christina; Forsberg, Lisa; Forsberg, Lars

    2015-07-01

    Many randomized controlled trials in which motivational interviewing (MI) is a key intervention make no provision for the assessment of treatment fidelity. This methodological shortcoming makes it impossible to distinguish between high- and low-quality MI interventions, and, consequently, to know whether MI provision has contributed to any intervention effects. This article makes some practical recommendations for the collection, selection, coding and reporting of MI fidelity data, as measured using the Motivational Interviewing Treatment Integrity Code. We hope that researchers will consider these recommendations and include MI fidelity measures in future studies. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Overview

    International Nuclear Information System (INIS)

    Stepp, J.C.

    1987-01-01

    A basic premise of seismic design practice is that structures and equipment designed for large, infrequent, design level earthquake motions will safely withstand the more frequent, smaller motions they may experience during their functional life. Moreover, based on experience data, there appears to be wide agreement among earthquake engineers that small-magnitude earthquakes (smaller than about M5.0) pose a negliable threat of damage to structures and equipment that have good seismic design and engineering. However, analytical approaches for engineering characterization of this lower-bound earthquake have not been developed. Largely this is because there has not, up to now, been a perceived need to do so. Moreover, because small earthquakes historically have not caused damage to well-engineered components, field investigations to determine their effects generally are not conducted. As a result, a robust earthquake experience data base, marking the earthquake magnitude corresponding to the onset of damage, has not been developed. The need to establish a lower-bound magnitude has now arisen in the context of probabilistic seismic hazard and risk assessments, where a limit on magnitude must be defined below which the contribution from smaller quakes is not considered. This workshop addresses the engineering characterization of small-magnitude earthquakes with a focus on developing technical bases for determining the lower-bound magnitude for probabilistic seismic hazard and risk computations at nuclear power generating plant sites, principally those located in the eastern U.S.. These facilities typically are designed for broad-band ground motion spectra which have spectral amplifications representative of large-magnitude earthquakes, and to conservative seismic design criteria

  3. Yellow Fever Vaccine Booster Doses: Recommendations of the Advisory Committee on Immunization Practices, 2015.

    Science.gov (United States)

    Staples, J Erin; Bocchini, Joseph A; Rubin, Lorry; Fischer, Marc

    2015-06-19

    On February 26, 2015, the Advisory Committee on Immunization Practices (ACIP) voted that a single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers. ACIP also approved recommendations for at-risk laboratory personnel and certain travelers to receive additional doses of yellow fever vaccine (Box). The ACIP Japanese Encephalitis and Yellow Fever Vaccines Workgroup evaluated published and unpublished data on yellow fever vaccine immunogenicity and safety. The evidence for benefits and risks associated with yellow fever vaccine booster doses was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. This report summarizes the evidence considered by ACIP and provides the updated recommendations for yellow fever vaccine booster doses.

  4. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice.

    Science.gov (United States)

    Anderson, Jaclyn; Caplan, Liron; Yazdany, Jinoos; Robbins, Mark L; Neogi, Tuhina; Michaud, Kaleb; Saag, Kenneth G; O'Dell, James R; Kazi, Salahuddin

    2012-05-01

    Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings. Copyright © 2012 by the American College of Rheumatology.

  5. The optimisation principle and the new ICRP recommendations: practical implications on operational radiation protection

    International Nuclear Information System (INIS)

    Lochard, J.

    1992-01-01

    The formulation of the optimisation principle proposed by the International Commission of Radiological Protection in its new recommendations is largely oriented towards better control of individual doses. In this perspective, the concept of doe constraint and the reference to equity in dose distributions are becoming key elements within the optimisation process. This paper discusses some first reflexions regarding this new orientation and outlines the main impacts that must be forwarded to the practical level. (author)

  6. Investigation of barriers to clinical practice guideline-recommended pharmacotherapy in the treatment of COPD.

    Directory of Open Access Journals (Sweden)

    Price L

    2007-06-01

    Full Text Available Background: The adoption of clinical practice guideline recommendations for COPD is suboptimal. Determining the barriers to the implementation of these practice guidelines may help improve patient care.Objective: To determine whether barriers to the use of pharmacotherapy according to practice guidelines are related primarily to patient or prescriber factors.Methods: Retrospective cohort study. Members of a health maintenance organization identified as having spirometry-defined COPD ranging from stage II to IV. Electronic medical records were reviewed for documentation of the following: 1 patient affordability issues, 2 history of an adverse drug reaction, 3 history of inefficacy to therapy, and 4 prescription history.Results: A total of 111 medical records were reviewed. There were 51% of patients who had not filled medications that had been prescribed in accordance with guidelines and 43% did not have the guideline recommended medications prescribed in the previous year. Only 4% and 2% of patients had documented inefficacy and affordability issues, respectively. There were no reported cases of adverse drug reactions. Conclusions: This study provides insight to the acceptance of COPD treatment recommendations by patients and providers. Further research is needed to design interventions to reduce barriers and optimize COPD treatment.

  7. Best practice recommendations for the development, implementation, and evaluation of online knowledge translation resources in rehabilitation.

    Science.gov (United States)

    Levac, Danielle; Glegg, Stephanie M N; Camden, Chantal; Rivard, Lisa M; Missiuna, Cheryl

    2015-04-01

    The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion. © 2015 American Physical Therapy Association.

  8. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.

    Science.gov (United States)

    Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

    2013-06-01

    Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  9. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines.

    Science.gov (United States)

    Frame, P S; Sawai, R; Bowen, W H; Meyerowitz, C

    2000-02-01

    The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling

  10. Compliance with NAGCAT work practices recommendations for youth cleaning service alleys in stall barns.

    Science.gov (United States)

    Canan, B D; Asti, L; Heaney, C; Ashida, S; Renick, K; Xiang, H; Stallones, L; Jepsen, S D; Crawford, J M; Wilkins, J R

    2011-04-01

    Unintentional injury is the leading cause of death in the U.S. among persons 1 to 44 years of age. Over one million children and adolescents in the U.S. live, work, and/or play on farms, where injury risk is relatively high compared to other settings. In an attempt to reduce the number of childhood agricultural injuries occurring on farms, the North American Guidelines for Children's Agricultural Tasks (NAGCAT) was developed to assist parents or other caregivers in assigning developmentally appropriate chores to youth exposed to agricultural hazards. The results presented here are from a longitudinal study in which we obtained (self-reported) daily chore, injury, and safety behavior data from children and adolescents. We focused on one NAGCAT chore, cleaning a service alley in a stall barn, in order to estimate the extent of compliance with specific work practice recommendations contained in the NAGCAT. Our results indicated that among the four NAGCAT-recommended safety practices for cleaning service alleys in stall barns (wearing nonskid shoes, leather gloves, a respirator, and eye protection), wearing non-skid shoes was the only safety practice reported with any degree of regularity. Overall, boys were more likely to wear non-skid shoes compared to girls. In addition, older youth were generally more likely to report higher work practice compliance compared to younger youth.

  11. Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults.

    Science.gov (United States)

    George, Elena S; Forsyth, Adrienne; Itsiopoulos, Catherine; Nicoll, Amanda J; Ryan, Marno; Sood, Siddharth; Roberts, Stuart K; Tierney, Audrey C

    2018-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. In the absence of effective pharmacotherapies, clinical guidelines focus primarily on weight loss to treat this condition. Established consensus, evidence-based, and clinical dietary recommendations for NAFLD are currently lacking. The aim of this paper is to provide evidence-based practical dietary recommendations for the prevention and management of NAFLD in adults. A literature review focusing on established principles for the development of clinical practice recommendations was employed using the following criteria: based on substantial evidence, ensures risk minimization, is flexible for an individual patient approach, and is open to further modification as evidence emerges. The Practice-based Evidence in Nutrition classification system was used to grade these principles. Five key dietary recommendations were developed: 1) follow traditional dietary patterns, such as the Mediterranean diet; 2) limit excess fructose consumption and avoid processed foods and beverages with added fructose; 3) PUFAs, especially long-chain omega-3 rich foods and MUFAs, should replace SFAs in the diet; 4) replace processed food, fast food, commercial bakery goods, and sweets with unprocessed foods high in fiber, including whole grains, vegetables, fruits, legumes, nuts, and seeds; and 5) avoid excess alcohol consumption. Improving diet quality may reduce the incidence and progression of NAFLD and associated risk factors. Many of the benefits are likely to result from the collective effect of dietary patterns. High-quality research-in particular, randomized clinical trials assessing dietary interventions that focus on liver-specific endpoints-are needed as a priority. © 2018 American Society for Nutrition. All rights reserved.

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

    Science.gov (United States)

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

    2013-01-01

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

  13. Korean older intimate partner violence survivors in North America: cultural considerations and practice recommendations.

    Science.gov (United States)

    Shim, Woochan S; Nelson-Becker, Holly

    2009-01-01

    While literature on elder abuse has expanded, elder abuse by intimate partners has been less investigated. Even less is known about intimate partner violence among older Koreans living in North America. This article identifies important cultural considerations for individuals helping the Korean older adult community, beginning with the definition of intimate partner violence in this community and barriers to leaving that include traditional views of the East Asian self. Current practice interventions are discussed and recommendations for future practice such as healing han, the accumulated suffering from years of abuse, are suggested. The ultimate goal of this paper is to expand awareness in order to develop the best culturally competent prevention and intervention practice for Korean older intimate partner violence survivors in North America.

  14. Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes.

    Science.gov (United States)

    McGilton, Katherine S; Bowers, Barbara J; Heath, Hazel; Shannon, Kay; Dellefield, Mary Ellen; Prentice, Dawn; Siegel, Elena O; Meyer, Julienne; Chu, Charlene H; Ploeg, Jenny; Boscart, Veronique M; Corazzini, Kirsten N; Anderson, Ruth A; Mueller, Christine A

    2016-02-01

    In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care

  15. Good practices in Local Government - A first overview of Portuguese reality

    Science.gov (United States)

    Carvalhosa, P.; Portela, F.; Machado, J.; Santos, M. F.; Abelha, A.

    2017-03-01

    Good practices in eGov are being increasingly used by Local Governments being that it is considered by them as an advantage. The main goal is providing to the town hall a differentiation point and approximate their services to the citizens. For this, it is necessary to define and apply innovative strategies in order to increase the use of services by the citizens. This paper is framed in a research work and it presents a first overview of the existing good practices in eGov, taking in consideration the Portuguese’s reality. The good practices identified were distinguished with many awards and with a positive response from the target audience. The use of digital marketing strategies aims to increase their membership and coming closer the municipalities of its citizens through the dissemination of the good practices. At this moment the data collected are almost exclusively of good practice in Portugal, however some international practices were also identified. As a result of this study the community has a list of good practices that can be applied in their municipalities.

  16. The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use.

    Science.gov (United States)

    Swiger, Pauline A; Patrician, Patricia A; Miltner, Rebecca S Susie; Raju, Dheeraj; Breckenridge-Sproat, Sara; Loan, Lori A

    2017-09-01

    The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment - defined as factors that enhance or attenuate a nurse's ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index's use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument. A narrative review of quantitative studies. PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI. Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations. Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest. The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality. Published by Elsevier Ltd.

  17. Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice.

    Science.gov (United States)

    Willis, Thomas A; Hartley, Suzanne; Glidewell, Liz; Farrin, Amanda J; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Collinson, Michelle; Clamp, Susan; Hunter, Cheryl; Ward, Vicky; Hulme, Claire; Meads, David; Bregantini, Daniele; Carder, Paul; Foy, Robbie

    2016-02-29

    There are recognised gaps between evidence and practice in general practice, a setting which provides particular challenges for implementation. We earlier screened clinical guideline recommendations to derive a set of 'high impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. We aim to evaluate the effectiveness and cost-effectiveness of a multifaceted, adaptable intervention package to implement four targeted, high impact recommendations in general practice. The research programme Action to Support Practice Implement Research Evidence (ASPIRE) includes a pair of pragmatic cluster-randomised trials which use a balanced incomplete block design. Clusters are general practices in West Yorkshire, United Kingdom (UK), recruited using an 'opt-out' recruitment process. The intervention package adapted to each recommendation includes combinations of audit and feedback, educational outreach visits and computerised prompts with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. In trial 1, practices are randomised to adapted interventions targeting either diabetes control or risky prescribing and those in trial 2 to adapted interventions targeting either blood pressure control in patients at risk of cardiovascular events or anticoagulation in atrial fibrillation. The respective primary endpoints comprise achievement of all recommended target levels of haemoglobin A1c (HbA1c), blood pressure and cholesterol in patients with type 2 diabetes, a composite indicator of risky prescribing, achievement of recommended blood pressure targets for specific patient groups and anticoagulation prescribing in patients with atrial fibrillation. We are also randomising practices to a fifth, non-intervention control group to further assess Hawthorne effects. Outcomes will be assessed using routinely collected data

  18. Hit Identification and Optimization in Virtual Screening: Practical Recommendations Based Upon a Critical Literature Analysis

    Science.gov (United States)

    Zhu, Tian; Cao, Shuyi; Su, Pin-Chih; Patel, Ram; Shah, Darshan; Chokshi, Heta B.; Szukala, Richard; Johnson, Michael E.; Hevener, Kirk E.

    2013-01-01

    A critical analysis of virtual screening results published between 2007 and 2011 was performed. The activity of reported hit compounds from over 400 studies was compared to their hit identification criteria. Hit rates and ligand efficiencies were calculated to assist in these analyses and the results were compared with factors such as the size of the virtual library and the number of compounds tested. A series of promiscuity, drug-like, and ADMET filters were applied to the reported hits to assess the quality of compounds reported and a careful analysis of a subset of the studies which presented hit optimization was performed. This data allowed us to make several practical recommendations with respect to selection of compounds for experimental testing, defining hit identification criteria, and general virtual screening hit criteria to allow for realistic hit optimization. A key recommendation is the use of size-targeted ligand efficiency values as hit identification criteria. PMID:23688234

  19. Hit identification and optimization in virtual screening: practical recommendations based on a critical literature analysis.

    Science.gov (United States)

    Zhu, Tian; Cao, Shuyi; Su, Pin-Chih; Patel, Ram; Shah, Darshan; Chokshi, Heta B; Szukala, Richard; Johnson, Michael E; Hevener, Kirk E

    2013-09-12

    A critical analysis of virtual screening results published between 2007 and 2011 was performed. The activity of reported hit compounds from over 400 studies was compared to their hit identification criteria. Hit rates and ligand efficiencies were calculated to assist in these analyses, and the results were compared with factors such as the size of the virtual library and the number of compounds tested. A series of promiscuity, druglike, and ADMET filters were applied to the reported hits to assess the quality of compounds reported, and a careful analysis of a subset of the studies that presented hit optimization was performed. These data allowed us to make several practical recommendations with respect to selection of compounds for experimental testing, definition of hit identification criteria, and general virtual screening hit criteria to allow for realistic hit optimization. A key recommendation is the use of size-targeted ligand efficiency values as hit identification criteria.

  20. Recommendations to bridge rural/urban drug-use(r) research and practice.

    Science.gov (United States)

    Leukefeld, C G; Edwards, R W

    1999-01-01

    This article presents recommendations developed by a group of United States drug-use(r) researchers interested in rural and urban research and practice who met in Lexington, Kentucky, in October 1996. Overall, there was consensus about the importance of better understanding the urban/rural drug and alcohol use/dependency continuum. It was emphasized that drug and alcohol use/dependency are chronic and relapsing disorders. Definitions of rural and urban are most important, and different definitions may be associated with factors that are masked by population density. Specific recommendations are presented in the following areas: Rural Factors, Epidemiology, HIV/AIDS, Treatment and Other Services, Migration, Youth, Protective Factors, Systems Perspective, Measurement, Confidentiality, Criminal Justice, Research, Policy Research, Economic Factors, Service Providers, and Managed Care.

  1. Practical evaluation of robots for elderly in Denmark — an overview

    DEFF Research Database (Denmark)

    Hansen, Søren Tranberg; Andersen, Hans Jørgen; Bak, Thomas

    2010-01-01

    Robots for elderly have drawn a great deal of attention as it is a controversial topic being pushed forward by the fact that there will be a dramatic increase of elderly in most western countries. Within the field of HRI, much research has been conducted on robots interacting with elderly and also...... a number of commercial products have been introduced to the market. Since 2006, a number of projects have been launched in Denmark in order to evaluate robot technology in practice in elder care. This paper gives an brief overview of a selected number of projects and outlines the characteristics...... and results. Finally it is discussed how HRI can benefit from these....

  2. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice

    Science.gov (United States)

    Houghton, Pamela; Anthony, Joseph; Rennie, Sandy; Shay, Barbara L.; Hoens, Alison M.

    2017-01-01

    Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice. PMID:29162949

  3. Feeding practices of low-income mothers: how do they compare to current recommendations?

    Science.gov (United States)

    Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

    2015-03-07

    Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Eighty low-income mothers and their preschool children were videotaped at dinner in their homes. Mothers were chosen from a larger study to create a 2 X 2 X 2 design: maternal ethnicity (African American vs. Latina) by child gender by child weight status (healthy weight vs. overweight/obese). Observers coded videotapes for a range of maternal feeding strategies and other behaviors. Many mothers spent considerable time encouraging eating--often in spite of the child's insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Latina mothers showed higher levels of teaching eating skills and encouraging their children to eat; African American mothers showed higher levels of enforcing table manners and getting children to clear their plates. Mothers of boys used more unelaborated commands and less questions/suggestions than mothers of girls. Finally, compared to mothers of overweight/obese children, mothers of healthy weight children showed higher levels of encouraging eating and lower levels of discouraging eating. Most of the mothers in this study did not engage in feeding practices that are consistent with current recommendations. They did this, despite the fact that they knew they were being observed. These results should be used to inform future research about the motivations behind mothers' feeding practices and the development of interventions by helping identify areas in greatest need of change.

  4. Using exploratory factor analysis in personality research: Best-practice recommendations

    Directory of Open Access Journals (Sweden)

    Sumaya Laher

    2010-11-01

    Research purpose: This article presents more objective methods to determine the number of factors, most notably parallel analysis and Velicer’s minimum average partial (MAP. The benefits of rotation are also discussed. The article argues for more consistent use of Procrustes rotation and congruence coefficients in factor analytic studies. Motivation for the study: Exploratory factor analysis is often criticised for not being rigorous and objective enough in terms of the methods used to determine the number of factors, the rotations to be used and ultimately the validity of the factor structure. Research design, approach and method: The article adopts a theoretical stance to discuss the best-practice recommendations for factor analytic research in the field of psychology. Following this, an example located within personality assessment and using the NEO-PI-R specifically is presented. A total of 425 students at the University of the Witwatersrand completed the NEO-PI-R. These responses were subjected to a principal components analysis using varimax rotation. The rotated solution was subjected to a Procrustes rotation with Costa and McCrae’s (1992 matrix as the target matrix. Congruence coefficients were also computed. Main findings: The example indicates the use of the methods recommended in the article and demonstrates an objective way of determining the number of factors. It also provides an example of Procrustes rotation with coefficients of agreement as an indication of how factor analytic results may be presented more rigorously in local research. Practical/managerial implications: It is hoped that the recommendations in this article will have best-practice implications for both researchers and practitioners in the field who employ factor analysis regularly. Contribution/value-add: This article will prove useful to all researchers employing factor analysis and has the potential to set the trend for better use of factor analysis in the South African context.

  5. A practical guide to cardiovascular 3D printing in clinical practice: Overview and examples.

    Science.gov (United States)

    Abudayyeh, Islam; Gordon, Brent; Ansari, Mohammad M; Jutzy, Kenneth; Stoletniy, Liset; Hilliard, Anthony

    2018-06-01

    The advent of more advanced 3D image processing, reconstruction, and a variety of three-dimensional (3D) printing technologies using different materials has made rapid and fairly affordable anatomically accurate models much more achievable. These models show great promise in facilitating procedural and surgical planning for complex congenital and structural heart disease. Refinements in 3D printing technology lend itself to advanced applications in the fields of bio-printing, hemodynamic modeling, and implantable devices. As a novel technology with a large variability in software, processing tools and printing techniques, there is not a standardized method by which a clinician can go from an imaging data-set to a complete model. Furthermore, anatomy of interest and how the model is used can determine the most appropriate technology. In this over-view we discuss, from the standpoint of a clinical professional, image acquisition, processing, and segmentation by which a printable file is created. We then review the various printing technologies, advantages and disadvantages when printing the completed model file, and describe clinical scenarios where 3D printing can be utilized to address therapeutic challenges. © 2017, Wiley Periodicals, Inc.

  6. [Nutrition in pregnancy - Practice recommendations of the Network "Healthy Start - Young Family Network"].

    Science.gov (United States)

    Koletzko, B; Bauer, C-P; Bung, P; Cremer, M; Flothkötter, M; Hellmers, C; Kersting, M; Krawinkel, M; Przyrembel, H; Rasenack, R; Schäfer, T; Vetter, K; Wahn, U; Weißenborn, A; Wöckel, A

    2012-06-01

    Nutrition, physical activity and lifestyle in pregnancy influence maternal and child health. The "Healthy start - Young Family Network" supported by the German Government with the national action plan IN FORM developed recommendations on nutrition in pregnancy. Folic acid supplements (400 µg/day) should be started before pregnancy and continue for at least the first trimester. Iodine rich foods and salt and an iodine supplement (100-150 µg/day) are recommended. Long-chain omega-3 fatty acids should be provided with ≥ 1 weekly portion of oily sea fish, or a DHA-supplement if regular fish consumption is avoided. Vitamin D supplementation is advisable unless there is regular exposure to sunlight. Iron supplements should be used based on medical history and blood testing. Vegetarian diets with nutritional supplements can provide adequate nutrition, but counselling is recommended. In contrast, a vegan diet is inadequate and requires additional micronutrient supplementation. For risk reduction of listeriosis and toxoplasmosis, raw animal foods, soft cheeses and packed fresh salads should be avoided; fresh fruit, vegetables and salad should be washed well and consumed promptly. Pregnant women should remain physically active and perform sports with moderate intensity. They should avoid alcohol, active and passive smoking. Up to 3 daily cups of coffee are considered harmless, but energy drinks should be avoided. Childhood allergy is not reduced by avoiding certain foods in pregnancy whereas oily sea fish is recommended. Health care professions should lead parents to health-promoting lifestyles. Subjects of part 1 of the article are practice recommendations on nutrition, on energy needs, micronutrient needs and body weight/weight gain in pregnancy. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Treatment of asthma: Identification of the practice behavior and the deviation from the guideline recommendations

    Directory of Open Access Journals (Sweden)

    Bhattacharyya Parthasarathi

    2010-01-01

    Full Text Available Background: Despite an exponential development of the understanding of the disease with availability of good therapy and feasibility of good control along with availability of globally accepted guidelines, there remains a significant gap between the guidelines and prevailing practice behavior for treating asthma all over the globe. This perhaps stands as the single most deterrent factor for good asthma care worldwide. The objective of the study is to analyze the asthma prescriptions to find out the available status of the practice behaviour and the deviations from the guideline in asthma practice. Materials and Methods: The asthma prescriptions of the referred patients presenting to the OPD services of the IPCR, Kolkata were photocopied and collected. They were further analyzed based on the available information upon a format being prepared on four major areas as qualifications, clinical recording habit, practice of evaluating patients, and treatment habit that stands apparent from the prescribed medications. The doctors were divided into three categories as a MBBS, b MD/DNB (medicine and respiratory medicine, and c DM (non respiratory sub-specialities and statistical analysis has been performed comparing the three groups as per the performance in the four pre-decided areas. Results: All the groups fall short of any guideline or text of asthma care in all the areas involved. Conclusion: The practice behaviour of our doctors for asthma care appears deficient in several areas and seems far from guideline recommendations. This needs further evaluation and adoption of appropriate interventions.

  8. Are Adults Diagnosed with Diabetes achieving the American Diabetes Association Clinical Practice Recommendations?

    Science.gov (United States)

    Pérez, Cynthia M.; Febo-Vázquez, Isaedmarie; Guzmán, Manuel; Ortiz, Ana Patricia; Suárez, Erick

    2012-01-01

    Objective This study assessed the proportion of adults with previously diagnosed diabetes mellitus (DM) who met selected preventive practices and treatment goals according to the American Diabetes Association (ADA) standards of medical care. Methods A secondary analysis of data collected for a previous epidemiologic study that used a probability cluster design to select 859 persons aged 21–79 years in the San Juan metropolitan area was undertaken. This study focused on 136 (15.8%) adults who self-reported DM. The Standards of Medical Care in Diabetes published by the ADA in 2011 were used to determine the proportion of adults achieving selected clinical practice recommendations. Results Less than half of adults achieved recommended treatment goals for LDL-cholesterol (47.8%), HDL-cholesterol (44.1%), blood pressure (41.2%) and HbA1c (28.7%). The percentage of adults achieving recommended levels of HbA1c, blood pressure and LDL-cholesterol simultaneously was 6.6%; the percentage achieving HbA1c, blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides and albumin-to-creatinine ratio target levels was only 2.2%. More than half (60.2%) reported daily self-monitoring of foot ulcers and HbA1c testing at least twice over the past year (52.3%). However, less than half reported annual dilated eye examination (49.2%), annual comprehensive foot examination (43.8%), daily self-monitoring blood glucose (37.5%), moderate or vigorous physical activity (33.8%), and self-management DM education (28.9%). Conclusion This study showed that a substantial proportion of adults with DM did not achieve ADA recommendations on selected preventive practices and treatment goals. Strategies to improve DM medical care and surveillance of preventive-care practices and treatment goals among affected individuals are essential for planning further initiatives that contribute to reduce the burden of DM complications. PMID:22432404

  9. [The school doctorand suspected child abuse : towards good practice recommendations in the child's interest].

    Science.gov (United States)

    Noirhomme-Renard, F; Blavier, A; Lachaussée, S; Monville, C; Nihoul, C; Gosset, C

    2016-10-01

    Child maltreatment, including all forms of mal¬treatment, remains a major public health problem in high-income countries. Healthcare professionals only contribute to a small proportion of reports. In French-speaking Belgium, almost 100 % of school-aged children are regularly submitted to periodical school health visits. The school health doctor is well placed to recognize neglected or abused children. Based on international good practice recommendations, this paper proposes means for the detection and management of child abuse in the context of school medicine.

  10. Practical consensus recommendations on fertility preservation in patients with breast cancer

    Directory of Open Access Journals (Sweden)

    Jyoti Bajpai

    2018-01-01

    Full Text Available Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

  11. Are ECG monitoring recommendations before prescription of QT-prolonging drugs applied in daily practice?

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Rutten, Frans Hendrik; Souverein, Patrick Cyriel

    2015-01-01

    PURPOSE: Monitoring of the QT duration by electrocardiography (ECG) prior to treatment is frequently recommended in the label of QT-prolonging drugs. It is, however, unknown how often general practitioners in daily clinical practice are adhering to these risk-minimization measures. We assessed...... the frequency of ECG measurements in patients where haloperidol was initiated in primary care. METHODS: Patients (≥18 years) with a first prescription of haloperidol in the UK Clinical Practice Research Datalink (2009-2013) were included. The proportion of ECGs made was determined in two blocks of 4 weeks......: during the exposure period when haloperidol was initiated, and during the control period, 1 year before. Conditional logistic regression analysis was applied to calculate the relative risk of having an ECG in the exposure period compared with the control period. Subgroup analyses were performed to assess...

  12. Corruption in Education Systems: A Review of Practices, Causes, Effects and Recommendations

    Directory of Open Access Journals (Sweden)

    Sergio Cárdenas Denham

    2012-11-01

    Full Text Available Achieving higher levels of transparency and accountability in education systems is essential for attaining an adequate distribution of educational opportunities. Studies of corruption in education systems are important since they can contribute to increasing public awareness of the harmful effects of corruption and promote political support for the implementation of anti-corruption initiatives in education. This paper describes a typology of corrupt practices and develops a classification for the findings reported in the literature on corruption in education, such as causes, consequences and recommendations, as well as a classification of the methodologies applied to the study of corrupt practices. Finally, it describes the possible implications of these findings for policymakers.

  13. Practical consensus recommendations on management of triple-negative metastatic breast cancer

    Directory of Open Access Journals (Sweden)

    R Rangarao

    2018-01-01

    Full Text Available Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR- and human epidermal growth factor receptor 2 (HER2-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

  14. Practical consensus recommendations on Her2 +ve breast cancer with solitary brain mets

    Directory of Open Access Journals (Sweden)

    Nitesh Rohatgi

    2018-01-01

    Full Text Available Breast cancer is a common cause of brain metastases, with metastases occurring in at least 10–16% of patients. Longer survival of patients with metastatic breast cancer and the use of better imaging techniques are associated with an increased incidence of brain metastases. Current therapies include surgery, whole-brain radiation therapy, stereotactic radiosurgery, chemotherapy and targeted therapies. However, the timing and appropriate use of these therapies is controversial and careful patient selection by using available prognostic tools is extremely important. Expert oncologist discussed on the mode of treatment to extend the OS and improve the quality of life ofHER2-positivebreast cancer patients with Solitary brain metastases. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

  15. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines.

    Science.gov (United States)

    Malhi, Gin S; Gessler, Danielle; Outhred, Tim

    2017-08-01

    Lithium is an effective mood stabilizer that is used principally for the management of bipolar disorder (BD). Its administration is complex and often requires sophisticated management and assiduous monitoring. When considering the use of lithium therapy for bipolar disorder, clinicians are advised to refer to recommendations outlined in clinical practice guidelines (CPGs); but because of varying emphases placed by different international CPGs, recommendations addressing the practical use of lithium lack consistency. In order to inform clinicians of optimal lithium therapy for bipolar disorder, we compared and synthesized recommendations for the treatment of bipolar disorder made by recognized CPGs internationally. We conducted a search of the literature and extracted guidance across multiple clinical issues, including clinical indications, disorder subtypes, additional uses, special populations, practical aspects, and side effects. Collectively, CPGs consider lithium most robustly as a first-line intervention for maintenance treatment of bipolar disorder and strongly for the treatment of mania, with relatively modest support for the management of acute bipolar depression. Additionally, there is consensus across the CPGs that lithium tangibly reduces the risk of suicide. Generally, CPGs provide guidance on the many facets of initiating and maintaining patients on lithium therapy, but individually the CPGs varied in terms of depth and practical guidance they provide across these areas. However, consensus was established across many key areas of practice such as the ideal lithium plasma concentration for maintenance and monitoring (0.6-0.8mmol/L), along with the need for regular monitoring of renal and endocrine function. However, with more complex aspects (e.g., atypical presentations) and in special populations (e.g., youth; pregnancy and post-partum; older adults), guidance varied considerably and clear consensus recommendations were more difficult to achieve. In

  16. The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders

    Directory of Open Access Journals (Sweden)

    Claire Fouché-Copley

    2016-06-01

    Full Text Available Audiologists managing children with auditory processing disorders (APD encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists’ level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049 was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03 to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team. Keywords: Screening; assessment

  17. Variation in adult vaccination policies across Europe: an overview from VENICE network on vaccine recommendations, funding and coverage.

    Science.gov (United States)

    Kanitz, Elisabeth E; Wu, Lauren A; Giambi, Cristina; Strikas, Raymond A; Levy-Bruhl, Daniel; Stefanoff, Pawel; Mereckiene, Jolita; Appelgren, Eva; D'Ancona, Fortunato

    2012-07-27

    In 2010-2011, in the framework of the VENICE project, we surveyed European Union (EU) and Economic Area (EEA) countries to fill the gap of information regarding vaccination policies in adults. This project was carried out in collaboration with the United States National Vaccine Program Office, who conducted a similar survey in all developed countries. VENICE representatives of all 29 EU/EEA-countries received an online questionnaire including vaccination schedule, recommendations, funding and coverage in adults for 17 vaccine-preventable diseases. The response rate was 100%. The definition of age threshold for adulthood for the purpose of vaccination ranged from 15 to 19 years (median=18 years). EU/EEA-countries recommend between 4 and 16 vaccines for adults (median=11 vaccines). Tetanus and diphtheria vaccines are recommended to all adults in 22 and 21 countries respectively. The other vaccines are mostly recommended to specific risk groups; recommendations for seasonal influenza and hepatitis B exist in all surveyed countries. Six countries have a comprehensive summary document or schedule describing all vaccines which are recommended for adults. None of the surveyed countries was able to provide coverage estimates for all the recommended adult vaccines. Vaccination policies for adults are not consistent across Europe, including the meaning of "recommended vaccine" which is not comparable among countries. Coverage data for adults should be collected routinely like for children vaccination. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases.

    Science.gov (United States)

    Schelenz, Silke; Barnes, Rosemary A; Barton, Richard C; Cleverley, Joanne R; Lucas, Sebastian B; Kibbler, Christopher C; Denning, David W

    2015-04-01

    Invasive fungal diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientific literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive fungal diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identification of clinically significant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (<48 hours) and optimised imaging for patients with suspected invasive fungal infection. All 43 recommendations are auditable and should be used to ensure best diagnostic practice and improved outcomes for patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2009-03-01

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

  20. Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices: A cost-minimization analysis.

    Science.gov (United States)

    Whittington, Melanie D; Curtis, Donna J; Atherly, Adam J; Bradley, Cathy J; Lindrooth, Richard C; Campbell, Jonathan D

    2017-07-01

    To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients. Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs. The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used. For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  1. Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

    Science.gov (United States)

    McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

    2016-01-01

    Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

  2. New radiation quantities recommended by ICRU for practical use in radiological protection: their implementation in the United Kingdom

    International Nuclear Information System (INIS)

    1986-06-01

    This report considers the practical application of both the ICRU Report No. 39 and the ICRP Statement of 1985 and recommends the implementation of the ICRU operational quantities in the United Kingdom but, at this stage, the increase in the Q values for neutrons is not recommended. No other changes in Q are expected for some years. (author)

  3. 1251 seed calibration using afterloading equipment SeedSelectron. Practical solution to meet the recommendations of the AAPM

    International Nuclear Information System (INIS)

    Perez-Calatayud, J.; Richart, J.; Perez-Garcia, J.; Guirado, D.; Ballester, F.; Rodriguez, S.; Santos, M.; Depiaggio, M.; Carmona, V.; Lliso, F.; Camacho, C.; Pujades, M. C.

    2011-01-01

    SeedSelectron is a system used in the afterloader permanent implant brachytherapy seeds 1-125 interstitial prostate. Two aspects are critical when you can meet the recommendations of the AAPM: a practical difficulty to check the quantity of seed required, and the great uncertainty of all measured diodes. The purpose of this paper is to present a practical solution that has been adopted to implement the recommendations of the AAPM

  4. Practical recommendations for breathing-adapted radiotherapy; Bonnes pratiques pour la radiotherapie asservie a la respiration

    Energy Technology Data Exchange (ETDEWEB)

    Simon, L.; Giraud, P.; Rosenwald, J.C. [Institut Curie, Dept. d' Oncologie-radiotherapie, 75 - Paris (France); Dumas, J.L.; Lorchel, F. [CHU de Besancon, Hopital Jean-Minjoz, Service Radiotherapie, 25 - Besancon (France); Marre, D. [Institut Claudius-Regaud, Dept. des Radiations, 31 - Toulouse (France); Dupont, S. [Hopital Europeen Georges-Pompidou, Service d' Oncoradiotherapie, 75 - Paris (France); Varmenot, N. [Centre Henri-Becquerel, UnitE de Physique Medicale, 76 - Rouen (France); Ginestet, C. [Centre Leon-Berard, Dept. de Radiotherapie, 69 - Lyon (France); Caron, J. [Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Marchesi, V. [Centre Alexis-Vautrin, Dept. de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France); Ferreira, I. [Institut Gustave-Roussy, Dept. d' Oncologie Radiotherapie, 94 - Villejuif (France); Garcia, R. [Institut Sainte-Catherine, Service de Radiotherapie, 84 - Avignon (France)

    2007-06-15

    Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. (authors)

  5. WE-AB-201-04: The Recommendations of MPPG #5 and Practical Implementation Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Smilowitz, J. [University of Wisconsin (United States)

    2015-06-15

    . The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

  6. WE-AB-201-04: The Recommendations of MPPG #5 and Practical Implementation Strategies

    International Nuclear Information System (INIS)

    Smilowitz, J.

    2015-01-01

    . The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations

  7. Introduction of Situation, Background, Assessment, Recommendation into Nursing Practice: A Prospective Study.

    Science.gov (United States)

    Achrekar, Meera S; Murthy, Vedang; Kanan, Sadhana; Shetty, Rani; Nair, Mini; Khattry, Navin

    2016-01-01

    The aim of the study was to introduce and evaluate the compliance to documentation of situation, background, assessment, recommendation (SBAR) form. Twenty nurses involved in active bedside care were selected by simple random sampling. Use of SBAR was illustrated thru self-instructional module (SIM). Content validity and reliability were established. The situation, background, assessment, recommendation (SBAR) form was disseminated for use in a clinical setting during shift handover. A retrospective audit was undertaken at 1 st week (A1) and 16 th week (A2), post introduction of SIM. Nurse's opinion about the SBAR form was also captured. Majority of nurses were females (65%) in the age group 21-30 years (80%). There was a significant association ( P = 0.019) between overall audit scores and graduate nurses. Significant improvement ( P = 0.043) seen in overall scores between A1 (mean: 23.20) and A2 (mean: 24.26) and also in "Situation" domain ( P = 0.045) as compared to other domains. There was only a marginal improvement in documentation related to patient's allergies and relevant past history (7%) while identifying comorbidities decreased by 40%. Only 70% of nurses had documented plan of care. Most (76%) of nurses expressed that SBAR form was useful, but 24% nurses felt SBAR documentation was time-consuming. The assessment was easy (53%) to document while recommendation was the difficult (53%) part. SBAR technique has helped nurses to have a focused and easy communication during transition of care during handover. Importance and relevance of capturing information need to be reinforced. An audit to look for reduced number of incidents related to communication failures is essential for long-term evaluation of patient outcomes. Use of standardized SBAR in nursing practice for bedside shift handover will improve communication between nurses and thus ensure patient safety.

  8. Prevention of Backover Fatalities in Highway Work Zones: A Synthesis of Current Practices and Recommendations

    Directory of Open Access Journals (Sweden)

    Wei Fan

    2014-12-01

    Full Text Available The purpose of this paper is to synthesize current practices and procedures on the prevention of backing fatalities in highway work zones. First, general work zone safety hazards are reviewed, particularly blind areas are identified. Second, engineering controls currently in use are examined and explained to help understand what steps can be taken to prevent future backing fatalities. Third, administrative controls (including signalers, drivers, and workers-on-foot training are also discussed. Fourth, existing technology controls are reviewed for use in aiding equipment operators in identifying when pedestrian personnel are in dangerous areas around their equipment (i.e., back-up camera, radar. Fifth, recommendations are made based on the comprehensive review of the backover fatality prevention techniques in construction work zones and the conducted testing results of several commercially available systems. Recommendations on engineering and technology controls are discussed, with detailed information such as improving internal traffic control plans, and integrating technology with traffic control plans. Information and drawings are provided to illustrate how to design work zones, and the internal traffic flow diagrams are created using the integrated technology available, and site specific characteristics. The drawings represent examples of using different types of technology, in different scenarios using the proper legend, as well as using the proper general and technology notes to help explain the traffic control plan, ensuring that full comprehension is made. Recommendations on administrative controls are also given such as how to conduct safety meetings, electing safety officers, how to set regulations and guidelines for workers, and how to handle training. Training should be used as a backover fatality prevention method for pedestrian workers, flaggers, spotters, and equipment operators. Finally, a summary and discussion of future research

  9. Efficacy of microbial sampling recommendations and practices in sub-Saharan Africa.

    Science.gov (United States)

    Taylor, David D J; Khush, Ranjiv; Peletz, Rachel; Kumpel, Emily

    2018-05-01

    Current guidelines for testing drinking water quality recommend that the sampling rate, which is the number of samples tested for fecal indicator bacteria (FIB) per year, increases as the population served by the drinking water system increases. However, in low-resource settings, prevalence of contamination tends to be higher, potentially requiring higher sampling rates and different statistical methods not addressed by current sampling recommendations. We analyzed 27,930 tests for FIB collected from 351 piped water systems in eight countries in sub-Saharan Africa to assess current sampling rates, observed contamination prevalences, and the ability of monitoring agencies to complete two common objectives of sampling programs: determine regulatory compliance and detect a change over time. Although FIB were never detected in samples from 75% of piped water systems, only 14% were sampled often enough to conclude with 90% confidence that the true contamination prevalence met an example guideline (≤5% chance of any sample positive for FIB). Similarly, after observing a ten percentage point increase in contaminated samples, 43% of PWS would still require more than a year before their monitoring agency could be confident that contamination had actually increased. We conclude that current sampling practices in these settings may provide insufficient information because they collect too few samples. We also conclude that current guidelines could be improved by specifying how to increase sampling after contamination has been detected. Our results suggest that future recommendations should explicitly consider the regulatory limit and desired confidence in results, and adapt when FIB is detected. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Introduction of Situation, Background, Assessment, Recommendation into Nursing Practice: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Meera S Achrekar

    2016-01-01

    Full Text Available Objective: The aim of the study was to introduce and evaluate the compliance to documentation of situation, background, assessment, recommendation (SBAR form. Methods: Twenty nurses involved in active bedside care were selected by simple random sampling. Use of SBAR was illustrated thru self-instructional module (SIM. Content validity and reliability were established. The situation, background, assessment, recommendation (SBAR form was disseminated for use in a clinical setting during shift handover. A retrospective audit was undertaken at 1 st week (A1 and 16 th week (A2, post introduction of SIM. Nurse′s opinion about the SBAR form was also captured. Results : Majority of nurses were females (65% in the age group 21-30 years (80%. There was a significant association (P = 0.019 between overall audit scores and graduate nurses. Significant improvement (P = 0.043 seen in overall scores between A1 (mean: 23.20 and A2 (mean: 24.26 and also in "Situation" domain (P = 0.045 as compared to other domains. There was only a marginal improvement in documentation related to patient′s allergies and relevant past history (7% while identifying comorbidities decreased by 40%. Only 70% of nurses had documented plan of care. Most (76% of nurses expressed that SBAR form was useful, but 24% nurses felt SBAR documentation was time-consuming. The assessment was easy (53% to document while recommendation was the difficult (53% part. Conclusions: SBAR technique has helped nurses to have a focused and easy communication during transition of care during handover. Importance and relevance of capturing information need to be reinforced. An audit to look for reduced number of incidents related to communication failures is essential for long-term evaluation of patient outcomes. Use of standardized SBAR in nursing practice for bedside shift handover will improve communication between nurses and thus ensure patient safety.

  11. Task 9 recommended practice guides - Executive summaries. Financing mechanisms for solar home systems in developing countries

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-09-15

    This Practice Guide issued by the Photovoltaic Power Systems (PVPS) group of the International Energy Agency (IEA) summarises how insufficient financing, the low incomes of the potential clients in remote rural areas and the high initial investment costs for the Solar Home System (SHS) are the factors responsible for insufficient progress in this area. The findings of the study such as access to finance, subsidies, formal and informal intermediaries and alternative financing solutions are discussed. SHS operating costs, possible higher priorities for other commodities and other market-driven factors are discussed. The report notes that most other reports concentrate more on technical and institutional rather than on the underlying financing schemes and associated data. Recommendations made deal with political aspects as well as technical, financial and awareness issues.

  12. Implementing AORN recommended practices for a safe environment of care, part II.

    Science.gov (United States)

    Kennedy, Lynne

    2014-09-01

    Construction in and around a working perioperative suite is a challenge beyond merely managing traffic patterns and maintaining the sterile field. The AORN "Recommended practices for a safe environment of care, part II" provides guidance on building design; movement of patients, personnel, supplies, and equipment; environmental controls; safety and security; and control of noise and distractions. Whether the OR suite evolves through construction, reconstruction, or remodeling, a multidisciplinary team of construction experts and health care professionals should create a functional plan and communicate at every stage of the project to maintain a safe environment and achieve a well-designed outcome. Emergency preparedness, a facility-wide security plan, and minimization of noise and distractions in the OR also help enhance the safety of the perioperative environment. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  13. Precision of commercial soil testing practice for phosphorus fertilizer recommendations in Finland

    Directory of Open Access Journals (Sweden)

    T. PELTOVUORI

    2008-12-01

    Full Text Available Implementation of the Agri-Environmental Program in 1995 has emphasized the role of advisory soil testing in phosphorus (P input planning and markedly expanded the market for commercial soil testing in Finland. A small precision experiment (5 laboratories and a simulation study on soil sampling were conducted to evaluate the current precision of the soil testing practice for P. The observed values of reproducibility (95% probability of soil P determination were 42-61% of the mean P concentration for three soils. This approximately corresponds to a maximum error of one P class in a seven-step classification system. Soil texture and organic matter content are used as secondary variables in P fertilization planning. In commercial soil testing these are both determined by finger assessment and the results have significant errors in most laboratories. Erroneous texture determinations are more likely to lead to errors in P fertilizer recommendations than soil P analysis itself. In this study the largest deviation from a correct P fertilization recommendation was +10 kg ha-1. In soil sampling simulation, stratified random sampling in areas of differing texture gave the most consistent results with geostatistical analysis of the soil test data, as compared with random, systematic, and judgment sampling strategies.;

  14. A Study of Business Incubators: Models, Best Practices, and Recommendations for NASA and Florida

    Science.gov (United States)

    1997-01-01

    This study was conducted to provide NASA-Kennedy Space Center with information and recommendations to support establishing one or more technology-based business incubators In Florida. The study involved assembling information about incubators: why they succeed, why they fail, how they are organized, and what services they provide. Consequently, this study focuses on widely-recognized "best practices," needed to establish successful technology- based business incubators. The findings are used to optimize the design and implementation of one or more technology-based business incubators to be established in Florida. Recommendations reflect both the essential characteristics of successful incubators and the optimal business demographics in Florida. Appendix A provides a fuller description of the objectives of the study. Technology-based business incubators are an increasing catalyst of new business development across the USi Incubators focus on providing entrepreneurs and small start-up firms with a wide array of support services necessary to bring forth new products and processes based on technologies developed in the nation's federal and private laboratories and universities. Appendix B provides extensive discussion of findings relative to technology- based business incubators.

  15. A Systematic Review of Marine-Based Species Distribution Models (SDMs with Recommendations for Best Practice

    Directory of Open Access Journals (Sweden)

    Néstor M. Robinson

    2017-12-01

    Full Text Available In the marine environment Species Distribution Models (SDMs have been used in hundreds of papers for predicting the present and future geographic range and environmental niche of species. We have analyzed ways in which SDMs are being applied to marine species in order to recommend best practice in future studies. This systematic review was registered as a protocol on the Open Science Framework: https://osf.io/tngs6/. The literature reviewed (236 papers was published between 1992 and July 2016. The number of papers significantly increased through time (R2 = 0.92, p < 0.05. The studies were predominantly carried out in the Temperate Northern Atlantic (45% followed by studies of global scale (11% and studies in Temperate Australasia (10%. The majority of studies reviewed focused on theoretical ecology (37% including investigations of biological invasions by non-native organisms, conservation planning (19%, and climate change predictions (17%. Most of the studies were published in ecological, multidisciplinary, or biodiversity conservation journals. Most of the studies (94% failed to report the amount of uncertainty derived from data deficiencies and model parameters. Best practice recommendations are proposed here to ensure that novice and advanced SDM users can (a understand the main elements of SDMs, (b reproduce standard methods and analysis, and (c identify potential limitations with their data. We suggest that in the future, studies of marine SDMs should report on key features of the approaches employed, data deficiencies, the selection of the best explanatory model, and the approach taken to validate the SDM results. In addition, based on the literature reviewed, we suggest that future marine SDMs should account for uncertainty levels as part of the modeling process.

  16. Radiosterilization of Medical Products and Recommended Code of Practice. Proceedings of a Symposium

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1967-09-15

    Proceedings of a Symposium organized by the IAEA and held in Budapest, 5-9 June 1967, together with the IAEA recommended 'Code of Practice for Radiosterilization of Medical Products' resulting from a panel meeting held in Vienna, December 1966, and considered at the Symposium. The meeting was attended by 160 participants from 25 Member States and 3 international organizations. The commercial use of ionizing radiation for sterilizing medical supplies extends back to the early 1960s. The ability of the process to sterilize products made of materials such as plastics, which are destroyed by traditional sterilization procedures, has promoted much new thinking in product design. Most important is the ability of the radiation to sterilize items finally sealed and packed for dispatch, eliminating risk of recontamination. Some new fields of research are discussed in the Proceedings. The Code of Practice, drawn up by experts at several meetings, is aimed at producing uniform, safe procedures throughout the world, facilitating international trade in radiosterilized products. Contents: Introductory lecture; Radiosterilization of pharmaceuticals and bioproducts (12 papers); Radiosterilization of biological tissues (6 papers); Vaccine production by ionizing radiation (5 papers); Radiosterilization of medical devices and supplies (4 papers); Radiosensitivity of micro-organisms and microbiological testing (4 papers); Technical and economic aspects of radiosterilization (6 papers); Code of practice for radiosterilization (full code and 1 review paper). The Code of Practice is in English. Each paper is in its original language (29 English, 5 French, 4 Russian and 1 Spanish) and is preceded by an abstract in English with one in the original language if this is not English. Discussions are in English. (author)

  17. Radiosterilization of Medical Products and Recommended Code of Practice. Proceedings of a Symposium

    International Nuclear Information System (INIS)

    1967-01-01

    Proceedings of a Symposium organized by the IAEA and held in Budapest, 5-9 June 1967, together with the IAEA recommended 'Code of Practice for Radiosterilization of Medical Products' resulting from a panel meeting held in Vienna, December 1966, and considered at the Symposium. The meeting was attended by 160 participants from 25 Member States and 3 international organizations. The commercial use of ionizing radiation for sterilizing medical supplies extends back to the early 1960s. The ability of the process to sterilize products made of materials such as plastics, which are destroyed by traditional sterilization procedures, has promoted much new thinking in product design. Most important is the ability of the radiation to sterilize items finally sealed and packed for dispatch, eliminating risk of recontamination. Some new fields of research are discussed in the Proceedings. The Code of Practice, drawn up by experts at several meetings, is aimed at producing uniform, safe procedures throughout the world, facilitating international trade in radiosterilized products. Contents: Introductory lecture; Radiosterilization of pharmaceuticals and bioproducts (12 papers); Radiosterilization of biological tissues (6 papers); Vaccine production by ionizing radiation (5 papers); Radiosterilization of medical devices and supplies (4 papers); Radiosensitivity of micro-organisms and microbiological testing (4 papers); Technical and economic aspects of radiosterilization (6 papers); Code of practice for radiosterilization (full code and 1 review paper). The Code of Practice is in English. Each paper is in its original language (29 English, 5 French, 4 Russian and 1 Spanish) and is preceded by an abstract in English with one in the original language if this is not English. Discussions are in English. (author)

  18. An overview of age estimation in forensic anthropology: perspectives and practical considerations.

    Science.gov (United States)

    Márquez-Grant, Nicholas

    2015-01-01

    Information on methods of age estimation in physical anthropology, in particular with regard to age-at-death from human skeletal remains, is widely available in the literature. However, the practicalities and real challenges faced in forensic casework are not always highlighted. To provide a practitioner's perspective, regarding age estimation in forensic anthropology (both in the living as well as the dead), with an emphasis on the types of cases, the value of such work and its challenges and limitations. The paper reviews the current literature on age estimation with a focus on forensic anthropology, but it also brings the author's personal perspective derived from a number of forensic cases. Although much is known about what methods to use, but not always how to apply them, little attention has been given in the literature to the real practicalities faced by forensic anthropologists, for example: the challenges in different types of scenarios; how to report age estimations; responsibilities; and ethical concerns. This paper gathers some of these aspects into one overview which includes the value of such work and the practical challenges, not necessarily with the methods themselves, but also with regard to how these are applied in the different cases where age estimation is required.

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

    Science.gov (United States)

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

    2014-11-15

    No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.

  20. New developments in technology-assisted supervision and training: a practical overview.

    Science.gov (United States)

    Rousmaniere, Tony; Abbass, Allan; Frederickson, Jon

    2014-11-01

    Clinical supervision and training are now widely available online. In this article, three of the most accessible and widely adopted new developments in clinical supervision and training technology are described: Videoconference supervision, cloud-based file sharing software, and clinical outcome tracking software. Partial transcripts from two online supervision sessions are provided as examples of videoconference-based supervision. The benefits and limitations of technology in supervision and training are discussed, with an emphasis on supervision process, ethics, privacy, and security. Recommendations for supervision practice are made, including methods to enhance experiential learning, the supervisory working alliance, and online security. © 2014 Wiley Periodicals, Inc.

  1. Adherence to recommendations for primary prevention of atopic disease in neonatology clinical practice.

    Science.gov (United States)

    Passariello, Annalisa; Terrin, Gianluca; Baldassarre, Maria E; Bisceglia, Massimo; Ruotolo, Serena; Berni Canani, Roberto

    2010-08-01

    The prevalence and severity of atopic manifestations in children are increasing in western countries in the last decades. Specific nutritional intervention may prevent or delay the onset of atopic diseases in infants at high risk of developing allergy. These nutritional interventions should be applied early in the perinatal period to have a chance of success. Thus, we assessed adherence to the dietary management recommendations of the Committee on Nutrition and Section on Allergy and Immunology of the American Academy of Pediatrics (AAP) for the prevention of atopic diseases in neonatal age through an audit study. Questionnaire was administered to the chiefs of 30 maternity units (MU) with more than 1500 live births/yr to report the policy applied in their MU. Twenty-two MU returned the questionnaire. Identification of high-risk newborns was routinely performed only in 7/22 MU (31.8%). High-risk newborns were identified by the presence of at least two or one first-degree relative (parent or sibling) with documented allergic disease by 18.2% and 45.5% of MU, respectively. Specific maternal dietary restrictions during lactation were adopted in 7/22 MU (31.8%). Extensively or partially hydrolyzed formula was prescribed for bottle-fed high-risk infants in 22.7% of MU. Only 2/22 MU have a policy in complete agreement with the nutritional intervention proposed by the AAP. Our study suggest a poor adherence to dietary recommendations for primary prevention of atopic disease in neonatology clinical practice. Further efforts should be planned to improve the knowledge and the application of these preventive strategies.

  2. Knowledge translation: an overview and recommendations in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia

    Science.gov (United States)

    2013-01-01

    The growing population of persons with dementia in Canada and the provision of quality care for this population is an issue that no healthcare authority will escape. Physicians often view dementia as a difficult and time-consuming condition to diagnose and manage. Current evidence must be effectively transformed into usable recommendations for physicians; however, we know that use of evidence-based practice recommendations is a challenge in all realms of medical care, and failure to utilize these leads to less than optimal care for patients. Despite this expanding need for readily available resources, knowledge translation (KT) is often seen as a daunting, if not confusing, undertaking for researchers. Here we offer a brief introduction to the processes around KT, including terms and definitions, and outline some common KT frameworks including the knowledge to action cycle, the Promoting Action on Research Implementation in Health Services framework and the Consolidated Framework for Implementation Research. We also outline practical steps for planning and executing a KT strategy particularly around the implementation of recommendations for practice, and offer recommendations for KT planning in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. PMID:24565407

  3. Teaching reading comprehension to learners with autism spectrum disorder: Discrepancies between teacher and research-recommended practices.

    Science.gov (United States)

    Accardo, Amy L; Finnegan, Elizabeth G

    2017-11-01

    Students with autism spectrum disorder have been found to experience difficulty with reading comprehension despite intact decoding and word recognition. This identified need for targeted reading comprehension remediation results in a need for teachers to utilize research-based practices and to individualize instruction for students with autism spectrum disorder; however, teachers report a lack of access to such practices. This study utilized survey methodology to gather perceptions and experiences of teachers and to compare teacher preparedness to use effective instructional practices emerging from the extant research to teacher-reported effective practices in the classroom. Study findings, based on 112 participants, reveal a discrepancy between teacher-reported effective practices, and the practices identified as effective through research, indicating a research to practice gap. Implications for practice include professional development recommendations, and the need for increased communication between researchers and teachers.

  4. Need for intraoperative ultrasound and surgical recommendation for partial nephrectomy: correlation with tumor imaging features and urologist practice patterns.

    Science.gov (United States)

    Sun, Maryellen R M; Wagner, Andrew A; San Francisco, Ignacio F; Brook, Alexander; Kavoussi, Louis; Russo, Paul; Steele, Graeme; Viterbo, Rosalia; Pedrosa, Ivan

    2012-03-01

    This study aimed to evaluate the need for intraoperative ultrasound (IOUS) and recommendation for surgical approach in the resection of renal tumors through a survey of practicing urologists, with correlation to tumor imaging features and urologist practice pattern. An institutional review board-approved retrospective review, compliant with the Health Insurance Portability and Accountability Act, of 44 renal tumors that underwent laparoscopic partial nephrectomy at the study institution was performed. The numeric component of the RENAL nephrometry score (radius [diameter], % exophytic, nearness [to collecting system/renal sinus], location) was calculated for each case using preoperative computed tomography/magnetic resonance imaging. Five anonymized images of each tumor were presented to 4 academic urologists with varying practice patterns. Reviewers independently scored each case for its need for IOUS, for recommendation of a surgical technique, and for the difficulty of the proposed surgery. The RENAL scores were as follows: RENAL 1 (low complexity, score 4-6; n = 19); RENAL 2 (moderate complexity, score 7-9; n = 23); RENAL 3 (high complexity, score 10-12; n = 2). The only RENAL score component significantly influencing need for IOUS was percentage exophytic (P = 0.00002). There was an inverse relationship between normalized and averaged need for IOUS and percentage exophytic (P recommendation of surgical method was the reviewer him/herself, with each reviewer's recommendations closely matching his/her practice pattern. Size and percentage exophytic represented the only tumor features significantly (P = 0.03) influencing surgical recommendation. There was a significant difference in the perceived need for IOUS and surgical recommendation when 4 academic urologists reviewed a series of renal masses requiring resection. Percentage exophytic correlated inversely with need for IOUS. Urologist's practice pattern and tumor size and percentage exophytic were most

  5. Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling

    Directory of Open Access Journals (Sweden)

    S Aggarwal

    2018-01-01

    Full Text Available Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

  6. Cutaneous epidermoid carcinoma (spinocellular carcinoma): clinical practice recommendations for diagnosis and therapy. Full report

    International Nuclear Information System (INIS)

    Martin, Ludovic; Bonerandi, Jean-Jacques; Brugneaux, Julie; Beauvillain, Claude; Chassagne, Jean-Francois; Clavere, Pierre; Grolleau, Jean-Louis; Grossin, Maggy; Sei, Jean-Francois; Caquant, Ludovic; Chaussade, Veronique; Desouches, Christophe; Garnier, Francois; Jourdain, Alain; Lemonnier, Jean-Yves; Maillard, Herve; Ortonne, Nicolas; Rio, Emmanuel; Simon, Etienne

    2009-01-01

    This guide aims at providing practitioners taking into care patients presenting a cutaneous cancer with recommendations based on scientific evidences or expert agreements. More precisely, the objectives are to clarify the terminology used to describe the different forms of cutaneous epidermoid carcinoma (CEC) and of their precursors (actinic keratosis, Bowen's disease), to propose a prognosis classification of CECs adapted to the previously identified prognosis factors, to optimise the diagnosis and therapy of actinic keratosis and Bowen's disease according to recent publications, and to recall the principles of a primary prevention of CECs and of their precursors, and of screening of high risk individuals. Thus, the different parts of this report address the following issues: anatomic-clinical forms and epidemiology of CECs and of their precursors, prognosis factors of CECs, means of treatment of CECs and of their precursors (medical, physical, surgical, radiation-based, and chemical treatments). Radiotherapy notably comprises external radiotherapy and interstitial brachytherapy. Indications for radiotherapy are discussed with respect to existing guides and to the clinical situation. The authors address the care of CECs and of their precursors (prevention, screening and clinical diagnosis, care of invasive CECs, keratoacanthoma treatment). They finally discuss quality criteria aimed at practice improvement, and perspectives regarding the evolution of this guide and studies to be performed

  7. Nursing-led management of side effects of radiation: evidence-based recommendations for practice

    Directory of Open Access Journals (Sweden)

    Poirier P

    2013-03-01

    Full Text Available Patricia PoirierUniversity of Maine School of Nursing, Orono, ME, USAAbstract: It has been estimated that 50%–60% of patients diagnosed with cancer will receive radiation therapy at some point in their treatment. Although radiation therapy can play a significant role in the cure or control of cancer, and the palliation of symptoms, it also has side effects. Side effects of radiation therapy can interfere with patient quality of life and daily functioning. Severe side effects can lead to delays in treatment, potentially affecting the outcome of treatment. All patients receiving radiation therapy are at risk of fatigue and skin reactions in the area of the body being treated. Other side effects of radiation therapy are specific to the part of the body being treated. Radiation therapy to the head and neck area may cause oral mucositis, dryness, and nutritional deficiencies. Radiation therapy to the chest or lung area may lead to difficulty in swallowing and eating. Radiation therapy to the pelvis frequently causes diarrhea. There are many nursing interventions available to manage the side effects of treatment based on best available evidence and expert opinion. Nurses in all settings are essential in helping patients manage the side effects of treatment and maintain their quality of life. The purpose of this review is to provide nurses with evidence-based recommendations and suggestions for managing common acute side effects of radiation therapy.Keywords: evidence-based practice, radiation therapy, side effects, nursing management

  8. Review of refugee mental health interventions following resettlement: best practices and recommendations.

    Science.gov (United States)

    Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

    2010-10-01

    There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. © 2010 American Orthopsychiatric Association.

  9. Deployment of Wind Turbines in the Built Environment: Risks, Lessons, and Recommended Practices

    Energy Technology Data Exchange (ETDEWEB)

    Fields, Jason [National Renewable Energy Lab. (NREL), Golden, CO (United States); Oteri, Frank [National Renewable Energy Lab. (NREL), Golden, CO (United States); Preus, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States); Baring-Gould, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-06-01

    Built-environment wind turbine (BEWT) projects are wind energy projects that are constructed on, in, or near buildings. These projects present an opportunity for distributed, low-carbon generation combined with highly visible statements on sustainability, but the BEWT niche of the wind industry is still developing and is relatively less mature than the utility-scale wind or traditional distributed wind sectors. The findings from this report cannot be extended to wind energy deployments in general because of the large difference in application and technology maturity. This paper investigates the current state of the BEWT industry by reviewing available literature on BEWT projects as well as interviewing project owners on their experiences deploying and operating the technology. The authors generated a series of case studies that outline the pertinent project details, project outcomes, and lessons learned. This paper integrates those information sources into recommended practices that can be utilized by future stakeholders to evaluate the feasibility of BEWTs for their unique applications and sites.

  10. Tagged at first listen: an examination of social tagging practices in a music recommender system

    Directory of Open Access Journals (Sweden)

    Audrey Laplante

    2015-01-01

    Full Text Available http://dx.doi.org/10.5007/1518-2924.2015v20nesp1p33 Social tagging has become a very common way to index different types of resources on the web. Less prevalent in music than in other domains, social tagging is nevertheless used in a popular recommender system, Last.fm. Although the number of publications on tagging and folksonomies has exploded in the last few years, music tagging is still not well studied. In this paper, we present a study of tagging practices of Last.fm users. We examine the social tagging of songs during the first three months after their release. Our analysis shows that the release of a song triggers a burst in tagging activity that lasts two weeks, after what it decreases sharply and then remains fairly constant for the next ten weeks. We also find that a majority of songs do not get tagged during the first week and that tagging was positively related to popularity. Finally, we find that tags that have been frequently applied to a given song are more likely to be genre related, shorter in length, and relatively objective than tags that have been applied only once.

  11. Recommended management practices for operation and closure of shallow injection wells at DOE facilities

    International Nuclear Information System (INIS)

    1993-07-01

    The Safe Drinking Water Act established the Underground Injection Control (UIC) program to ensure that underground injection of wastes does not endanger an underground source of drinking water. Under UIC regulations, an injection well is a hole in the ground, deeper than it is wide, that receives wastes or other fluid substances. Types of injection wells range from deep cased wells to shallow sumps, drywells, and drainfields. The report describes the five classes of UIC wells and summarizes relevant regulations for each class of wells and for the UIC program. The main focus of the report is Class IV and V shallow injection wells. Class IV wells are prohibited and should be closed when they are identified. Class V wells are generally authorized by rule, but EPA or a delegated state may require a permit for a Class V well. This report provides recommendations on sound operating and closure practices for shallow injection wells. In addition the report contains copies of several relevant EPA documents that provide additional information on well operation and closure. Another appendix contains information on the UIC programs in 21 states in which there are DOE facilities discharging to injection wells. The appendix includes the name of the responsible regulatory agency and contact person, a summary of differences between the state's regulations and Federal regulations, and any closure guidelines for Class IV and V wells

  12. Carcinogenicity assessments of biotechnology-derived pharmaceuticals: a review of approved molecules and best practice recommendations.

    Science.gov (United States)

    Vahle, John L; Finch, Gregory L; Heidel, Shawn M; Hovland, David N; Ivens, Inge; Parker, Suezanne; Ponce, Rafael A; Sachs, Clifford; Steigerwalt, Ronald; Short, Brian; Todd, Marque D

    2010-06-01

    An important safety consideration for developing new therapeutics is assessing the potential that the therapy will increase the risk of cancer. For biotherapeutics, traditional two-year rodent bioassays are often not scientifically applicable or feasible. This paper is a collaborative effort of industry toxicologists to review past and current practice regarding carcinogenicity assessments of biotherapeutics and to provide recommendations. Publicly available information on eighty marketed protein biotherapeutics was reviewed. In this review, no assessments related to carcinogenicity or tumor growth promotion were identified for fifty-one of the eighty molecules. For the twenty-nine biotherapeutics in which assessments related to carcinogenicity were identified, various experimental approaches were employed. This review also discusses several key principles to aid in the assessment of carcinogenic potential, including (1) careful consideration of mechanism of action to identify theoretical risks, (2) careful investigation of existing data for indications of proliferative or immunosuppressive potential, and (3) characterization of any proliferative or immunosuppressive signals detected. Traditional two-year carcinogenicity assays should not be considered as the default method for assessing the carcinogenicity potential of biotherapeutics. If experimentation is considered warranted, it should be hypothesis driven and may include a variety of experimental models. Ultimately, it is important that preclinical data provide useful guidance in product labeling.

  13. Technology transfer through a network of standard methods and recommended practices - The case of petrochemicals

    Science.gov (United States)

    Batzias, Dimitris F.; Karvounis, Sotirios

    2012-12-01

    Technology transfer may take place in parallel with cooperative action between companies participating in the same organizational scheme or using one another as subcontractor (outsourcing). In this case, cooperation should be realized by means of Standard Methods and Recommended Practices (SRPs) to achieve (i) quality of intermediate/final products according to specifications and (ii) industrial process control as required to guarantee such quality with minimum deviation (corresponding to maximum reliability) from preset mean values of representative quality parameters. This work deals with the design of the network of SRPs needed in each case for successful cooperation, implying also the corresponding technology transfer, effectuated through a methodological framework developed in the form of an algorithmic procedure with 20 activity stages and 8 decision nodes. The functionality of this methodology is proved by presenting the path leading from (and relating) a standard test method for toluene, as petrochemical feedstock in the toluene diisocyanate production, to the (6 generations distance upstream) performance evaluation of industrial process control systems (ie., from ASTM D5606 to BS EN 61003-1:2004 in the SRPs network).

  14. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

    Science.gov (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

    2016-01-01

    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  15. Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

    Science.gov (United States)

    Loyola-Sanchez, Adalberto; Richardson, Julie; Pelaez-Ballestas, Ingris; Sánchez, José Guadalupe; González, Martha Alicia; Sánchez-Cruz, Juan; Jiménez-Baez, María Valeria; Nolasco-Alonso, Nancy; Alvarado, Idolina; Rodríguez-Amado, Jacqueline; Alvarez-Nemegyei, José; Wilson, Mike G

    2014-01-01

    To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  16. Upper limb robotics applied to neurorehabilitation: An overview of clinical practice.

    Science.gov (United States)

    Duret, Christophe; Mazzoleni, Stefano

    2017-01-01

    During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders. Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.

  17. Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice.

    Science.gov (United States)

    Deek, Hiba; Newton, Phillip; Sheerin, Noella; Noureddine, Samar; Davidson, Patricia M

    2014-11-01

    Contrast media induced nephropathy (CIN) is a sudden compromise of renal function 24-48 h after administering contrast medium during a CT scan or angiography. CIN accounts for 10% of hospital acquired renal failure and is ranked the third cause of acquiring this condition. Identifying patients at risk through proper screening can reduce the occurrence of this condition. This review paper aims to critique current evidence, provide a better understanding of CIN, inform nursing practice and make recommendations for bedside nurses and future research. An integrative review of the literature was made using the key terms: "contrast media", "nephritis", "nephropathy", "contrast media induced nephropathy scores", "acute kidney failure", "acute renal failure" and "acute kidney injury". MeSH key terms used in some databases were: "prevention and control", "acute kidney failure" and "treatment". Databases searched included Medline, CINAHL and Academic Search Complete, and references of relevant articles were also assessed. The search included all articles between the years 2000 and 2013. Sixty-seven articles were obtained as a result of the search, including RCTs, systematic reviews, and retrospective studies. Contrast media induced nephropathy is an iatrogenic complication occurring secondary to diagnostic or therapeutic procedures. At times it is unavoidable but a systematic method of risk assessment should be adopted to identify high risk patients for tailored and targeted approaches to management interventions. As the use of contrast media is increasing for diagnostic purposes, it is important that nurses be aware of the risk factors for CIN, identify and monitor high risk patients to prevent deterioration in renal function when possible. Copyright © 2014 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Communication in healthcare: a narrative review of the literature and practical recommendations.

    Science.gov (United States)

    Vermeir, P; Vandijck, D; Degroote, S; Peleman, R; Verhaeghe, R; Mortier, E; Hallaert, G; Van Daele, S; Buylaert, W; Vogelaers, D

    2015-11-01

    Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. Narrative literature review. A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms 'communication', 'primary health care', 'correspondence', 'patient safety', 'patient handoff' and 'continuity of patient care'. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta-analyses or letters to the editor. A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver. © 2015 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

  19. Energy efficiency in the European Union: overview of policies and good practices

    International Nuclear Information System (INIS)

    2008-01-01

    The world is facing increasing energy prospects and stakes, in terms of energy supply security and safety, environmental impact as well as economic and social costs. In Europe, these fast-growing concerns have led to the adoption of new energy efficiency policies at national and European levels: legislation, regulations, institutional measures, awareness-raising and training campaigns, financial incentives, investment schemes, etc. As in other sectors and at each stage of European development, knowledge and experience feedback drive the Member States towards a growing harmonization of national policies: the most encouraging national measures may be adopted by other countries and even implemented at a European level. The valorization and exchange of best practices therefore contributes to the fulfilment of European commitments on energy efficiency and greenhouse gas emissions reduction. All these schemes are integrally part of a common European energy policy to be applied to energy production, transportation and distribution - the supply side - as well as to all social and economic activities which make up the demand side, and which is the subject of this document. The presentation hereafter provides an overview of energy efficiency policies and programs implemented in the European Union and in the Member States. It shows the diversity of available means of action and strategic choices within the different countries whilst highlighting the most innovative and significant measures. The various tools available are of course used in different ways in each country depending on their characteristics. Economic structure, for example, can explain the differences in the implementation of certain measures as it results in concentrating on the sectors which produce the most greenhouse gases - and which differ from one country to another. Energy balances -energy-producing countries or energy-dependent countries - and political contexts - with more or less liberal governments

  20. Ethical Issues in Designing Internet-Based Research: Recommendations for Good Practice

    Science.gov (United States)

    Gupta, Shikha

    2017-01-01

    This article presents an overview of internet-based research, highlighting the absence of a standard terminology to define and classify such research. The label internet-based research or online research can cover a diverse range of research designs and methods, involving different degrees of ethical concern regarding privacy, transparency,…

  1. Conservative sharp wound debridement: an overview of Canadian education, practice, risk, and policy.

    Science.gov (United States)

    Rodd-Nielsen, Elise; Harris, Connie L

    2013-01-01

    The purpose of this study was to describe the education, policy, practice, and risk management strategies of nurses performing conservative sharp wound debridement (CSWD) in Canada, prior to the release of the Canadian Association for Enterostomal Therapy Evidence-Based Recommendations for Conservative Sharp Wound Debridement. Data collection was based on a nonrandomized, nonexperimental study design and reported using descriptive statistics. Invitations for health care professionals to participate in a CSWD scan were sent to 4315 people via e-mail through the membership lists of 2 Canadian voluntary professional wound care associations. Skip logic screened out respondents who had no experience in CSWD (n = 57). The total number of professionals who participated was 487. A 26-question electronic scan addressed demographics, education, policy, practice, and risk/quality issues related to CSWD. A comment section was included for some questions. A selected subsample of 397 nurses was chosen from the original total of 487 respondents. Nonnurse respondents were excluded due to the low total number of participants in each of these other professional categories. Nurses perform CSWD in all types of care settings in Canada from outpost nursing stations to hospital wards, homes, and long-term care facilities. The wound education preparation reported varied. The most frequently reported formal wound care education was a 2-day course (59%; n = 220), followed by an enterostomal therapy course (42%; n = 155) and the International Interdisciplinary Wound Care Course (26%; n = 98), with overlapping preparation evident. Eleven percent of respondents (n = 47) reported having taken no formal wound course, and 7% (n = 27) taught themselves to perform CSWD. Twenty-eight percent of nurses (n = 112) were unclear about whether CSWD was within their scope of practice or replied that it was not, and 69% (n = 273) did not know if there was provincial legislation that restricted their

  2. Investing in Youth: A Compilation of Recommended Policies and Practices. National Conference (New Orleans, Louisiana, December 9-11, 1992).

    Science.gov (United States)

    National Governors' Association, Washington, DC.

    These proceedings include 13 "perspectives from the field" and 9 selected papers (with abstracts) from a national conference on recommended policies and practices for investing in youth. The 13 perspectives papers are as follows: "Saving the Next Generation" (Berlin); "Effective Strategies for Investing in Youth"…

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  5. [Infant food diversification. Assessment of practices in relation to French recommendations in pediatricians and pediatric residents in southern France].

    Science.gov (United States)

    Banti, T; Carsin, A; Chabrol, B; Reynaud, R; Fabre, A

    2016-10-01

    Infant food diversification has undergone a rapid succession of good practice recommendations in France, but there has been no assessment of pediatrician practices on food diversification. To assess the practices of pediatricians in relation to current recommendations of the French Society of Pediatrics on infant food diversification. This was an observational study conducted from 1 November 2014 to 31 March 2015. The study population consisted of 97 pediatricians in the Var department and 84 pediatric residents assigned to the University of Aix-Marseille in France. A questionnaire was sent by email or post to determine physician characteristics, food diversification methods in healthy children and those at atopic risk, and how the pediatric consultation was conducted. The expected answers were based on the most recent recommendations of the French Society of Pediatrics published in 2008, updated from 2003. In summary, breastfeeding is recommended up to 6 months. Food diversification can be started between 4 and 6 months in children with no allergy risk. Gluten, honey, legumes and cow's milk are introduced between 4 and 7 months, after 12 months and after 36 months, respectively. In atopic children, food diversification is delayed until after 6 months and the most allergenic foods (nuts, exotic fruits, peanuts, and shellfish) are introduced after the age of 12 months. Eighty-four responses were obtained (51%): 50 pediatricians and 34 pediatric residents. Sixteen items were classified depending on whether or not an update after 2003 existed. Over 80% of the physicians responded as recommended for the recently updated items for the age of introduction of "solid food in healthy children", "gluten", "cow's milk protein hydrolysates", and "the time until introduction of cow's milk in the atopic child". At best, 65% of physicians responded in accordance with recommendations for items without a recent update, age of introduction of "cow's milk", "milk desserts

  6. A scalable and practical one-pass clustering algorithm for recommender system

    Science.gov (United States)

    Khalid, Asra; Ghazanfar, Mustansar Ali; Azam, Awais; Alahmari, Saad Ali

    2015-12-01

    KMeans clustering-based recommendation algorithms have been proposed claiming to increase the scalability of recommender systems. One potential drawback of these algorithms is that they perform training offline and hence cannot accommodate the incremental updates with the arrival of new data, making them unsuitable for the dynamic environments. From this line of research, a new clustering algorithm called One-Pass is proposed, which is a simple, fast, and accurate. We show empirically that the proposed algorithm outperforms K-Means in terms of recommendation and training time while maintaining a good level of accuracy.

  7. Sonic branding: a framework for understanding sound branding and an overview of its most noticeable practices across industries

    OpenAIRE

    Bollue, Sebastien

    2015-01-01

    This thesis presents the importance and relevance of sound in branding, as very few studies on sonic branding have been conducted so far. The aim of this thesis is to lay out a framework for understanding sonic branding as a phenomenon and for getting an overview of the most notable practices of sonic branding across various industries. The study is commissioned by the advertising agency Wondergarden for who a workshop was also created. Additionally this thesis hopefully can inspire other...

  8. Considering children's advertising literacy from a methodological point of view : past practices and future recommendations

    OpenAIRE

    Zarouali, Brahim; Pauw, De, Pieter; Ponnet, Koen; Walrave, Michel; Poels, Karolien; Cauberghe, Veroline; Hudders, Liselot

    2018-01-01

    Abstract: Childrens advertising literacy is a well-documented research area. Yet, the literature on how to measure advertising literacy is not straightforward due to conceptual and operational differences in the existing studies. This has led to inconsistent results with regard to the development, possession and application of advertising literacy. The aim of this article is to give an overview of the different measurement methodologies used in past research efforts to assess childrens advert...

  9. Recommendations for future low-level and mixed waste management practices at Los Alamos National Laboratory

    International Nuclear Information System (INIS)

    Jennrich, E.A.; Klein, R.B.; Murphy, E.S.; Shuman, R.; Hickman, W.W.; Rutz, A.C.; Uhl, D.L.

    1989-01-01

    This report describes recommendations concerning the management of low-level radioactive wastes and mixtures at Los Alamos National Laboratory. Performance assessments, characterization, site disposal design, shipment, and storage are discussed

  10. [Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice].

    Science.gov (United States)

    Hewer, Walter; Thomas, Christine

    2017-02-01

    Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services. Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language. The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment. The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation

  11. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2018.

    Science.gov (United States)

    Kim, David K; Riley, Laura E; Hunter, Paul

    2018-02-09

    In October 2017, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018. The 2018 adult immunization schedule summarizes ACIP recommendations in two figures and a table of contraindications and precautions for vaccines recommended for adults, and is intended is to assist health care providers in implementing the current ACIP recommendations for vaccinating adults. The schedule can be found at https://www.cdc.gov/vaccines/schedules.* The full ACIP recommendations for each vaccine are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2018 adult immunization schedule has also been approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (https://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org). The ACIP-recommended use of each vaccine is developed after an in-depth review of vaccine-related data, including data on disease epidemiology, vaccine efficacy and effectiveness, vaccine safety, feasibility of program implementation, and economic aspects of immunization policy (1).

  12. The Application of Standards and Recommendations to Clinical Ethics Consultation in Practice: An Evaluation at German Hospitals.

    Science.gov (United States)

    Schochow, Maximilian; Rubeis, Giovanni; Steger, Florian

    2017-06-01

    The executive board of the Academy for Ethics in Medicine (AEM) and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data available yet that could indicate whether these standards and recommendations have been implemented in German hospitals. This desideratum is addressed in the present study. We contacted 1.858 German hospitals between September 2013 and January 2014. A follow-up survey was conducted between October 2014 and January 2015. The data of the initial survey and the follow-up survey were merged and evaluated. The statements of the participants were compared with the standards and recommendations. The standards of the AEM concerning the tasks of clinical ethics consultation (including ethics consultation, ethics training and the establishment of policy guidelines) are employed by a majority of participants of the study. Almost all of these participants document their consultation activities by means of protocols or entries in the patient file. There are deviations from the recommendations of the AEM working groups regarding the drafting of statutes, activity reports, and financial support. The activities of clinical ethics consultation predominantly comply with the standards of the AEM and recommendations for the documentation. The recommendations for evaluation should be improved in practice. This applies particularly for activity reports in order to evaluate the activities. Internal evaluation could take place accordingly.

  13. Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment.

    Science.gov (United States)

    Munday, Judy; Hines, Sonia Jane; Chang, Anne M

    2013-12-01

    The prevention of inadvertent perioperative hypothermia (IPH) remains an important issue in perioperative healthcare. The aims of this project were to: (i) assess current clinical practice in the management of IPH and (ii) promote best practice in the management of IPH in adult operating theatres. This project from August 2010 to March 2012 utilised a system of audit and feedback to implement best practice recommendations. Data were collected via chart audits against criteria developed from best practice recommendations for managing IPH. Evidence-based best practices, such as consistent temperature monitoring and patient warming, were implemented using multifaceted interventions. Perioperative records for 73 patients (baseline) and 72 patients (post-implementation) were audited. Post-implementation audit showed an increase in patients with temperatures >36°C admitted to the post-anaesthetic care unit (PACU) (8%) and discharged from PACU (28%). The percentage of patients receiving preoperative temperature monitoring increased (38%); however, low levels of intraoperative monitoring remained (31% of patients with surgery of 30 min or longer duration). Small increases were found in patient warming of 5% intraoperatively and 8% postoperatively. Preoperative warming was not successfully implemented during this phase of the project. Temperature monitoring, warming and rates of normothermia improved; however, barriers to best practice of IPH management were experienced, which negatively impacted on the project. Further stages of implementation and audit were added to further address IPH management in this department. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  14. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview.

    Science.gov (United States)

    Gualtierotti, Roberta; Parisi, Marco; Ingegnoli, Francesca

    2018-04-01

    Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.

  15. Biosimilars for psoriasis: worldwide overview of regulatory guidelines, uptake and implications for dermatology clinical practice.

    Science.gov (United States)

    Cohen, A D; Wu, J J; Puig, L; Chimenti, S; Vender, R; Rajagopalan, M; Romiti, R; de la Cruz, C; Skov, L; Zachariae, C; Young, H S; Foley, P; van der Walt, J M; Naldi, L; Prens, E P; Blauvelt, A

    2017-12-01

    The introduction of biological drugs for the treatment of patients with psoriasis has revolutionized treatment paradigms and enabled numerous patients to achieve disease control with an acceptable safety profile. However, the high cost of biologics limits access to these medications for the majority of patients worldwide. In recent years, the introduction of biosimilars for inflammatory diseases has become a fast evolving field. The future use of biosimilars offers the potential for decreased cost and increased access to biologics for patients with psoriasis. For approval of biosimilars, different regulatory agencies use highly variable methods for definition, production, approval, marketing and postmarketing surveillance. Due to potential interchangeability between biologics and biosimilars, traceability and pharmacovigilance are required to collect accurate data about adverse events in patients with psoriasis; spontaneous reporting, registries and use of 'big data' should facilitate this process on a global basis. The current article describes biosimilar regulatory guidelines and examples of biosimilar uptake in clinical practice in several countries around the world. As it is apparent that biological therapy treatment decisions may become more physician independent, the International Psoriasis Council recommends that dermatologists should take an active role in the development of biosimilar prescribing policies with their respective healthcare settings and government agencies. © 2017 British Association of Dermatologists.

  16. Is there a gap between recommended and ‘real world’ practice in the management of depression in young people? A medical file audit of practice

    Directory of Open Access Journals (Sweden)

    Hetrick Sarah E

    2012-06-01

    Full Text Available Abstract Background Literature has shown that dissemination of guidelines alone is insufficient to ensure that guideline recommendations are incorporated into every day clinical practice. Methods We aimed to investigate the gaps between guideline recommendations and clinical practice in the management of young people with depression by undertaking an audit of medical files in a catchment area public mental health service for 15 to 25 year olds in Melbourne, Australia. Results The results showed that the assessment and recording of depression severity to ensure appropriate treatment planning was not systematic nor consistent; that the majority of young people (74.5% were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken and that less than 50% were monitored for depression symptom improvement and antidepressant treatment emergent suicide related behaviours (35% and 30% respectively. Encouragingly 92% of first line prescriptions for those aged 18 years or under who were previously antidepressant-naïve was for fluoxetine as recommended. Conclusions This research has highlighted the need for targeted strategies to ensure effective implementation. These strategies might include practice system tools that allow for systematic monitoring of depression symptoms and adverse side effects, particularly suicide related behaviours. Additionally, youth specific psychotherapy that incorporates the most effective components for this age group, delivered in a youth friendly way would likely aid effective implementation of guideline recommendations for engagement in an adequate trial of psychotherapy before medication is initiated.

  17. Utilizing reliability concepts in the development of IEEE recommended good practices for nuclear plant maintenance

    International Nuclear Information System (INIS)

    Gradin, L.P.

    1986-01-01

    This paper presents information describing the concern for nuclear power plant electrical equipment maintenance and the IEEE Nuclear Power Engineering Committee's method to address that concern. That method includes the creation of Working Group 3.3, ''Maintenance Good Practices'' which is developing specific maintenance good practice documents, supporting technical information exchange, and providing a vehicle to promote practices which can reduce cost and enhance plant safety. The foundation for that effort is the utilization of Reliability concepts

  18. STP Position Paper: Recommended Practices for Sampling and Processing the Nervous System (Brain, Spinal Cord, Nerve, and Eye) during Nonclinical General Toxicity Studies

    Science.gov (United States)

    The Society of Toxicologic Pathology charged a Nervous System Sampling Working Group with devising recommended practices to routinely screen the central and peripheral nervous systems in Good Laboratory Practice-type nonclinical general toxicity studies. Brains should be trimmed ...

  19. Extremity dosimetry in medical applications within Europe: an overview of doses and monitoring practices

    International Nuclear Information System (INIS)

    Donadille, Laurent; Carinou, E.; Ginjaume, M.; Jankowski, J.; Rimpler, A.; Sans Merce, M.; Vanhavere, F.

    2008-01-01

    Full text: Some activities of the EURADOS Working Group 9 (WG9) related to the radiation protection dosimetry of medical staff were funded by the European Commission in the framework of the CONRAD project, Work Package 7. The objective of WG9 was to promote and co-ordinate research activities for the assessment of occupational exposure to staff at workplaces in therapeutic and diagnostic radiology and nuclear medicine. At these workplaces, from the point of view of the individual monitoring for external radiation, the skin of the fingers is generally the limiting organ. Subgroup 1 of WG9 had as main objective the study of the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in medicine together with the difficulties of measuring a local dose which should be representative for the maximum skin dose using one single detector, makes it difficult to perform extremity dosimetry with an accuracy similar to that of whole-body one. A recent intercomparison organised by WG9 showed that some types of dosemeters significantly underestimate or overestimate skin doses. Subgroup 1 carried out a thorough literature review on extremity dosimetry issues. It covered diagnostic and therapeutic nuclear medicine and PET, interventional radiology and cardiology, and brachytherapy. It has notably pointed out the consensus about the requirement of regular extremity dose monitoring for nuclear medicine and PET, and the great difficulty of measuring extremity doses for procedures in interventional radiology and cardiology, activities for which routine extremity dose monitoring has been found to be poor. Furthermore, information on the status of extremity dosimetry in medical applications and associated monitoring practices was gathered from 7 European countries: France, Germany, Greece, Ireland, Poland, Spain and Switzerland. Interpretation of the data was not easy because of the wide range of procedures involved and also

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  1. The translation of the new ICRP recommendations into practice: a new challenge for International Co-operation

    International Nuclear Information System (INIS)

    Ilari, O.; Gonzalez, A.; Boutrif, E.; Hanson, G.; Borras, C.

    1992-01-01

    The new ICRP recommendations have introduced several elements of novelty which may have a significant impact on the requirements and costs of radiation protection in Member countries. There is now a need for a conversion of the ICRP guidance into terms that are sufficiently practical and straightforward to facilitate their transfer into regulatory texts and operational practices at the national level. The paper discusses the strategy adopted for the revision of the Basic Safety Standards for Radiation Protection and highlights the main issues to be considered in this work.(author)

  2. Chancellors and Superintendents Employment Terms: Contracts, Policies, and Practices. Recommendations and Survey Results.

    Science.gov (United States)

    Smith, Cindra

    This document provides recommendations to Community College chancellors and superintendents based on survey responses from 11 multi-college district chancellors and 37 single college district superintendents and/or presidents of the Community College League of California. The report provides demographic information, such as gender, ethnicity,…

  3. Glossary of terms recommended for use in radiation control legislation and associated codes of practice

    International Nuclear Information System (INIS)

    Swindon, T.; Kennedy, K.N.; Elliott, G.

    1983-06-01

    A glossary of terms associated with radiological health is presented. It includes basic physics terms, quantities and units, radiological physics terms and radiation protection terms. The National Health and Medical Research Council has recommended that the glossary be used by organizations producing official documents and by appropriate regulatory authorities

  4. Practical recommendations for improvement of the physical health care of patients with severe mental illness

    NARCIS (Netherlands)

    van Hasselt, F. M.; Oud, M. J. T.; Loonen, A. J. M.

    ObjectiveHealth care for the physical health of patients with severe mental illness (SMI) needs to be improved. Therefore, we aimed to develop policy recommendations to improve this physical health care in the Netherlands based on consensus (general agreement) between the major stakeholders. MethodA

  5. Launch and recovery of ROV: Investigation of operational limit from DNV Recommended Practices and time domain simulations in SIMO

    OpenAIRE

    Valen, Magnus

    2010-01-01

    Offshore contractors seek to operate their remotely operated vehicles for the widest range of sea conditions where particularly launch and recovery through splash zone are critical phases in the offshore operation. The analytical methods for calculation of operational limit proposed by guidelines from DNV Recommended Practices may lead to an over-estimation of the hydrodynamic forces and consequently to an unduly restrictive operational limit. Accurate predictions of the hydrodynamic forces a...

  6. The VCU Pressure Ulcer Summit: Collaboration to Operationalize Hospital-Acquired Pressure Ulcer Prevention Best Practice Recommendations.

    Science.gov (United States)

    Brindle, C Tod; Creehan, Sue; Black, Joyce; Zimmermann, Deb

    2015-01-01

    This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best practice recommendations to sustain organizational culture change in hospital-acquired pressure ulcer prevention, to develop a hospital-acquired pressure ulcer severity score, and to address topics related to the unavoidable pressure ulcer.

  7. Positioning Mentoring as a Coach Development Tool: Recommendations for Future Practice and Research

    Science.gov (United States)

    McQuade, Sarah; Davis, Louise; Nash, Christine

    2015-01-01

    Current thinking in coach education advocates mentoring as a development tool to connect theory and practice. However, little empirical evidence exists to evaluate the effectiveness of mentoring as a coach development tool. Business, education, and nursing precede the coaching industry in their mentoring practice, and research findings offered in…

  8. Practical recommendations for pharmacogenomics-based prescription: 2010 ESF-UB Conference on Pharmacogenetics and Pharmacogenomics

    NARCIS (Netherlands)

    Becquemont, Laurent; Alfirevic, Ana; Amstutz, Ursula; Brauch, Hiltrud; Jacqz-Aigrain, Evelyne; Laurent-Puig, Pierre; Molina, Miguel A.; Niemi, Mikko; Schwab, Matthias; Somogyi, Andrew A.; Thervet, Eric; Maitland-van der Zee, Anke-Hilse; van Kuilenburg, André B. P.; van Schaik, Ron H. N.; Verstuyft, Céline; Wadelius, Mia; Daly, Ann K.

    2011-01-01

    The present article summarizes the discussions of the 3rd European Science Foundation University of Barcelona (ESF-UB) Conference in Biomedicine on Pharmacogenetics and Pharmacogenomics, which was held in June 2010 in Spain. It was focused on practical applications in routine medical practice. We

  9. Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries

    Science.gov (United States)

    Lannin, Natasha A; Hoffmann, Tammy

    2018-01-01

    Objectives Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations. Design Systematic review. Interventions Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. Results From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high (>75%) across all domains of AGREE-II; highest rated domains were ‘scope and purpose’ (85.1, SD 18.3) and ‘clarity’ (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines. Conclusion Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality. PROSPERO registration number CRD42016026936. PMID:29490958

  10. Energy efficiency in the Southern and Eastern Mediterranean countries - Overview of policies and good practices

    International Nuclear Information System (INIS)

    Dyevre, Nicolas; Salama, Anna Maria; Agrebi, Hassen; Ben Jannet Allal, Houda; Taussat, Thibaut

    2012-04-01

    A development of the Mediterranean region solely based on fossil fuels is unsustainable: 582 million inhabitants in 2030 will consume 40% more energy than today, from 80% of fossil fuels, 10% of nuclear and 10% of renewable energy. These figures are based on OME trend scenario considering that economic growth will follow on the same pattern that has prevailed so far. This increase in demand will come mainly from the South and East Mediterranean Countries (SEMC), whose energy intensity is constantly growing: energy consumption is, in fact, growing faster than the economy measured by the gross domestic product. There is also a great potential for energy savings in different consuming sectors (industry, building, transport, agriculture..). Such a trend scenario has adverse consequences on different plans: energy, economic, social or environmental. It is, therefore, necessary to lower these trends. Exploiting the tremendous potential of energy efficiency of the region seems to be a key element in energy strategy, as targeted by the Mediterranean Solar Plan along with its goal of an installed capacity of renewable electricity of 20 GW for 2020. The scope of work to be done has already led to the development of energy efficiency policies at the national level both in North and South: laws, regulations, institutional arrangements, training and awareness campaigns, decision aids, investment financial incentives, etc. All these mechanisms are integral parts of an energy policy that applies to both the system of production, transmission and distribution of energy- supply- and to all social and economic activities that constitute energy demand which are treated in this work. An overall perspective of policies is presented, especially implemented energy efficiency measures in the SEMCs. This overview reflects the diversity of available policy actions and strategic choices of different countries, focusing on the most innovative and significant measures. The feedback of

  11. Remote control systems for space heating. Product overview 2010 and recommendations - Final report; Fernsteuerungen fuer Raumheizungen. Produktuebersicht 2010 und Empfehlungen - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Geilinger, E.; Bush, E. [Bush Energie GmbH, Felsberg (Switzerland); Venzin, T. [Hochschule fuer Technik und Wirtschaft (HTW) Chur, Chur (Switzerland); Nipkow, J. [Arena, Zuerich (Switzerland)

    2010-09-15

    indicate that remote-controlled heating systems are not promoted actively enough in consulting, sales and heating service. This report not only gives an overview of the current market situation and recommendations on remote controls for heating, but also serves as the basis for communication. The key target groups need to be better informed and motivated. (authors)

  12. Remote control systems for space heating. Product overview 2010 and recommendations - Final report; Fernsteuerungen fuer Raumheizungen. Produktuebersicht 2010 und Empfehlungen - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Geilinger, E.; Bush, E. [Bush Energie GmbH, Felsberg (Switzerland); Venzin, T. [Hochschule fuer Technik und Wirtschaft (HTW) Chur, Chur (Switzerland); Nipkow, J. [Arena, Zuerich (Switzerland)

    2010-09-15

    . Their responses indicate that remote-controlled heating systems are not promoted actively enough in consulting, sales and heating service. This report not only gives an overview of the current market situation and recommendations on remote controls for heating, but also serves as the basis for communication. The key target groups need to be better informed and motivated. (authors)

  13. Mentoring advanced practice nurses in research: recommendations from a pilot program.

    Science.gov (United States)

    Leung, Doris; Widger, Kimberley; Howell, Doris; Nelson, Sioban; Molassiotis, Alex

    2012-01-01

    Advanced Practice Nurses (APNs) need research skills to develop and advance their practice and, yet, many have limited access to research training and support following completion of their advanced degree. In this paper we report on the development, delivery, and evaluation of an innovative pilot program that combined research training and one-to-one mentorship for nine APNs in conducting research relevant to their practice. The program was organized within an academic institution and its affiliated hospitals in Toronto, Canada. Our experience with this program may assist those in other organizations to plan and deliver a similar program for APN research mentorship.

  14. Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice: A microsimulation screening analysis.

    Science.gov (United States)

    Carlsson, Sigrid V; de Carvalho, Tiago M; Roobol, Monique J; Hugosson, Jonas; Auvinen, Anssi; Kwiatkowski, Maciej; Villers, Arnauld; Zappa, Marco; Nelen, Vera; Páez, Alvaro; Eastham, James A; Lilja, Hans; de Koning, Harry J; Vickers, Andrew J; Heijnsdijk, Eveline A M

    2016-11-15

    Prostate-specific antigen (PSA) screening and concomitant treatment can be implemented in several ways. The authors investigated how the net benefit of PSA screening varies between common practice versus "good practice." Microsimulation screening analysis (MISCAN) was used to evaluate the effect on quality-adjusted life-years (QALYs) if 4 recommendations were followed: limited screening in older men, selective biopsy in men with elevated PSA, active surveillance for low-risk tumors, and treatment preferentially delivered at high-volume centers. Outcomes were compared with a base model in which annual screening started at ages 55 to 69 years and were simulated using data from the European Randomized Study of Screening for Prostate Cancer. In terms of QALYs gained compared with no screening, for 1000 screened men who were followed over their lifetime, recommended good practice led to 73 life-years (LYs) and 74 QALYs gained compared with 73 LYs and 56 QALYs for the base model. In contrast, common practice led to 78 LYs gained but only 19 QALYs gained, for a greater than 75% relative reduction in QALYs gained from unadjusted LYs gained. The poor outcomes for common practice were influenced predominantly by the use of aggressive treatment for men with low-risk disease, and PSA testing in older men also strongly reduced potential QALY gains. Commonly used PSA screening and treatment practices are associated with little net benefit. Following a few straightforward clinical recommendations, particularly greater use of active surveillance for low-risk disease and reducing screening in older men, would lead to an almost 4-fold increase in the net benefit of prostate cancer screening. Cancer 2016;122:3386-3393. © 2016 American Cancer Society. © 2016 American Cancer Society.

  15. Development of the practical application of the recommendations of the international commission on radiological protection

    International Nuclear Information System (INIS)

    Dunster, H.J.

    1998-01-01

    The International Commission on Radiological Protection grew out of the International X-ray and Radium Protection Commission set up in 1928. Its Recommendations have developed from simple prescriptive rules for protecting the medical staff using x rays and radium to a complete System of Protection for all human activities that involve exposure to ionizing radiation. The Commission is satisfied that some of the health effects of radiation are caused, albeit with small probabilities, by small doses. Its System of Protection is therefore risk-based. It is no longer prescriptive and has to be applied with judgement. The basis of that judgement and the framework for its application are set out in ICRP Publication 60, the 1990 Recommendations of the Commission

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some...... Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications...... non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging...

  17. EULAR RECOMMENDATIONS FOR THE USE OF IMAGING IN SPONDYLOARTHRITIS IN CLINICAL PRACTICE

    DEFF Research Database (Denmark)

    Mandl, P; Navarro-Compán, V; Terslev, L

    2014-01-01

    , tenosynovitis, bursitis and particularly peripheral enthesitis, which may support the diagnosis of SpA. MRI of the SIJ and/or spine may be used to assess and monitor disease activity, while CR of the SIJ and/or spine may be used for long-term monitoring of structural damage, particularly new bone formation...... of the included studies was performed using the QUADAS-2 tool. Results: A total of 7550 references were identified in the search process, from which 157 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of axial Sp...... in axial SpA. In patients with AS (not nonradiographic axial SpA), initial CRs of the lumbar and cervical spine are recommended to detect syndesmophytes, which are predictive of development of new syndesmophytes. MRI (vertebral corner inflammatory lesion) may also be used to predict development of new...

  18. Recommended practices for disinfection and preservation of instrumental for use in laparoscopies

    OpenAIRE

    Machado Guimarães, Solange; Busin, Lurdes; Machado Ludwig, Maria Luiza; Maciel, Miriam; Feix, Maria Augusta; Karnas Hoefel, Heloisa Helena

    2008-01-01

    The present study describes the antimicrobiological methods used for ooscopic instruments and also recommends a routine of material caring, methods and products to be employed. These orientation were also based on the author`s experience with those methods of cleaning, disinfection and sterilization at a school hospital. It is expected to simplify the procedures describing its steps with cientific embasement. El presente estudio espera simplificar las orientaciones seguras sobre los método...

  19. Development of Offshore Wind Recommended Practice for U.S. Waters: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Musial, W. D.; Sheppard, R. E.; Dolan, D.; Naughton, B.

    2013-04-01

    This paper discusses how the American Petroleum Institute oil and gas standards were interfaced with International Electrotechnical Commission and other wind turbine and offshore industry standards to provide guidance for reliable engineering design practices for offshore wind energy systems.

  20. Introduction and Overview: Prevention Services--From Optimistic Promise to Widespread, Effective Practice.

    Science.gov (United States)

    Weissberg, Roger P.; Kuster, Carol Bartels; Gullotta, Thomas P.

    This opening chapter provides an overview of the book, "Healthy Children 2010: Establishing Preventive Services." The article describes the purpose of the work, which is to provide strategies to establish and successfully implement effective prevention services in key socializing settings that powerfully affect the growth an development…

  1. A well-started beginning elementary teacher's beliefs and practices in relation to reform recommendations about inquiry-based science

    Science.gov (United States)

    Avraamidou, Lucy

    2017-06-01

    Given reform recommendations emphasizing scientific inquiry and empirical evidence pointing to the difficulties beginning teachers face in enacting inquiry-based science, this study explores a well-started beginning elementary teacher's (Sofia) beliefs about inquiry-based science and related instructional practices. In order to explore Sofia's beliefs and instructional practices, several kinds of data were collected in a period of 9 months: a self-portrait and an accompanying narrative, a personal philosophy assignment, three interviews, three journal entries, ten lesson plans, and ten videotaped classroom observations. The analysis of these data showed that Sofia's beliefs and instructional practices were reform-minded. She articulated contemporary beliefs about scientific inquiry and how children learn science and was able to translate these beliefs into practice. Central to Sofia's beliefs about science teaching were scientific inquiry and engaging students in investigations with authentic data, with a prevalent emphasis on the role of evidence in the construction of scientific claims. These findings are important to research aiming at supporting teachers, especially beginning ones, to embrace reform recommendations.

  2. Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

    Science.gov (United States)

    Drolet, Marie-Josée; Williams-Jones, Bryn

    2015-01-01

    ABSTRACT Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported—through education, research, and good governance—in providing the best possible care for their patients. PMID:25931663

  3. Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review.

    Science.gov (United States)

    Hudon, Anne; Drolet, Marie-Josée; Williams-Jones, Bryn

    2015-01-01

    Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.

  4. Recommender systems

    OpenAIRE

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

    2012-01-01

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

  5. Contingency planning for electronic health record-based care continuity: a survey of recommended practices.

    Science.gov (United States)

    Sittig, Dean F; Gonzalez, Daniel; Singh, Hardeep

    2014-11-01

    Reliable health information technology (HIT) in general, and electronic health record systems (EHRs) in particular are essential to a high-performing healthcare system. When the availability of EHRs are disrupted, alternative methods must be used to maintain the continuity of healthcare. We developed a survey to assess institutional practices to handle situations when EHRs were unavailable for use (downtime preparedness). We used literature reviews and expert opinion to develop items that assessed the implementation of potentially useful practices. We administered the survey to U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of HIT-related best practices among its members. All members were large integrated health systems. We received responses from 50 of the 59 (84%) member institutions. Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last 3 years and 70% had at least one unplanned downtime greater than 8h in the last 3 years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime. The majority of institutions (70-85%) had implemented a portion of the useful practices we identified, but very few practices were followed by all organizations. Unexpected downtimes related to EHRs appear to be fairly common among institutions in our survey. Most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Achievement of national clinical practice recommendations among those in the Puerto Rican population with diabetes mellitus.

    Science.gov (United States)

    Rodríguez-Vigil, Efraín; Rodríguez-Chacón, Migdalia; Trabanco, Cesar; Irizarry-Ramos, Jessica

    2014-12-01

    To analyze glycemic control among patients with diabetes mellitus (DM) in Puerto Rico (PR) using the 2011 American Diabetes Association (ADA) recommendations and glycemic goals as standards. We also explored other factors that are related to glycemic control. Glycemic data were obtained from 600 adults with DM from 5 different regions in PR. The patient's health insurance coverage, type of health care provider, type of diabetes treatment, gender, age, physical activity, weight, degree of hypertension and degree and type of dyslipidemia comorbidities (when one or both were applicable), and disease duration were variables of interest. Univariate and bivariate analyses were conducted to describe the population and determine the statistical differences in the glycemic control of the subjects. Fewer than half of the participants achieved the ADA-recommended levels for HbA1c (37.3%) and blood pressure (34%). However, relatively more participants met the goals for high-density lipoprotein cholesterol (51.7%), low-density lipoprotein cholesterol (59.9%), and triglycerides (61.5%). The percentage of participants reaching the HbA1c, blood pressure, and low-density lipoprotein cholesterol goals at the same time was 9.9%. Patients with private health insurance achieved better glycemic control than did patients in the public-managed healthcare system. Half of the population presented simultaneous hypertension, dyslipidemia, and DM comorbidities. Only 50% of the participants were physically active. In the sample population, glycemic control levels and blood pressure levels in adults with DM were far from the ADA-recommended standards. Physical activity levels, type of medical insurance, and type of DM medical treatment were the main modifiable factors associated with the goal of attaining glycemic control. Barriers that limit the achievement of this goal should be analyzed in more detail to improve the medical care for people with DM.

  7. Health issues and the practicing radiologist: defining concepts and developing recommendations for leave options and policies.

    Science.gov (United States)

    Heilbrun, Marta E; Bender, Claire E; Truong, Hang B; Bluth, Edward I

    2013-09-01

    Radiologists today are faced with the challenges of maintaining and balancing individual and family health needs and the demands of the workplace. To provide the highest quality and safest care of our patients, a corresponding ethos of support for a healthy workforce is required. There is a paucity of targeted information describing protections for and maintenance of the health of the practicing radiologist, in both private and academic settings. However, a review of existing family and medical leave policies may be helpful to practice leaders and practicing radiologists as a platform for the development of strategic workforce plans. This writing, by members of the ACR Commission on Human Resources, addresses the following areas: (1) medical leave, (2) maternity and/or paternity leave, and (3) disability. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Management of Emergence Delirium in Adult PTSD Patients: Recommendations for Practice.

    Science.gov (United States)

    Lovestrand, Donnamarie; Lovestrand, Steven; Beaumont, Denise M; Yost, Jonathan G

    2017-08-01

    Emergence delirium is a known phenomenon which occurs after general anesthesia in approximately 5% of the general population. However, individuals who have been diagnosed with post-traumatic stress disorder may present with symptoms refractory to conventional methods of reorientation. In the past several years, literature has begun to address the problem, but no standardized guidelines exist at present. The authors synthesize the available literature, combining data with evidence-driven principles from multiple disciplines, to submit an initial set of guidelines until research either supports or disproves these recommendations. Copyright © 2016 American Society of PeriAnesthesia Nurses. All rights reserved.

  9. After Chernobyl more important than ever: Radiation exposure and radioactivity. Recommendations for the (dental) practice

    International Nuclear Information System (INIS)

    Sonnabend, E.

    1986-01-01

    Comparisons between the doses to which the skin surface and gonads are generally exposed for X-ray pictures of the teeth and jaws and the elevated environmentl levels of radioactivity measured after the Chernobyl reactor accident have led to the conclusion that during such X-ray procedures relatively high local doses of radioactivity are inevitably applied to the skin surface. The exposure of the gonads, by contrast, can be described as being minimal during X-ray imaging of the teeth and jaws, if the recommended protective measures are taken. (DG) [de

  10. Practical recommendations for the early use of m-TOR inhibitors (sirolimus) in renal transplantation.

    Science.gov (United States)

    Campistol, Josep M; Cockwell, Paul; Diekmann, Fritz; Donati, Donato; Guirado, Luis; Herlenius, Gustaf; Mousa, Dujanah; Pratschke, Johann; San Millán, Juan Carlos Ruiz

    2009-07-01

    m-TOR inhibitors (e.g. sirolimus) are well-tolerated immunosuppressants used in renal transplantation for prophylaxis of organ rejection, and are associated with long-term graft survival. Early use of sirolimus is often advocated by clinicians, but this may be associated with a number of side-effects including impaired wound-healing, lymphoceles and delayed graft function. As transplant clinicians with experience in the use of sirolimus, we believe such side-effects can be limited by tailored clinical management. We present recommendations based on published literature and our clinical experience. Furthermore, guidance is provided on sirolimus use during surgery, both at transplantation and for subsequent operations.

  11. Overview, practical tips and potential pitfalls of using automatic exposure control in CT: Siemens care dose 4D

    International Nuclear Information System (INIS)

    Soederberg, Marcus

    2016-01-01

    Today, computed tomography (CT) systems routinely use automatic exposure control (AEC), which modulates the tube current. However, for optimal use, there are several aspects of an AEC system that need to be considered. The purpose of this study was to provide an overview of the Siemens CARE Dose 4D AEC system, discuss practical tips and demonstrate potential pitfalls. Two adult anthropomorphic phantoms were examined using two different Siemens CT systems. When optimising the CT radiation dose and image quality, the projection angle of the localiser, patient centring, protocol selection, scanning direction and the use of protective devices requires special attention. (authors)

  12. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

    Science.gov (United States)

    Batra, U; Parikh, P M; Prabhash, K; Tongaonkar, H B; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, S K; Rajappa, S; Rajendranath, R; Rawal, S K; Singh, Manisha; Singh, R; Somashekhar, S P; Sood, R

    2016-01-01

    The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

  13. Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    U Batra

    2016-01-01

    Full Text Available The Oncology Gold Standard (OGS Expert Group on renal cell carcinoma (RCC developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

  14. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018.

    Science.gov (United States)

    Robinson, Candice L; Romero, José R; Kempe, Allison; Pellegrini, Cynthia; Szilagyi, Peter

    2018-02-09

    In October 2017, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2018. The 2018 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2017 immunization schedules, in three figures and footnotes to the figures. These documents can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). These immunization schedules are approved by ACIP (https://www.cdc.gov/vaccines/acip/index.html), the American Academy of Pediatrics (https://www.aap.org), the American Academy of Family Physicians (https://www.aafp.org), and the American College of Obstetricians and Gynecologists (https://www.acog.org). Health care providers are advised to use the figures and the footnotes together. The full ACIP recommendations for each vaccine, including contraindications and precautions, can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Providers should be aware that changes in recommendations for specific vaccines can occur between annual updates to the childhood/adolescent immunization schedules. If errors or omissions are discovered within the child and adolescent schedule, CDC posts revised versions on the CDC immunization schedule website.

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

    Science.gov (United States)

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

    2007-07-01

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

  16. School-community learning partnerships for sustainability: Recommended best practice and reality

    Science.gov (United States)

    Wheeler, Leone; Guevara, Jose Roberto; Smith, Jodi-Anne

    2018-05-01

    Effective partnerships across different stakeholders are essential to the collaboration required for learning cities to contribute to sustainable development. Through partnerships, formal educational institutions, such as schools and universities, play a vital role in establishing and sustaining learning cities, often by facilitating the meaningful participation of different local community members. The research presented in this article examines the characteristics of effective school-community partnerships in the literature and compares it to the results of a three-year research study which examined 16 case studies of school-community partnerships in the state of Victoria in Australia. Using participatory action research, the researchers identified four approaches to implementing partnerships for sustainability, explored challenges to achieving an idealised partnership, and made recommendations for establishing successful partnership networks. The researchers propose that partnerships be viewed as a dynamic resource rather than merely a transactional arrangement that addresses the identified challenges of time, funding, skills and personnel. Furthermore, the use of "partnership brokers", such as local government or non-government organisations, is recommended to expand the current school-centred approach to partnerships. These insights aim to contribute to providing quality education and lifelong learning through partnerships - outcomes crucial for establishing and sustaining learning cities.

  17. The evaluation of behavioural changes in brain-injured patients: SOFMER recommendations for clinical practice.

    Science.gov (United States)

    Prouteau, A; Stéfan, A; Wiart, L; Mazaux, J M

    2016-02-01

    Behavioural changes are the main cause of difficulties in interpersonal relationships and social integration among traumatic brain injury (TBI) patients. The Société française de médecine physique et réadaptation (SOFMER) decided to develop recommendations for the treatment and care provision for these problem under the auspices of the French health authority, the Haute Autorité de la santé (HAS). Assessment of behaviour is essential to describe, understand and define situations, assess any change and suggest lines for intervention. The relationship of these behavioural changes with the brain lesion is likewise of crucial importance in legal and forensic expertise. Using a literature review and expert opinions, the aim was to define the optimal conditions for the collection of data on behavioural changes in individuals having sustained brain trauma, to identify the situations in which they arise, to review the instruments available, and to suggest lines of intervention. A literature search identified 981 articles, among which 122 on the target subject were selected and analysed in detail and confronted with the experience of professionals and user representatives. A first draft of the recommendations was produced by the working group, and then submitted to a review group for opinions and complements. The literature on this subject is heterogeneous, and presents low levels of evidence. No article enabled the development of recommendations above the "expert opinion" level. After prior clarification of the aims of the evaluation, it is recommended first to carefully describe the changes in behaviour, from patient and third-person narratives, and where possible from direct observations. The information enabling the description of the phenomena occurring should be collected by different individuals (multi-source evaluation): the patient, his or her close circle, and professionals with different training backgrounds (multidisciplinary evaluation). The analysis of

  18. A Hybrid Trust-Based Recommender System for Online Communities of Practice

    Science.gov (United States)

    Zheng, Xiao-Lin; Chen, Chao-Chao; Hung, Jui-Long; He, Wu; Hong, Fu-Xing; Lin, Zhen

    2015-01-01

    The needs for life-long learning and the rapid development of information technologies promote the development of various types of online Community of Practices (CoPs). In online CoPs, bounded rationality and metacognition are two major issues, especially when learners face information overload and there is no knowledge authority within the…

  19. TOC: Table of Contents Practices of Primary Journals--Recommendations for Monolingual, Multilingual and International Journals.

    Science.gov (United States)

    Juhasz, Stephen; And Others

    Table of contents (TOC) practices of some 120 primary journals were analyzed. The journals were randomly selected. The method of randomization is described. The samples were selected from a university library with a holding of approximately 12,000 titles published worldwide. A questionnaire was designed. Purpose was to find uniformity and…

  20. Flipped Classrooms: A Review of Key Ideas and Recommendations for Practice

    Science.gov (United States)

    DeLozier, Sarah J.; Rhodes, Matthew G.

    2017-01-01

    Flipped classrooms refer to the practice of assigning lectures outside of class and devoting class time to a variety of learning activities. In this review, we discuss the range of approaches to the flipped classroom and focus on activities frequently used in these settings. Amongst these, we examine both out-of-class activities (e.g., video…

  1. Open lung high frequency ventilation in preterm infants with respiratory distress syndrome: practical considerations and recommendations

    NARCIS (Netherlands)

    De Jaegere, A.P.M.C.

    2012-01-01

    In premature infants ventilated because of RDS the favorable effect of HFV OLV compared to conventional mechanical ventilation on the incidence of BPD remains a matter of debate. An important lack in published human studies is the clinical practice surrounding the thorough application of OLV with

  2. Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci.

    Science.gov (United States)

    Stepanović, Srdjan; Vuković, Dragana; Hola, Veronika; Di Bonaventura, Giovanni; Djukić, Slobodanka; Cirković, Ivana; Ruzicka, Filip

    2007-08-01

    The details of all steps involved in the quantification of biofilm formation in microtiter plates are described. The presented protocol incorporates information on assessment of biofilm production by staphylococci, gained both by direct experience as well as by analysis of methods for assaying biofilm production. The obtained results should simplify quantification of biofilm formation in microtiter plates, and make it more reliable and comparable among different laboratories.

  3. Recommended engineering practice to enhance the EMI/EMP immunity of electric power systems

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, C.L.; Feero, W.E. (Electric Research and Management, Inc., State College, PA (United States))

    1992-12-01

    Many papers and reports have been written on studies conducted by the Oak Ridge National Laboratory and investigations by others on the effect of high-altitude electromagnetic pulses (HEMP) on electric power systems. More than 100 of the published unclassified documents were reviewed with the objectives of: 1. summarizing the mitigation methods suggested in the documents and providing a subjective evaluation of each 2. discussing various standards . that presently apply to the effects of HEMP on utility systems and suggesting additions or modifications or new standards where deficiencies appear to exist; and 3. recommending future studies or actions to improve the utility response to HEMP. While all three components of HEMP were mentioned, only the early-time short-duration E[sub 1] pulse and the late-time long-duration E[sub 3] pulse were considered in detail; the E[sub 2] intermediate component was not considered to affect the power system significantly.

  4. Recommended engineering practice to enhance the EMI/EMP immunity of electric power systems

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, C.L.; Feero, W.E. [Electric Research and Management, Inc., State College, PA (United States)

    1992-12-01

    Many papers and reports have been written on studies conducted by the Oak Ridge National Laboratory and investigations by others on the effect of high-altitude electromagnetic pulses (HEMP) on electric power systems. More than 100 of the published unclassified documents were reviewed with the objectives of: 1. summarizing the mitigation methods suggested in the documents and providing a subjective evaluation of each 2. discussing various standards . that presently apply to the effects of HEMP on utility systems and suggesting additions or modifications or new standards where deficiencies appear to exist; and 3. recommending future studies or actions to improve the utility response to HEMP. While all three components of HEMP were mentioned, only the early-time short-duration E{sub 1} pulse and the late-time long-duration E{sub 3} pulse were considered in detail; the E{sub 2} intermediate component was not considered to affect the power system significantly.

  5. Practical recommendations to help students bridge the research-implementation gap and promote conservation.

    Science.gov (United States)

    Pietri, Diana M; Gurney, Georgina G; Benitez-Vina, Nancy; Kuklok, Audrey; Maxwell, Sara M; Whiting, Libby; Vina, Michael A; Jenkins, Lekelia D

    2013-10-01

    Seasoned conservation researchers often struggle to bridge the research-implementation gap and promote the translation of their work into meaningful conservation actions. Graduate students face the same problems and must contend with obstacles such as limited opportunities for relevant interdisciplinary training and a lack of institutional support for application of research results. However, students also have a crucial set of opportunities (e.g., access to academic resources outside their degree programs and opportunities to design research projects promoting collaboration with stakeholders) at their disposal to address these problems. On the basis of results of breakout discussions at a symposium on the human dimensions of the ocean, a review of the literature, and our own experiences, we devised recommendations on how graduate students can create resources within their academic institutions, institutionalize resources, and engage with stakeholders to promote real-world conservation outcomes. Within their academic institutions, graduate students should foster links to practitioners and promote knowledge and skill sharing among students. To institutionalize resources, students should cultivate student leaders and faculty sponsors, systematically document their program activities, and engage in strategic planning to promote the sustainability of their efforts. While conducting research, students should create connections to and engage actively with stakeholders in their relevant study areas and disseminate research results both to stakeholders and the broader public. Our recommendations can serve as a template for graduate students wishing to bridge the research-implementation gap, both during their current studies and in their future careers as conservation researchers and practitioners. © 2013 Society for Conservation Biology.

  6. Recommended practices and guidelines for procurement of magnetic-fusion-energy electrical equipment

    International Nuclear Information System (INIS)

    1982-06-01

    The followng three chapters are included: (1) administrative guidelines, (2) technical practices, and (3) check list. The first two chapters contain detailed information which is to be used as a reference by specification writers in preparing specifications. Chapter 3 is intended to provide a uniform specification format for specification writers, and is further intended to satisfy equipment manufactures' complaints that different specification formats are used to describe essentially identical equipment

  7. Clinical practice breastfeeding recommendations for primary care: applying a tri-core breastfeeding conceptual model.

    Science.gov (United States)

    Busch, Deborah W; Logan, Kathleen; Wilkinson, Ashley

    2014-01-01

    Promotional practice efforts are needed in primary care to support and foster breastfeeding as the first and natural choice of nutrition for all infants regardless of race, ethnicity, educational, or income demographics in the United States. Societal awareness is increasing with regard to the significant protective qualities that human milk bestows upon public health. An estimated 75% of American mothers attempt to breastfeed, but according to the Centers for Disease Control and Prevention, just 13% are able to exclusively breastfeed by 6 months. Early identification of lactation issues is crucial to establishing and sustaining breastfeeding for the first 6 to 12 months of the child's life and beyond. We propose a set of primary care guidelines, applying a Tri-Core Model approach, to promote and foster breastfeeding efforts in the postpartum period. Breastfeeding promotion is a fundamental public health endeavor, and pediatric nurse practitioners and other advanced practice registered nurses (APRNs) are uniquely qualified to become specialists and experts in lactation care and management. Lactation support, which should be an integral facet of an APRN's practice and education, will aid in improving national breastfeeding rates and patient care outcomes. Application of the Tri-Core Model approach will help APRNs develop and implement evidence-based practice efforts that incorporate the mother-baby dyad and other multiprofessionals who are vested in successful breastfeeding outcomes. The goal of pediatric health care is provide safe and effective health care to all infants, children, and adolescents, and lactation care is an integral and crucial component of this effort. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  8. Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons.

    Science.gov (United States)

    Gupta, Asheesh; Suarez-Ahedo, Carlos; Redmond, John M; Gerhardt, Michael B; Hanypsiak, Bryan; Stake, Christine E; Finch, Nathan A; Domb, Benjamin G

    2015-09-01

    To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the

  9. Evaluation of Fourth-Year Veterinary Students' Client Communication Skills: Recommendations for Scaffolded Instruction and Practice.

    Science.gov (United States)

    Stevens, Brenda J; Kedrowicz, April A

    Effective client communication is important for success in veterinary practice. The purpose of this project was to describe one approach to communication training and explore fourth-year veterinary students' communication skills through an evaluation of their interactions with clients during a general practice rotation. Two raters coded 20 random videotaped interactions simultaneously to assess students' communication, including their ability to initiate the session, incorporate open-ended questions, listen reflectively, express empathy, incorporate appropriate nonverbal communication, and attend to organization and sequencing. We provide baseline data that will guide future instruction in client communication. Results showed that students' communication skills require development. Half of the students sampled excelled at open-ended inquiry (n=10), and 40% (n=8) excelled at nonverbal communication. Students needed improvement on greeting clients by name and introducing themselves and their role (n=15), reflective listening (n=18), empathy (n=17), and organization and sequencing (n=18). These findings suggest that more focused instruction and practice is necessary in maintaining an organized structure, reflective listening, and empathy to create a relationship-centered approach to care.

  10. Portal imaging practice patterns of children's oncology group institutions: Dosimetric assessment and recommendations for minimizing unnecessary exposure

    International Nuclear Information System (INIS)

    Olch, Arthur J.; Geurts, Mark; Thomadsen, Bruce; Famiglietti, Robin; Chang, Eric L.

    2007-01-01

    Purpose: To determine and analyze the dosimetric consequences of current portal imaging practices for pediatric patients, and make specific recommendations for reducing exposure from portal imaging procedures. Methods and Materials: A survey was sent to approximately 250 Children's Oncology Group (COG) member institutions asking a series of questions about their portal imaging practices. Three case studies are presented with dosimetric analysis to illustrate the magnitude of unintended dose received by nontarget tissues using the most common techniques from the survey. Results: The vast majority of centers use double-exposure portal image techniques with a variety of open field margins. Only 17% of portal images were obtained during treatment, and for other imaging methods, few centers subtract monitor units from the treatment delivery. The number of monitor units used was nearly the same regardless of imager type, including electronic portal imaging devices. Eighty-six percent imaged all fields the first week and 17% imaged all fields every week. An additional 1,112 cm 3 of nontarget tissue received 1 Gy in one of the example cases. Eight new recommendations are made, which will lower nontarget radiation doses with minimal impact on treatment verification accuracy. Conclusion: Based on the survey, changes can be made in portal imaging practices that will lower nontarget doses. It is anticipated that treatment verification accuracy will be minimally affected. Specific recommendations made to decrease the imaging dose and help lower the rate of radiation-induced secondary cancers in children are proposed for inclusion in future COG protocols using radiation therapy

  11. Creating and connecting recommended practices for reproducible research through collaborative culture and consensus in the Research Data Alliance

    Science.gov (United States)

    Parsons, M. A.; Yarmey, L.; Dillo, I.

    2017-12-01

    Data are the foundation of a robust, efficient, and reproducible scientific enterprise. The Research Data Alliance (RDA) is a community-driven, action-oriented, virtual organization committed to enabling open sharing and reuse of data by building social and technical bridges. The international RDA community includes almost 6000 members bringing diverse perspectives, domain knowledge, and expertise to a common table for identification of common challenges and holistic solutions. RDA members work together to identify common interests and form exploratory Interest Groups and outcome-oriented Working Groups. Participants exchange knowledge, share discoveries, discuss barriers and potential solutions, articulate policies, and align standards to enhance and facilitate global data sharing within and across domains and communities. With activities defined and led by members, RDA groups have organically been addressing issues across the full research cycle with community-ratified Recommendations and other outputs that begin to create the components of a global, data-sharing infrastructure. This paper examines how multiple RDA Recommendations can be implemented together to improve data and information discoverability, accessibility, and interconnection by both people and machines. For instance, the Persistent Identifier Types can support moving data across platforms through the Data Description Registry Interoperability framework following the RDA/WDS Publishing Data Workflows model. The Scholix initiative connects scholarly literature and data across numerous stakeholders can draw on the Practical Policy best practices for machine-actionable data policies. Where appropriate, we use a case study approach built around several flagship data sets from the Deep Carbon Observatory to examine how multiple RDA Recommendations can be implemented in actual practice.

  12. Condutas usuais entre os reumatologistas brasileiros: levantamento nacional Routine clinical practices of Brazilian rheumatologists: national overview

    Directory of Open Access Journals (Sweden)

    Marta M. C. Medeiros

    2006-04-01

    ão-hormonais (AINHs (89,3%, relaxante muscular (72,9%, fisioterapia (33,3%. O repouso no leito foi orientado por 31,6% dos especialistas. Num caso de lombalgia crônica com raio X recente mostrando espondilolistese grau 1 e discoartrose, 39,6% dos reumatologistas não solicitavam nenhum exame adicional, enquanto 26,2% e 24,4% solicitavam tomografia computadorizada (TC e ressonância nuclear magnética (RNM, respectivamente. As condutas mais indicadas nesse caso foram: fisioterapia (75,1%, relaxante muscular (48,5%, RPG (45,6%, exercícios físicos (41%, AINH seletivo da Cox-2 (40,5%, amitriptilina (35,3%, analgésicos opióides (34,7%. Outros cenários de artrose de joelho e ombro doloroso foram apresentados. CONCLUSÕES: a baixa taxa de devolução dos questionários pode refletir uma prática ainda não-incorporada na nossa cultura. O perfil dos reumatologistas respondedores é muito semelhante entre as regiões. A maioria das condutas escolhidas está de acordo com as melhores evidências disponíveis, refletindo uma homogeneidade de abordagem terapêutica entre os reumatologistas. Embora este estudo traga importantes dados sobre a prática reumatológica, pode não ser representativo da população de reumatologistas brasileiros, tendo em vista o baixo percentual de respondedores.OBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7, with an average time since graduation from medical school of 19.8 years (SD=10.1. In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7% chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying

  13. Evaluation of an inpatient psychiatric hospital physician education program and adherence to American Diabetes Association practice recommendations.

    Science.gov (United States)

    Koffarnus, Robin L; Mican, Lisa M; Lopez, Debra A; Barner, Jamie C

    2016-03-01

    This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital. This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample. Included subjects were admitted and discharged from an inpatient psychiatric institution within 90 days prior to (pre-intervention) and following (post-intervention) the physician education program. The medical staff was presented an educational program intervention, consisting of a 30 minute overview of the ADA 2010 Standards of Care recommendations and distribution of laminated treatment reminders. Electronic grouped order sets for patients with diabetes were also created and implemented. The primary outcome was change (pre-intervention to post-intervention) in frequency of hemoglobin A1c documentation on admission following the intervention. Secondary outcomes included the change in frequency of documentation of fasting plasma glucose, serum creatinine, urine creatinine/microalbumin ratio (UMA), fasting lipid profile (FLP), and change in days on sliding scale insulin. Regarding change in frequency of documentation of A1c values on admission, chi-square analysis revealed a significant increase from pre-intervention to post-intervention period of 30% (n = 18) to 61.7% (n = 37), respectively (p = 0.0005). Documentation of FLP also significantly increased [73.3% vs. 91.7% (p = 0.0082)]. There were no significant differences in the documentation of fasting plasma glucose, serum creatinine, and UMA or days treated with sliding scale insulin. The physician education program was successful in increasing the assessment of A1c values and lipid profiles for patients with diabetes mellitus in a psychiatric

  14. Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach.

    Science.gov (United States)

    Mertz, Marcel; Strech, Daniel

    2014-12-04

    Clinical practice guidelines (CPGs), a core tool to foster medical professionalism, differ widely in whether and how they address disease-specific ethical issues (DSEIs), and current manuals for CPG development are silent on this issue. The implementation of an explicit method faces two core challenges: first, it adds further complexity to CPG development and requires human and financial resources. Second, in contrast to the in-depth treatment of ethical issues that is standard in bioethics, the inclusion of DSEIs in CPGs need to be more pragmatic, reductive, and simplistic, but without rendering the resulting recommendations useless or insufficiently justified. This paper outlines a six-step approach, EthicsGuide, for the systematic and transparent inclusion of ethical issues and recommendations in CPGs. The development of EthicsGuide is based on (a) methodological standards in evidence-based CPG development, (b) principles of bioethics, (c) research findings on how DSEIs are currently addressed in CPGs, and (d) findings from two proof-of-concept analyses of the EthicsGuide approach. The six steps are 1) determine the DSEI spectrum and the need for ethical recommendations; 2) develop statements on which to base ethical recommendations; 3) categorize, classify, condense, and paraphrase the statements; 4) write recommendations in a standard form; 5) validate and justify recommendations, making any necessary modifications; and 6) address consent. All six steps necessarily come into play when including DSEIs in CPGs. If DSEIs are not explicitly addressed, they are unavoidably dealt with implicitly. We believe that as ethicists gain greater involvement in decision-making about health, personal rights, or economic issues, they should make their methods transparent and replicable by other researchers; and as ethical issues become more widely reflected in CPGs, CPG developers have to learn how to address them in a methodologically adequate way. The approach proposed

  15. Subjective memory impairment in general practice : Short overview and design of a mixed methods study.

    Science.gov (United States)

    Pentzek, Michael; Leve, Verena; Leucht, Verena

    2017-05-01

    Public awareness for dementia is rising and patients with concerns about forgetfulness are not uncommon in general practice. For the general practitioner (GP) subjectively perceived memory impairment (SMI) also offers a chance to broach the issue of cognitive function with the patient. This may support GPs' patient-centered care in terms of a broader frailty concept. What is SMI (definition, operationalization, prevalence and burden)? Which conceptions and approaches do GPs have regarding SMI? Narrative overview of recent SMI criteria and results, selective utilization of results from a systematic literature search on GP dementia care, non-systematic search regarding SMI in general practice, deduction of a study design from the overview and development according to international standards. Studies revealed that approximately 60% of GP patients aged >74 reported a declining memory, every sixth person had concerns about this aspect and only relatively few seek medical advice. Concerns about SMI are considered a risk factor for future dementia. Specific general practice conceptions about SMI could not be identified in the literature. Using guidelines for mixed methods research, the design of an exploratory sequential mixed methods study is presented, which should reveal different attitudes of GPs towards SMI. Subjective memory impairment (SMI) is a common feature and troubles a considerable proportion of patients. Neuropsychiatric research is progressing, but for the transfer of the SMI concept into routine practice, involvement of GP research is necessary. A new study aims to make a contribution to this.

  16. Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop.

    Science.gov (United States)

    Hamandi, Khalid; Beniczky, Sandor; Diehl, Beate; Kandler, Rosalind H; Pressler, Ronit M; Sen, Arjune; Solomon, Juliet; Walker, Matthew C; Bagary, Manny

    2017-08-01

    Inpatient video-EEG monitoring (VEM) is an important investigation in patients with seizures or blackouts, and in the pre-surgical workup of patients with epilepsy. There has been an expansion in the number of Epilepsy Monitoring Units (EMU) in the UK offering VEM with a necessary increase in attention on quality and safety. Previous surveys have shown variation across centres on issues including consent and patient monitoring. In an effort to bring together healthcare professionals in the UK managing patients on EMU, we conducted an online survey of current VEM practice and held a one-day workshop convened under the auspices of the British Chapter of the ILAE. The survey and workshop aimed to cover all aspects of VEM, including pre-admission, consent procedures, patient safety, drug reduction and reinstatement, seizure management, staffing levels, ictal testing and good data recording practice. This paper reports on the findings of the survey, the workshop presentations and workshop discussions. 32 centres took part in the survey and there were representatives from 22 centres at the workshop. There was variation in protocols, procedures and consent processes between units, and levels of observation of monitored patients. Nevertheless, the workshop discussion found broad areas of agreement on points. A survey and workshop of UK epilepsy monitoring units found that some variability in practice is inevitable due to different local arrangements and patient groups under investigation. However, there were areas of clear consensus particularly in relation to consent and patient safety that can be applied to most units and form a basis for setting minimum standards. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. Intravenous high-dose immunotherapy: practical recommendations for use in the treatment of neurological disimmune diseases

    Directory of Open Access Journals (Sweden)

    N. A. Suponeva

    2015-01-01

    Full Text Available Current publication summarizes main indications and benefits of intravenous high-dose immunotherapy (IHI in the treatment of various autoimmune diseases of the peripheral nervous system. Available products of intravenous immunoglobulin (IVIG on the Russian market are reviewed. Tactics for choosing optimal medication for IHI based on its effectiveness and safety are analyzed. Dosage calculation and way of administration of IVIG are described, beeing of a high practical value in neurologist’s daily work.

  18. A general overview of support materials for enzyme immobilization: Characteristics, properties, practical utility

    DEFF Research Database (Denmark)

    Zdarta, Jakub; Meyer, Anne S.; Jesionowski, Teofil

    2018-01-01

    on the properties of the produced catalytic system. A large variety of inorganic and organic as well as hybrid and composite materials may be used as stable and efficient supports for biocatalysts. This review provides a general overview of the characteristics and properties of the materials applied for enzyme...... immobilization. For the purposes of this literature study, support materials are divided into two main groups, called Classic and New materials. The review will be useful in selection of appropriate support materials with tailored properties for the production of highly effective biocatalytic systems for use...

  19. An overview of practice and regulations concerning aircraft noise protection in Serbia

    Directory of Open Access Journals (Sweden)

    Mirković Bojana D.

    2015-01-01

    Full Text Available This paper gives an overview of studies and regulation concerning the issue of aircraft noise protection in Republic of Serbia. After crossing the limit of 50.000 operations in 2014, Airport 'Nikola Tesla' is classified as major airport, and with that urged to fulfill various requirements related to nose protection. Major airports are obliged to monitor noise, as well as to prepare strategic noise maps and action plans aiming to decrease number of people exposed to aircraft noise above acceptable level.

  20. Evaluation of training effectiveness- overview of principles, problems and practices in Sweden

    International Nuclear Information System (INIS)

    Andersson, Haakan

    2003-01-01

    Evaluation of training is a complex concept that involves many interrelated activities. Successful evaluation studies require a basic understanding of this complexity. Evaluation of training and training effects is therefore a part of the basic instructor-training program at KSU, The Swedish nuclear training and safety centre. Complex evaluation studies require, however, preconditions that far from always can be met. It is therefore also important to learn from successful evaluation studies and try to extrapolate the conclusions to other similar situations. A short overview of one such study at a Swedish nuclear power plant is presented. (author)

  1. First brazilian consensus of advanced prostate cancer: recommendations for clinical practice

    Directory of Open Access Journals (Sweden)

    Andre Deeke Sasse

    Full Text Available ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

  2. Conclusions and recommendations of the European ORAMED project for practical interventional radiology and nuclear medicine

    International Nuclear Information System (INIS)

    Nikodemova, Denisa; Fueloep, Marko; Cabanekova, Helena

    2012-01-01

    The results of the recently published doses obtained by medical staff working in pulsed radiation fields, and performing interventional radiology (IR) or interventional cardiology (IC) procedures, as well as applications of radionuclides in nuclear medicine (NM), have shown significantly high levels of exposure, mainly to the hands and other parts of their bodies uncovered by protective equipment. The coordinated project ORAMED (Optimization of Radiation Protection of Medical Staff) was set-up by participation of 12 European countries and 34 IR/IC and NM departments, with the 5 main tasks: (i) optimization of radiation protection in IR and IC,with the aim to standardize a unified method of extremities and eye lens doses estimation, for 3 cardiac and 5 interventional diagnostic and therapeutic examinations; (ii) verification of the possibilities to use active personal dosemeters for typical pulsed radiation fields used in IR and IC; (iii) contribution to the extremities and eye lens dose reduction in nuclear medicine; (iv) development and application of a suitable eye lens dosemeter; and (v) elaboration of training materials and guidelines for radiation protection issues at IR, IC and NM workplaces. The present study presents some important results and recommendations for dose reduction and avoidance of some typical failures during work near ionizing radiation sources. (P.A.)

  3. IEEE recommended practices for seismic qualification of Class 1E equipment for nuclear power generating stations

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    The IEEE has developed this document to provide direction for developing programs to seismically qualify Class 1E equipment for nuclear power generating stations. It supplements IEEE Std 323-1974, IEEE Standard for Qualifying Class 1E Equipment for Nuclear Power Generating Stations, which describes the basic requirements for equipment qualification. The Class 1E equipment to be qualified by produres or standards established by this document are of many forms, characteristics, and materials; therefore, the document presents many acceptable methods with the intent of permitting the user to make a judicious selection from among the various options. In making such a selection, the user should choose those that best meet a particular equipment's requirements. Further, in using this document as a specification for the purchase of equipment, the many options should also be recognized and the document invoked accordingly. It is recommended that the need for specific standards for the seismic qualifiction of particular kinds of equipment be evaluated by those responsible for such documents and that consideration be given to the application of particular methods from these documents which are most suitable

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

    Directory of Open Access Journals (Sweden)

    N. V. Latysheva

    2015-01-01

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

  5. Application of the ICRP recommendations in medical radiation practice and in medical monitoring of workers

    International Nuclear Information System (INIS)

    Lafontaine, A.

    1979-01-01

    Medical exposure in connection with an existing or suspected illness may be made subject to the ICRP principles, but it must be realized that the dose limitation system cannot necessarily be applied when the individual at risk is the one benefiting from examination or treatment. Justification is the responsibility of the doctor prescribing the examination or treatment and/or of the person carrying it out. Optimization will be achieved by virtue of the rules imposed on doctors and by the requirements applicable to equipment and techniques. The same rules and requirements apply mutatis mutandis to check-ups, routine medical examinations, examinations for professional purposes, medico-legal examinations and medical research. In the last case ethical rules and criteria for the validity of the proposed research also need to be applied. Medical monitoring of workers must take the ICRP principles into account, but a qualified doctor should nevertheless be able to form his own judgement on the basis of his knowledge of different types of exposure (both to radiation and to other agents), to intervene in cases of accidental or planned exposure, and to gather data in order to evaluate the long-term effects and the consequences of occupational exposure in terms of doses to the public. Moreover, the doctor should inform the worker of his conclusions and recommendations. (author)

  6. Recommended practice for fracture toughness testing of weldments with strength mismatch

    International Nuclear Information System (INIS)

    Hornet, P.; Eripret, C.; Wang, Y.Y.; Kirk, M.T.; Gordon, J.R.

    1997-01-01

    Fracture toughness testing requires relationships between experimentally measured quantities, such as load and displacement, and J and crack tip opening displacement (CTOD).The relationships provided in the presently codified procedures (ASTM E813, E1152, E1290 et BSI 7848:Part 1) were derived under the assumption that the specimens have homogeneous mechanical properties. However, these codified procedures are frequently used for testing of weldments despite their strong mechanical properties variations. As a result, the accuracy of the toughness values (J or CCTOD) is sometimes in question. Systematic finite element studies of mismatched single-edge-notched-bend specimens (SENB) having a crack on the centerline have been conducted to resolve this question. The effect of various parameters on these relationships, such as weld size, degree of mismatch, and crack depth, is investigated. The accuracy of the codified J and CTOD testing procedures when applied to the mismatched SE(B) specimens is examined. This systematic examination is extended to several newly proposed procedures, such as those from Joch et al. and Hornet and Eripret. New J and CTOD estimations procedures are proposed. The expected error in applying the codified and the new procedures are shown are proposed. The expected error in applying the codified and the new procedures are shown in terms of mismatch level and level width. Recommendations are made on the use of those procedures for a variety of weld mismatch and crack depth conditions. (authors)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-01-01

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

  8. Practical recommendations for outpatients after differentiated thyroid carcinoma treatment with iodine-131

    International Nuclear Information System (INIS)

    Carlier, T.; Kraeber-Bodere, F.; Ansquer, C.; Couturier, O.; Lisbona, A.; Kraeber-Bodere, F.; Couturier, O.

    2004-01-01

    Few studies on radiation protection recommendation for patients leaving hospitalization area after thyroid carcinoma treatment with iodine-131 are based on experimental determination of effective half life. The aim of this work was to calculate times of adhesion to restrictions for patients using one dose rate measurement at 30 cm the last day, just before leaving hospital. Dose rate measurements were achieved every day at two localizations (abdomen mid trunk and neck) during hospitalization. Data were fitted by a monoexponential or a biexponential model in order to derive the effective half life. We considered 7 exposure states between patient and neighboring. We showed, according to our realistic scatter state, a dose rate variation inversely proportional to the distance from patient. Effective half life is equal to 16 ± 6 h whatever the measurement localization. Thus the times of adhesion to restrictions is never greater than 2 days after 3 days of hospitalization. A simple table is given to allow the computation of restrictions times according to the dose rate measurement before the patient is discharged. This protocol is applied in our institution and gives whole satisfaction as far as the ALARA principle and the patient information are concerned. (author)

  9. Contraceptive practices in Nigeria: Literature review and recommendation for future policy decisions

    Directory of Open Access Journals (Sweden)

    Emmanuel Monjok

    2010-05-01

    Full Text Available Emmanuel Monjok1, Andrea Smesny1, John E Ekabua2, E James Essien11Institute of Community Health, University of Houston, Texas, USA; 2Department of Obstetrics and Gynecology, University of Calabar, NigeriaAbstract: The current prevalence rate for contraceptive use in Nigeria is approximately 11%–13%. This rate is very low in spite of the high rate of sexual activity and widespread awareness of the various contraceptive methods among Nigerian adolescence and youths. As a result there are many unintended pregnancies and illegal abortions contributing to a high maternal mortality ratio, which seems to indicate a large unmet need for contraceptive use. There is ample research evidence identifying the various factors that contribute to the low prevalence of modern contraceptive use in Nigeria, with the most common factor being the myth about the side effects of modern contraceptives. However, what is lacking is a political will in Nigeria to provide family planning programs on a much larger scale, using community-oriented approaches and communication programs, to help change the myth about the side effects of modern contraceptives. This review highlights current methods and concepts in contraception, reasons for low contraceptive use and practice in Nigeria, and the need for Nigeria to generate a political priority and a will to make a change in maternal health indicators, with the ultimate goal of providing direction to guide changes in the Nigerian Population Policy as it affects contraceptive use and family planning.Keywords: contraceptive practice, literature review, research, Nigeria

  10. MERGING conventional and complementary medicine in a clinic department - a theoretical model and practical recommendations.

    Science.gov (United States)

    Pérard, Marion; Mittring, Nadine; Schweiger, David; Kummer, Christopher; Witt, Claudia M

    2015-06-09

    Today, the increasing demand for complementary medicine encourages health care providers to adapt and create integrative medicine departments or services within clinics. However, because of their differing philosophies, historical development, and settings, merging the partners (conventional and complementary medicine) is often difficult. It is necessary to understand the similarities and differences in both cultures to support a successful and sustainable integration. The aim of this project was to develop a theoretical model and practical steps that are based on theories from mergers in business to facilitate the implementation of an integrative medicine department. Based on a literature search and expert discussions, the cultures were described and model domains were developed. These were applied to two case studies to develop the final model. Furthermore, a checklist with practical steps was devised. Conventional medicine and complementary medicine have developed different corporate cultures. The final model, which should help to foster integration by bridging between these cultures, is based on four overall aspects: culture, strategy, organizational tools and outcomes. Each culture is represented by three dimensions in the model: corporate philosophy (core and identity of the medicine and the clinic), patient (all characteristics of the professional team's contact with the patient), and professional team (the characteristics of the interactions within the professional team). Overall, corporate culture differs between conventional and complementary medicine; when planning the implementation of an integrative medicine department, the developed model and the checklist can support better integration.

  11. Mixed-methods research in pharmacy practice: recommendations for quality reporting. Part 2.

    Science.gov (United States)

    Hadi, Muhammad Abdul; Alldred, David Phillip; Closs, S José; Briggs, Michelle

    2014-02-01

    This is the second of two papers that explore the use of mixed-methods research in pharmacy practice. This paper discusses the rationale, applications, limitations and challenges of conducting mixed-methods research. As with other research methods, the choice of mixed-methods should always be justified because not all research questions require a mixed-methods approach. Mixed-methods research is particularly suitable when one dataset may be inadequate in answering the research question, an explanation of initial results is required, generalizability of qualitative findings is desired or broader and deeper understanding of a research problem is necessary. Mixed-methods research has its own challenges and limitations, which should be considered carefully while designing the study. There is a need to improve the quality of reporting of mixed-methods research. A framework for reporting mixed-methods research is proposed, for researchers and reviewers, with the intention of improving its quality. Pharmacy practice research can benefit from research that uses both 'numbers' (quantitative) and 'words' (qualitative) to develop a strong evidence base to support pharmacy-led services. © 2013 Royal Pharmaceutical Society.

  12. Managing the clinical setting for best nursing practice: a brief overview of contemporary initiatives.

    Science.gov (United States)

    Henderson, Amanda; Winch, Sarah

    2008-01-01

    Leadership strategies are important in facilitating the nursing profession to reach their optimum standards in the practice environment. To compare and contrast the central tenets of contemporary quality initiatives that are commensurate with enabling the environment so that best practice can occur. Democratic leadership, accessible and relevant education and professional development, the incorporation of evidence into practice and the ability of facilities to be responsive to change are core considerations for the successful maintenance of practice standards that are consistent with best nursing practice. While different concerns of management drive the adoption of contemporary approaches, there are many similarities in the how these approaches are translated into action in the clinical setting. Managers should focus on core principles of professional nursing that add value to practice rather than business processes.

  13. Effective implementation of research into practice: an overview of systematic reviews of the health literature

    OpenAIRE

    Boaz, Annette; Baeza, Juan; Fraser, Alec

    2011-01-01

    Abstract Background The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. Findings A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing...

  14. Vector-Borne Diseases - constant challenge for practicing veterinarians: recommendations from the CVBD World Forum

    Directory of Open Access Journals (Sweden)

    Baneth Gad

    2012-03-01

    Full Text Available Abstract The human-animal bond has been a fundamental feature of mankind's history for millennia. The first, and strongest of these, man's relationship with the dog, is believed to pre-date even agriculture, going back as far as 30,000 years. It remains at least as powerful today. Fed by the changing nature of the interactions between people and their dogs worldwide and the increasing tendency towards close domesticity, the health of dogs has never played a more important role in family life. Thanks to developments in scientific understanding and diagnostic techniques, as well as changing priorities of pet owners, veterinarians are now able, and indeed expected, to play a fundamental role in the prevention and treatment of canine disease, including canine vector-borne diseases (CVBDs. The CVBDs represent a varied and complex group of diseases, including anaplasmosis, babesiosis, bartonellosis, borreliosis, dirofilariosis, ehrlichiosis, leishmaniosis, rickettsiosis and thelaziosis, with new syndromes being uncovered every year. Many of these diseases can cause serious, even life-threatening clinical conditions in dogs, with a number having zoonotic potential, affecting the human population. Today, CVBDs pose a growing global threat as they continue their spread far from their traditional geographical and temporal restraints as a result of changes in both climatic conditions and pet dog travel patterns, exposing new populations to previously unknown infectious agents and posing unprecedented challenges to veterinarians. In response to this growing threat, the CVBD World Forum, a multidisciplinary group of experts in CVBDs from around the world which meets on an annual basis, gathered in Nice (France in 2011 to share the latest research on CVBDs and discuss the best approaches to managing these diseases around the world. As a result of these discussions, we, the members of the CVBD Forum have developed the following recommendations to veterinarians

  15. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations.

    Science.gov (United States)

    Halabchi, Farzin; Alizadeh, Zahra; Sahraian, Mohammad Ali; Abolhasani, Maryam

    2017-09-16

    Multiple sclerosis (MS) can result in significant mental and physical symptoms, specially muscle weakness, abnormal walking mechanics, balance problems, spasticity, fatigue, cognitive impairment and depression. Patients with MS frequently decrease physical activity due to the fear from worsening the symptoms and this can result in reconditioning. Physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental symptoms without any concern about triggering the onset or exacerbation of disease symptoms or relapse. Appropriate exercise can cause noteworthy and important improvements in different areas of cardio respiratory fitness (Aerobic fitness), muscle strength, flexibility, balance, fatigue, cognition, quality of life and respiratory function in MS patients. Aerobic exercise training with low to moderate intensity can result in the improvement of aerobic fitness and reduction of fatigue in MS patients affected by mild or moderate disability. MS patients can positively adapt to resistance training which may result in improved fatigue and ambulation. Flexibility exercises such as stretching the muscles may diminish spasticity and prevent future painful contractions. Balance exercises have beneficial effects on fall rates and better balance. Some general guidelines exist for exercise recommendation in the MS population. The individualized exercise program should be designed to address a patient's chief complaint, improve strength, endurance, balance, coordination, fatigue and so on. An exercise staircase model has been proposed for exercise prescription and progression for a broad spectrum of MS patients. Exercise should be considered as a safe and effective means of rehabilitation in MS patients. Existing evidence shows that a supervised and individualized exercise program may improve fitness, functional capacity and

  16. Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations.

    Science.gov (United States)

    Sherf-Dagan, Shiri; Hod, Keren; Buch, Assaf; Mardy-Tilbor, Limor; Regev, Ziva; Ben-Porat, Tair; Sakran, Nasser; Goitein, David; Raziel, Asnat

    2018-01-01

    Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS, based on our clinical experience and current scientific literature in both nutrition fields. Cross-sectional analysis of a prospectively maintained database of all primary laparoscopic sleeve gastrectomies (LSG) performed at a bariatric center of excellence between January 2014 and November 2016 was carried out querying patients who declared a vegetarian or vegan lifestyle before surgery. Preoperative data collected included demographics, anthropometrics, dietary patterns, supplementation use, physical activity, smoking habits, co-morbidities, and blood tests. Each vegetarian was matched to five different omnivores based on age, gender, and BMI. During the study period, 1470 patients underwent primary LSG surgery (63.7% females). Twenty-one declared a vegetarian or vegan lifestyle (1.4%) pre-surgery. Most were classified as lacto-ovo (57.1%) and were driven from ethical reasons (85.7%). No differences were found between vegetarian and omnivore LSG candidates regarding co-morbidities and nutritional deficiencies, except for lower prevalence of impaired fasting glucose (14.3 vs. 47.1%;P = 0.007), lower ferritin levels (54.3 ± 50.5 vs. 96.8 ± 121.8 ng/ml; P = 0.052) and higher transferrin levels (313.9 ± 42.7 vs. 278.4 ± 40.4 mg/dl; P = 0.009) among the vegetarian cohort. Preoperative use of vitamin B12 and iron supplementation was higher among vegetarian LSG candidates than their omnivore counterparts (57.1 vs. 6.7%;P nutritional deficiencies, lower iron stores, and higher supplementation use before surgery compared to omnivore LSG candidates.

  17. The Impact of Marketing of Breast-Milk Substitutes on WHO-Recommended Breastfeeding Practices.

    Science.gov (United States)

    Piwoz, Ellen G; Huffman, Sandra L

    2015-12-01

    Suboptimal breastfeeding results in 800 000 child deaths annually. There are multiple causes of suboptimal breastfeeding, including marketing of breast-milk substitutes. To describe sales and marketing of breast-milk substitutes and their influence on World Health Organization-recommended breastfeeding behaviors, focusing on low- and middle-income countries. Literature review. Global sales of breast-milk substitutes reached US$40 billion in 2013. Growth in sales exceeds 10% annually in many low- and middle-income countries, while it is close to stagnant in high-income countries. Breast-milk substitutes are marketed directly to consumers via mass media and print advertisements and indirectly via incentives, free supplies, and promotions to and through health workers and facilities, retailers, and policy makers. Internet marketing via company web sites and social media is on the rise. Marketing influences social norms by making formula use seem to be extensive, modern, and comparable to or better than breast milk. Clear evidence of a negative impact is found when breast-milk substitutes are provided for free in maternity facilities and when they are promoted by health workers and in the media. Influences through other channels are plausible, but rigorous studies are lacking. It was not possible with the data available to quantify the impact of marketing relative to other factors on suboptimal breastfeeding behaviors. Marketing remains widespread even in countries that have adopted the International Code of Marketing of Breast-milk Substitutes to restrict such activities. Adoption of stricter regulatory frameworks coupled with independent, quantitative monitoring and compliance enforcement are needed to counter the impacts of formula marketing globally. © The Author(s) 2015.

  18. Internationally Recommended Best Practices in Transportation Financing Public-Private Partnerships (P3s)

    DEFF Research Database (Denmark)

    Martin, Lawrence; Lawther, Wendell; Hodge, Graeme

    2013-01-01

    Transportation financing public-private partnerships (P3s) are a common practice in many countries. However, they represent a relatively new approach to transportation infrastructure financing for state and local governments in the United States. In a transportation financing P3 project, a private...... sector partner designs-builds-finances-operates- maintains (DBFOM) a transportation infrastructure asset (road, highway, bridge, tunnel, etc.) with an emphasis on financing. Under this type of arrangement, the private sector partner is primarily responsible for securing all or substantially all...... of the funding necessary to construct new transportation infrastructure and/or rehabilitate existing transportation infrastructure. This study reviews the international experience of national and sub-national governments with transportation financing P3s. The primary purpose of this study is to identify...

  19. Application of the GRAPPA psoriatic arthritis treatment recommendations in clinical practice.

    LENUS (Irish Health Repository)

    Mumtaz, Aizad

    2012-02-01

    Psoriatic disease presents with a complex array of clinical features, including peripheral synovitis and skin psoriasis, but there is also variable involvement of the nail, dactylitis, enthesitis, and spinal disease. Composite assessment of disease activity and response taking into account the impact of the disease as a whole on an individual\\'s health and quality of life is of vital importance. Following an extensive literature review, discussions, and consensus, the Group for Research in Psoriasis and Psoriatic Arthritis (GRAPPA) published guidelines to help clinicians make treatment decisions. The utility of these guidelines in routine clinical practice is further enhanced by incorporating them into a Composite Psoriatic Disease Activity Index (CPDAI). The potential application of the CPDAI in typical psoriatic disease patients is presented and discussed. Validation and possible modification of a composite disease activity and responder index is currently being undertaken by GRAPPA.

  20. Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?

    Science.gov (United States)

    Lefèvre-Colau, Marie-Martine; Nguyen, Christelle; Haddad, Rebecca; Delamarche, Paul; Paris, Guillaume; Palazzo, Clémence; Poiraudeau, Serge; Rannou, François; Roren, Alexandra

    2016-06-01

    In this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors' expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to sport. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Overview of industries policies and practices on fertile female and ionizing radiation

    International Nuclear Information System (INIS)

    Burns, L.

    1982-01-01

    Health physicists representing nuclear reactors, government contracting agencies, hospitals and universities, cousulting and personnel firms were surveyed on the policies of their organizations regarding the fertile female and her exposure to ionizing radiation. NCRP Report 39 recommends limiting the exposure of pregnant females to 500 mrem during the gestational period. The responses to the survey questionnaire are summarized

  2. Clinical practice guidelines: 2004 standards, options and recommendations for the management of patient with adenocarcinoma of the stomach - radiotherapy

    International Nuclear Information System (INIS)

    Ychou, M.; Duffour, J.; Lemanski, C.; Masson, B.; Gory-Delabaere, G.; Bosquet, L.; Blanc, P.; Giovannini, M.; Monge, G.; Guillemin, F.; Marchal, F.; Conroy, T.; Merrouche, Y.; Adenis, A.; Bosset, J.F.; Bouche, O.; Pezet, D.; Triboulet, J.P.

    2004-01-01

    Context. - The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French regional cancer centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. Objectives. - To elaborate clinical practice guidelines for patients with stomach adenocarcinoma. These recommendations cover the diagnosis, treatment and follow-up of these tumors. Methods. - The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. The Standards, Options and Recommendations are thus based on the best available evidence and expert agreement. Results. - Adjuvant radiation therapy alone is not a standard treatment for patients with stomach adenocarcinoma. Adjuvant concomitant chemoradiotherapy is not a standard treatment for patients with stage II or III stomach adenocarcinoma R0, with D1 or D2 lymphadenectomy who have undergone surgery. Following surgical resection, adjuvant concomitant chemoradiotherapy should be proposed to patients without de-nutrition with a lymphadenectomy < D1 (fewer than 15 lymph nodes examined) and those with T3 and/or N+ tumours following the protocol used in the MacDonald trials (SWOG-9008) (Level of evidence B1). Adjuvant concomitant chemoradiotherapy can be administered to patients without de-nutrition with D1 or D2 lymphadenectomy and with involvement of regional lymph nodes (N2 or N3). (authors)

  3. Medical negligence. An overview of legal theory and neurosurgical practice: duty of care.

    Science.gov (United States)

    Todd, Nicholas V

    2014-04-01

    A working knowledge of the legal principles of medical negligence is helpful to neurosurgeons. It helps them to act in a "reasonable, responsible and logical" manner, that is a practice that is consistent with the surgical practice of their peers. This article will review and explain the relevant medical law in relation to duty of care with illustrative neurosurgical cases.

  4. Clustering of unhealthy lifestyle behaviors is associated with a low adherence to recommended preventive practices among COPD patients in Spain.

    Science.gov (United States)

    de Miguel-Díez, Javier; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Maestu, Luis Puente; Aparicio, Irene Jarana; Ramos, Alicia Oliva; López de Andrés, Ana; Carrasco-Garrido, Pilar

    2014-08-01

    To analyze clustering of unhealthy lifestyle behavior and its relationship with non-adherence to recommended clinical preventive care services among Spanish COPD patients. Cross-sectional study including 2,575 COPD subjects from the 2006 Spanish National Health Survey (NHS) and 2009 European Health Survey for Spain (EHISS). Subjects were asked about the following recommended preventive practices: uptake of blood pressure (BP) measurement, lipid profile, influenza vaccination and dental examination. Lifestyle behaviors included: smoking status, physical activity, alcohol consumption and obesity. Logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of preventive activities. Blood pressure measurement in the previous 6 months and a blood lipid test in the last year had not been taken by 11.74% and 23.26% of the subjects, respectively, in 2006 NHS and by 11.16% and 16.33% of the subjects, respectively, in EHISS 2009. Then, 36.36% percent had not been vaccinated and 70.61% had not received dental examination in 2006 NHS and these percentages decreased to 27.33% and 66.22%, respectively, in 2009 EHISS. A higher number of unhealthy lifestyle behaviors increased the probability of not being vaccinated and not having a dental examination. Clustering of unhealthy lifestyle behaviors is linearly associated with a greater number of preventive measures unfulfilled. Compliance with healthy lifestyles and adherence to recommended clinical preventive services is under desirable levels among Spanish COPD patients. Patients with lifestyles considered as "worse" are those who also have lower uptake of recommended preventive activities.

  5. Termination of resuscitation in the prehospital setting: A comparison of decisions in clinical practice vs. recommendations of a termination rule.

    Science.gov (United States)

    Verhaert, Dominique V M; Bonnes, Judith L; Nas, Joris; Keuper, Wessel; van Grunsven, Pierre M; Smeets, Joep L R M; de Boer, Menko Jan; Brouwer, Marc A

    2016-03-01

    Of the proposed algorithms that provide guidance for in-field termination of resuscitation (TOR) decisions, the guidelines for cardiopulmonary resuscitation (CPR) refer to the basic and advanced life support (ALS)-TOR rules. To assess the potential consequences of implementation of the ALS-TOR rule, we performed a case-by-case evaluation of our in-field termination decisions and assessed the corresponding recommendations of the ALS-TOR rule. Cohort of non-traumatic out-of-hospital cardiac arrest (OHCA)-patients who were resuscitated by the ALS-practising emergency medical service (EMS) in the Nijmegen area (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Of the 598 cases reviewed, resuscitative efforts were terminated in the field in 46% and 15% survived to discharge. The ALS-TOR rule would have recommended in-field termination in only 6% of patients, due to high percentages of witnessed arrests (73%) and bystander CPR (54%). In current practice, absence of ROSC was the most important determinant of termination [aOR 35.6 (95% CI 18.3-69.3)]. Weaker associations were found for: unwitnessed and non-public arrests, non-shockable initial rhythms and longer EMS-response times. While designed to optimise hospital transportations, application of the ALS-TOR rule would almost double our hospital transportation rate to over 90% of OHCA-cases due to the favourable arrest circumstances in our region. Prior to implementation of the ALS-TOR rule, local evaluation of the potential consequences for the efficiency of triage is to be recommended and initiatives to improve field-triage for ALS-based EMS-systems are eagerly awaited. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. [Specific language impairment and electroencephalogram: which recommendations in clinical practice? A cohort of 24 children].

    Science.gov (United States)

    Billard, C; Hassairi, I; Delteil, F

    2010-04-01

    reported in the literature, which confirms that there is no parallel between EEG progression and language development, contrary to Landau-Kleffner's syndrome. Systematic EEG recording is not recommended in SLI. It is indicated in cases of fluctuation or stagnation of language development or if there is a family history of cognitive disorders or epilepsy. Antiepileptic treatment is justified in cases with fluctuation or stagnation in language development after 6 months of progression associated with frequent EA. However, when the EA is particularly diffuse and dense, an additional moderate aggravating effect on language development cannot be eliminated. The method most likely to clarify this question is to compare a child's baseline phase followed by a treatment phase, with the same double follow-up. Copyright 2010 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

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

    2018-01-01

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

  8. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: screening and diagnosis recommendations.

    Science.gov (United States)

    Mehta, S; Guy, S D; Bryce, T N; Craven, B C; Finnerup, N B; Hitzig, S L; Orenczuk, S; Siddall, P J; Widerström-Noga, E; Casalino, A; Côté, I; Harvey, D; Kras-Dupuis, A; Lau, B; Middleton, J W; Moulin, D E; O'Connell, C; Parrent, A G; Potter, P; Short, C; Teasell, R; Townson, A; Truchon, C; Wolfe, D; Bradbury, C L; Loh, E

    2016-08-01

    Clinical practice guidelines. To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI). The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations. Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation. The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.

  9. Diesel fuel long term storage and treatment- recommended tests and practices (U)

    Energy Technology Data Exchange (ETDEWEB)

    Gross, R. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2009-06-05

    The Clean Air Act (1970) is the comprehensive federal law that regulates air emissions from stationary and mobile sources. Among other things, this law authorized the Environmental Protection Agency (EPA) to establish National Ambient Air Quality Standards to protect public health and public welfare and to regulate emissions of hazardous air pollutants. In recent years, EPA regulations have forced oil refineries into producing a very low sulfur diesel fuel and incentives for adding up to 5% bio-diesel. These changes to the fuel oil formulation are beneficial to air quality and to energy conservation, but adversely impact heat content, long term storage stability, engine power, and injection system reliability. Diesel engines typically have a high incidence of injector failure resulting from poor diesel fuel quality. Since standby diesel engines do not run continuously it is necessary to implement periodic surveillance's to ensure the quality of diesel fuel is acceptable for reliable operation when a loss of power occurs. The information contained in this document is a compilation of best practices to be used as a guide for maintenance of a reliable diesel fuel system.

  10. Recommended practice for small punch (SP) testing of metallic materials (draft)

    International Nuclear Information System (INIS)

    Takahashi, Hideaki; Shoji, Tetsuo; Mao, Xinyuan

    1988-09-01

    This practice covers the determination of fracture toughness characteristics of metallic materials such as ductile to brittle transition temperature (SPDBTT) and elastic-plastic fracture toughness (J ICSP ) using miniature small punch (SP) specimens. Three kinds of specimens with different shape; 10 by 10 by 0.5 mm, 10 by 10 by 0.25 mm and φ3 by 0.25 mm, are selected as the standard SP specimens. Two types of fixture shall be respectively used for the 10 and φ3 specimens. The relationship between load and deflection during buldge tests shall be recorded from low to high temperatures. Following two parameters in relation to fracture toughness are obtained from analyses of load-deflection curves: (1) The SP energy is calculated from the area surrounded with load-deflection curves, which corresponds to the total energy consumed up to the fracture. (2) The equivalent fracture strain (ε-bar qf ) is calculated from the maximum deflection at fracture (δ*). The SPDBTT can be derived from temperature dependence of SP energy, and the J ICSP can be estimated from the rational correlation curve between ε-bar qf and J IC . (author)

  11. Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations.

    Science.gov (United States)

    Assefa, Yibeltal; Van Damme, Wim; Hermann, Katharina

    2010-01-01

    PURPOSE OF VIEW: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention.

  12. Cognitive functioning, aging, and work: A review and recommendations for research and practice.

    Science.gov (United States)

    Fisher, Gwenith G; Chaffee, Dorey S; Tetrick, Lois E; Davalos, Deana B; Potter, Guy G

    2017-07-01

    There is a larger proportion and number of older adults in the labor force than ever before. Furthermore, older adults in the workforce are working until later ages. Although a great deal of research has examined physical health and well-being of working older adults, less research has focused on cognitive functioning. The purpose of this article is to provide a broad contemporary and multidisciplinary review of the intersection between cognitive functioning, aging, and work as a follow-up to a paper previously written by Fisher et al. (2014). We begin by providing definitions and background about cognitive functioning and how it changes over the life span. Next we discuss theories relevant to the intersection of cognitive functioning and work, including the use-it-or-lose-it hypothesis, the cognitive reserve hypothesis, hypotheses regarding environmental influences on intellectual functioning, and the job-demands-resources model. Then we summarize recent research about the effects of work on cognitive functioning, as well as ways that cognitive functioning may influence work motivation, learning, development, training, and safety. We conclude by emphasizing the importance of person-environment fit, suggesting avenues for future research, and discussing practical implications for the field of occupational health psychology. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. External cues challenging the internal appetite control system-Overview and practical implications.

    Science.gov (United States)

    Bilman, Els; van Kleef, Ellen; van Trijp, Hans

    2017-09-02

    Inadequate regulation of food intake plays an important role in the development of overweight and obesity, and is under the influence of both the internal appetite control system and external environmental cues. Especially in environments where food is overly available, external cues seem to override and/or undermine internal signals, which put severe challenges on the accurate regulation of food intake. By structuring these external cues around five different phases in the food consumption process this paper aims to provide an overview of the wide range of external cues that potentially facilitate or hamper internal signals and with that influence food intake. For each of the five phases of the food consumption process, meal initiation, meal planning, consumption phase, end of eating episode and time till next meal, the most relevant internal signals are discussed and it is explained how specific external cues exert their influence.

  14. An Overview of Total Quality Management (TQM) practice in Construction Sector

    Science.gov (United States)

    Likita, A. J.; Zainun, N. Y.; Rahman, I. Abdul; Awal, A. S. M. Abdul; Alias, A. R.; Rahman, M. Q. Abdul; Ghazali, F. E. Mohamed

    2018-04-01

    In construction sector TQM can be termed as a philosophy which guides construction professionals on the proper execution of construction projects in terms of quality. The aim of this paper is to discuss on quality management practice in construction sector. This paper evaluated five previous researches and the findings were discussed to find a conclusion of TQM practise in construction sector. The study found that TQM had been successfully practice in construction sector at Saudi Arabia, India, US and South Africa. Application of Artificial Neural Network (ANN) help to improve the implementation of TQM in construction sector. In conclusion, quality management practices will give better control of processes in construction sector.

  15. Implementation of antiretroviral therapy guidelines for under-five children in Tanzania: translating recommendations into practice

    Science.gov (United States)

    Nuwagaba-Biribonwoha, Harriet; Wang, Chunhui; Kilama, Bonita; Jowhar, Farhat K; Antelman, Gretchen; Panya, Milembe F; Abrams, Elaine J

    2015-01-01

    Introduction Paediatric antiretroviral therapy (ART) guidelines have been updated several times in recent years. We assessed implementation of ART guidelines among under-five children to inform the transition to universal paediatric ART in Tanzania. Methods We conducted a retrospective cohort analysis of infants (0 to 11 months) and children (12 to 59 months) enrolled between 2010 and 2012 using routinely collected data. Infants and children were initiated on ART according to the 2008 World Health Organization (WHO) recommendations/2009 Tanzania guidelines (universal ART for infants). Cumulative ART initiation incidence and correlates of ART initiation were examined using competing risk methods accounting for attrition (death or loss to follow-up). Kaplan-Meier methods and Cox regression models were used to examine attrition on ART and its correlates. Results A total of 1679 children were enrolled at 69 clinics: 469 (28%) infants and 1210 (74%) children. Infant cumulative ART initiation incidence was 59.6, 71.3 and 78.0% at one, three and six months of follow-up. Infants were more likely to start ART if enrolled in 2012 [adjusted sub-hazard ratio (AsHR)=2.2, 95% confidence interval (CI): 1.7 to 2.8] or 2011 (AsHR=1.8, 95% CI: 1.4 to 2.3) compared to 2010; they were more likely to start ART from prevention of mother-to-child HIV transmission (AsHR=1.6, 95% CI: 1.3 to 2.1) and inpatient wards (AsHR=1.5, 95% CI: 1.2 to 2.0) versus being enrolled from voluntary counselling and testing centres. Attrition at 12 months on ART was 33.9% and was more likely among infants with WHO Stage 4 [adjusted hazard ratio (AHR)=3.1. 95% CI: 1.8 to 5.2] and severe malnutrition (AHR=1.4, 95% CI: 1.0 to 1.9). Among 599 children eligible for ART at enrolment, cumulative ART initiation incidence was 51.8, 68.6 and 76.1% at one, three, and six months. Children were more likely to start ART if enrolled in 2012 (AsHR=1.8, 95% CI: 1.4 to 2.3) or 2011 (AsHR=1.5, 95% CI: 1.2 to 1.8) compared to

  16. What Canada could learn from U.S. defence procurement: Issues, best practices and recommendations

    Directory of Open Access Journals (Sweden)

    Anessa L. Kimball

    2015-04-01

    Full Text Available Despite differences in scale, Canada and the U.S. face common challenges in military procurement and there is much Canada can learn as both countries pursue reforms. The U.S. employs a system of systems approach, based on requirements, resource allocation and acquisition. The process begins with the Joint Capabilities and Development System, focused on identifying and prioritizing needs and assessing alternatives. This is followed by the Planning, Programming, Budgeting and Execution System, which leads to the creation of a budget and provides guidance for the project’s execution. The third and final step is the Defense Acquisition System, which oversees the development and purchase of the new equipment. While deceptively simple in summary, U.S. defence procurement is dogged by problems — particularly cost overruns, a surfeit of key players and delayed schedules which degrade troops’ performance in the field. Additionally, the defence products market is restricted, inevitably limiting competition, encouraging misbehaviour on the part of business and driving up prices. The DoD is in the midst of consultations with contractors and Congress is undertaking an effort to rewrite acquisition laws. But the most pressing questions remain: Does a best procurement practice exist? If so, what criteria define it? In light of Canada’s new Defence Procurement Strategy (DPS, some lessons are clear. Further analysis is needed to figure out whether reforms can succeed in so narrow a marketplace. More attention must be paid to shaping contracts and clarifying expectations about sticking to schedules. And Ottawa must think carefully about the military’s needs, as it pushes ahead with the DPS. In surveying change at the DoD, this brief draws pointed conclusions to which Canada’s defence planners must pay heed, if they’re to leave the military stronger than they found it.

  17. Surgical Management of Infective Endocarditis Complicated by Embolic Stroke: Practical Recommendations for Clinicians.

    Science.gov (United States)

    Yanagawa, Bobby; Pettersson, Gosta B; Habib, Gilbert; Ruel, Marc; Saposnik, Gustavo; Latter, David A; Verma, Subodh

    2016-10-25

    There has been an overall improvement in surgical mortality for patients with infective endocarditis (IE), presumably because of improved diagnosis and management, centered around a more aggressive early surgical approach. Surgery is currently performed in approximately half of all cases of IE. Improved survival in surgery-treated patients is correlated with a reduction in heart failure and the prevention of embolic sequelae. It is reported that between 20% and 40% of patients with IE present with stroke or other neurological conditions. It is for these IE patients that the timing of surgical intervention remains a point of considerable discussion and debate. Despite evidence of improved survival in IE patients with earlier surgical treatment, a significant proportion of patients with IE and preexisting neurological complications either undergo delayed surgery or do not have surgery at all, even when surgery is indicated and guideline endorsed. Physicians and surgeons are caught in a common conundrum where the urgency of the heart operation must be balanced against the real or perceived risks of neurological exacerbation. Recent data suggest that the risk of neurological exacerbation may be lower than previously believed. Current guidelines reflect a shift toward early surgery for such patients, but there continue to be important areas of clinical equipoise. Individualized clinical assessment is of major importance for decision making, and, as such, we emphasize the need for the functioning of an endocarditis team, including cardiac surgeons, cardiologists, infectious diseases specialists, neurologists, neurosurgeons, and interventional neuroradiologists. Here, we present 2 illustrative cases, critically review contemporary data, and offer conceptual and practical suggestions for clinicians to address this important, common, and often fatal cardiac condition. © 2016 American Heart Association, Inc.

  18. Systematic tailoring for the implementation of guideline recommendations for anxiety and depressive disorders in general practice: perceived usefulness of tailored interventions

    NARCIS (Netherlands)

    Sinnema, H.; Terluin, B.; Wensing, M.; Volker, D.; Franx, G.; van Balkom, A.J.L.M.; de Lange, J.

    2013-01-01

    Background: The uptake of guideline recommendations in general practice can potentially be improved by designing implementation interventions that are tailored to prospectively identify barriers. However, there is insufficient evidence regarding the most effective and efficient approaches to

  19. Systematic tailoring for the implementation of guideline recommendations for anxiety and depressive disorders in general practice: perceived usefulness of tailored interventions

    NARCIS (Netherlands)

    Sinnema, H.; Terluin, B.; Wensing, M.; Volker, D.; Franx, G.; Balkom, A. van; Lange, J.

    2013-01-01

    BACKGROUND: The uptake of guideline recommendations in general practice can potentially be improved by designing implementation interventions that are tailored to prospectively identify barriers. However, there is insufficient evidence regarding the most effective and efficient approaches to

  20. Cumulative Risk Assessment: Overview of Agency Guidance, Practice and Current Major Research Activities

    Science.gov (United States)

    Powerpoint presentation that includes the EPA's definition of CRA, relevant publications already in existence, the CRA Guidelines effort, science issues where research is still needed, program office practices related to CRA, and EPA research activities.

  1. Modeling of novel diagnostic strategies for active tuberculosis - a systematic review: current practices and recommendations.

    Directory of Open Access Journals (Sweden)

    Alice Zwerling

    Full Text Available The field of diagnostics for active tuberculosis (TB is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB.Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts.From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4, key determinants of diagnostic delay (n = 5, operational context (n = 5, and the pre-diagnostic infectious period (n = 1. The majority of models implemented sensitivity analysis, although only 18 studies described multi-way sensitivity analysis of more than 2 parameters simultaneously. Among the models used to make cost-effectiveness estimates, most frequent diagnostic assays studied included Xpert MTB/RIF (n = 7, and alternative nucleic acid amplification tests (NAATs (n = 4. Most (n = 16 of the cost-effectiveness models compared new assays to an existing baseline and generated an incremental cost-effectiveness ratio (ICER.Although models have addressed a small number of important issues, many decisions regarding implementation of TB diagnostics are being made without the full benefits of insight from mathematical

  2. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement.

    Science.gov (United States)

    Patel, Sanjay; Abrahamson, Ed; Goldring, Stephen; Green, Helen; Wickens, Hayley; Laundy, Matt

    2015-02-01

    There is compelling evidence to support the rationale for managing children on intravenous antimicrobial therapy at home whenever possible, including parent and patient satisfaction, psychological well-being, return to school/employment, reductions in healthcare-associated infection and cost savings. As a joint collaboration between the BSAC and the British Paediatric Allergy, Immunity and Infection Group, we have developed good practice recommendations to highlight good clinical practice and governance within paediatric outpatient parenteral antibiotic therapy (p-OPAT) services across the UK. These guidelines provide a practical approach for safely delivering a p-OPAT service in both secondary care and tertiary care settings, in terms of the roles and responsibilities of members of the p-OPAT team, the structure required to deliver the service, identifying patients and pathologies that are suitable for p-OPAT, ensuring appropriate vascular access, antimicrobial choice and delivery and the clinical governance aspects of delivering a p-OPAT service. The process of writing a business case to support the introduction of a p-OPAT service is also addressed. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Development of recommended practices and guidance documents for upstream oil and gas flow measurement

    Energy Technology Data Exchange (ETDEWEB)

    Dahl, Eivind; Scheers, Lex; Ting, Frank; Letton, Chip

    2005-07-01

    As first stated in the Introduction, improvements in multiphase flow meters during the last 15 years have resulted in their increased usage in upstream oil and gas applications, especially in difficult offshore locations both topside and deep subsea. To address user needs for information and standardization in the area, documentation has recently been created under the auspices of the NFOGM, API, and ISO. Our intent here was to familiarize potential users with the three new documents, which should be helpful in a number of respects, e.g., (a) distribution of best knowledge and operational practices on the subject, (b) provision of a common language for discussing multiphase flow, and (c) accounting for the requirements of governing regulatory authorities. At this stage of completion of NFOGM, API, and ISO reports, a natural question arises as to what the future holds for another round of flow measurement documentation. Candidate areas include: 1) In Situ Verification of Multiphase Flow Meters. 2) Wet Gas Flow Measurement. 3) Flare Gas Meters. 4) Virtual Metering. 5) Composition and Phase Behavior Issues In Measurement. 6) Flow Measurement Uncertainty. Addressing certain of these is already being proposed in several possible venues, among which are (1) the DeepStar Consortium, (2) a JIP for investigating total system (meter + flowline + separator) uncertainty organized by a group at Tulsa University, and (3) a program for development of drilling and production capabilities in ultradeep water to be sponsored by the US Department of Energy. The creation of the three documents discussed in this paper demonstrates the benefits that strong international cooperation can achieve in producing standardization documents, ensuring their true global input and acceptance. On the other hand, it should also be questioned why two or more documents are required, which are the result of much duplication of effort. For example, although there are differences between API RP86 and the

  4. Overview of Court Practice Relating to the Right of the Limited Use of Someone Else's Property in an English Law

    Directory of Open Access Journals (Sweden)

    Viktoria S. Arhipova

    2016-09-01

    Full Text Available In this article author carries out the detailed overview of the court practice concerning the right of limited use of someone else's property in system of a common law. In it definition the concept "servitude", servitude signs of an English law is given, each of them is in detail described and additional requirements which are necessary for existence of the servitude are described. In the conclusion the author emphasizes that the case law, unfortunately, has for the judge certainly no binding force. In certain cases the judge has the right to deviate from precedents and to pass the decision, new on the content. This fact proves flexibility of case law, but at the same time and some uncertainty, the choice of one of a set of the available precedents and its interpretation at discretion depends on the judge.

  5. Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices.

    Science.gov (United States)

    Radix, Asa; Sevelius, Jae; Deutsch, Madeline B

    2016-01-01

    Studies have shown that transgender women (TGW) are disproportionately affected by HIV, with an estimated HIV prevalence of 19.1% among TGW worldwide. After receiving a diagnosis, HIV-positive TGW have challenges accessing effective HIV treatment, as demonstrated by lower rates of virologic suppression and higher HIV-related mortality. These adverse HIV outcomes have been attributed to the multiple sociocultural and structural barriers that negatively affect their engagement within the HIV care continuum. Guidelines for feminizing hormonal therapy among TGW recommend combinations of oestrogens and androgen blockers. Pharmacokinetic studies have shown that certain antiretroviral therapy (ART) agents, such as protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and cobicistat, interact with ethinyl estradiol, the key oestrogen component of oral contraceptives (OCPs). The goal of this article is to provide an overview of hormonal regimens used by TGW, to summarize the known drug-drug interactions (DDIs) between feminizing hormonal regimens and ART, and to provide clinical care recommendations. The authors identified English language articles examining DDIs between oestrogen therapy, androgen blockers and ART published between 1995 and 2015 using PubMed, Cumulative Index to Nursing and Allied Health Literature and EBSCOhost. Published articles predominantly addressed interactions between ethinyl estradiol and NNRTIs and PIs. No studies examined interactions between ART and the types and doses of oestrogens found in feminizing regimens. DDIs that may have the potential to result in loss of virologic suppression included ethinyl estradiol and amprenavir, unboosted fosamprenavir and stavudine. No clinically significant DDIs were noted with other anti-retroviral agents or androgen blockers. There are insufficient data to address DDIs between ART and feminizing hormone regimens used by TGW. There is an urgent need for further research in this

  6. Creative Problem Solving and Social Cooperation of Effective Physical Therapy Practice: A Pioneer Study and Overview

    Directory of Open Access Journals (Sweden)

    Eli Carmeli

    2003-01-01

    Full Text Available Action research (AR has an important role to play in educating physical therapists. Increasing efforts should be encouraged to instigate AR programs in physical therapy practice and clinical education. Such programs commonly require considerable effort and understanding by clinical instructors, and require adoption of new educational methods. AR programs can lead physical therapists and clinicians to be more questioning and reflective in evaluating practical questions regarding patient therapy and education. The purpose of this article is to educate the readers on the importance of AR and to provide a few relevant references on that topic. A specific study is described in this paper in which physical therapy clinical instructors participated in a structured workshop designed to demonstrate the values of AR and how such values can be incorporated in teaching their students. AR can lead to improved therapist-patient interaction and help solve specific practical problems arising during therapy sessions.

  7. The joint industry development of a recommended practice for the site specific assessment of mobile jackup units

    International Nuclear Information System (INIS)

    Jones, D.E.; Bennett, W.T.; Hoyle, M.J.R.

    1993-01-01

    The mobile self-elevating (drilling) unit, or jack-up, has been central to the exploration and development of offshore oil and gas reserves. In recent years there has been an increased desire to benefit from the potential economics of using these units in longer term production roles either in association with a fixed platform or as a stand-alone facility. However, until recently there had been no concerted effort to develop a consistent and commonly accepted standard for general industry use in site specific assessment of jack-ups. This paper describes the background and work carried out to develop such a standard. The project is nearing completion and has resulted in the publication of a Guideline document. A Recommended Practice and associated Commentary are (at the time of writing) in the final stage of drafting for release to the project sponsors for trial and comment prior to issuing the first Edition early in 1994

  8. Applying a Social Justice Lens to Youth Mentoring: A Review of the Literature and Recommendations for Practice.

    Science.gov (United States)

    Albright, Jamie N; Hurd, Noelle M; Hussain, Saida B

    2017-06-01

    Youth mentoring interventions are often designed with the intention of promoting improved outcomes among marginalized youth. Despite their promise to reduce inequality through the provision of novel opportunities and increased social capital to marginalized youth, youth mentoring interventions hold the potential to reproduce rather than reduce inequality. In the current review, we explore literature on youth mentoring that has incorporated a social justice lens. We conclude that there is a need for greater attention to principles of social justice in the design, implementation, and evaluation of youth mentoring interventions. After reviewing the literature, we make recommendations for research and practice based on a social justice perspective and explore alternatives to traditional youth mentoring that may allow for better alignment with social justice principles. © Society for Community Research and Action 2017.

  9. Interest of seeing Precision Viticulture through two distributed competences: Determination of resources and schemes allowing some practical recommendations

    Directory of Open Access Journals (Sweden)

    Moreiro Leslie B.

    2017-01-01

    Full Text Available The aim of this article is to better understand resources needed and constraints to avoid in implementation of Precision Viticulture technologies. In this view, we adapt distributed cognition theory to multilevel model of competence in management sciences. We use a qualitative methodology based on semi-structured interviews in 7 cases study. The main results allow us to distinguish the two aspects of Precision Viticulture, artifacts, providers of resources, and their utilization scheme. Furthermore, Precision Viticulture is decomposed here in two tasks. The first task is characterization of heterogeneity. The second is modulation of technical itineraries. These two tasks are complementary. In addition, we present ours results by highlighting resources used by firm using these technologies and constraints that they face. Finally, with these results, we can do some practical recommendations to designers and users of these technologies.

  10. Definition and specification for PACS. A checklist based on the standard ''IEEE Recommended Practice for Software Requirements Specifications''

    International Nuclear Information System (INIS)

    Koenig, H.; Klose, K.J.

    1999-01-01

    Problem: The formulation of requirements is necessary to control the goals of a PACS project. Furthermore, in this way, the scope of functionality necessary to support radiological working processes becomes clear. Method: Definitions of requirements and specification are formulated independently of systems according to the IEEE standard 'Recommended Practice for Software Requirements Specifications'. Definitions are given in the Request for Information, specifications in the Request for Proposal. Functional and non-functional requirements are distinguished. The solutions are rated with respect to scope, appropriateness and quality of implementation. Results: A PACS checklist was created according to the methods described above. It is published on the homepage of the 'Arbeitsgemeinschaft Informationstechnologie' (AGIT) within the 'Deutsche Roentgengesellschaft' (DRG) (http://www.uni-marburg.de/mzr.agit). Conclusion: The checklist provides a discussion forum which should contribute to an agreement on accepted basic PACS functionalities. (orig.) [de

  11. PRACTICAL RECOMMENDATIONS OF DATA PREPROCESSING AND GEOSPATIAL MEASURES FOR OPTIMIZING THE NEUROLOGICAL AND OTHER PEDIATRIC EMERGENCIES MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Ionela MANIU

    2017-08-01

    Full Text Available Time management, optimal and timed determination of emergency severity as well as optimizing the use of available human and material resources are crucial areas of emergency services. A starting point for achieving these optimizations can be considered the analysis and preprocess of real data from the emergency services. The benefits of performing this method consist in exposing more useful structures to data modelling algorithms which consequently will reduce overfitting and improves accuracy. This paper aims to offer practical recommendations for data preprocessing measures including feature selection and discretization of numeric attributes regarding age, duration of the case, season, period, week period (workday, weekend and geospatial location of neurological and other pediatric emergencies. An analytical, retrospective study was conducted on a sample consisting of 933 pediatric cases, from UPU-SMURD Sibiu, 01.01.2014 – 27.02.2017 period.

  12. Experimental Assessment of Flow Fields Associated with Heart Valve Prostheses Using Particle Image Velocimetry (PIV): Recommendations for Best Practices.

    Science.gov (United States)

    Raghav, Vrishank; Sastry, Sudeep; Saikrishnan, Neelakantan

    2018-03-12

    Experimental flow field characterization is a critical component of the assessment of the hemolytic and thrombogenic potential of heart valve substitutes, thus it is important to identify best practices for these experimental techniques. This paper presents a brief review of commonly used flow assessment techniques such as Particle image velocimetry (PIV), Laser doppler velocimetry, and Phase contrast magnetic resonance imaging and a comparison of these methodologies. In particular, recommendations for setting up planar PIV experiments such as recommended imaging instrumentation, acquisition and data processing are discussed in the context of heart valve flows. Multiple metrics such as residence time, local velocity and shear stress that have been identified in the literature as being relevant to hemolysis and thrombosis in heart valves are discussed. Additionally, a framework for uncertainty analysis and data reporting for PIV studies of heart valves is presented in this paper. It is anticipated that this paper will provide useful information for heart valve device manufacturers and researchers to assess heart valve flow fields for the potential for hemolysis and thrombosis.

  13. Iodination and stability of somatostatin analogues: comparison of iodination techniques. A practical overview.

    Science.gov (United States)

    de Blois, Erik; Chan, Ho Sze; Breeman, Wouter A P

    2012-01-01

    For iodination ((125/127)I) of tyrosine-containing peptides, chloramin-T, Pre-Coated Iodo-Gen(®) tubes and Iodo-Beads(®) (Pierce) are commonly used for in vitro radioligand investigations and there have been reliant vendors hereof for decades. However, commercial availability of these radio-iodinated peptides is decreasing. For continuation of our research in this field we investigated and optimized (radio-)iodination of somatostatin analogues. In literature, radioiodination using here described somatostatin analogues and iodination techniques are described separately. Here we present an overview, including High Performance Liquid Chromatography (HPLC) separation and characterisation by mass spectrometry, to obtain mono- and di-iodinated analogues. Reaction kinetics of (125/127)I iodinated somatostatin analogues were investigated as function of reaction time and concentration of reactants, including somatostatin analogues, iodine and oxidizing agent. To our knowledge, for the here described somatostatin analogues, no (127)I iodination and optimization are described. (Radio-)iodinated somatostatin analogues could be preserved with a >90% radiochemical purity for 1 month after reversed phase HPLC-purification.

  14. Recommendations for physical and occupational therapy practice from the perspective of clients undergoing therapy for breast cancer-related impairments.

    Science.gov (United States)

    Lattanzi, Jill B; Giuliano, Susan; Meehan, Caitlin; Sander, Beth; Wootten, Rachel; Zimmerman, Amanda

    2010-01-01

    Evidence points to the efficacy of physical and occupational therapy intervention for the management of impairments and functional limitations related to the treatment of breast cancer. However, few studies give voice to the women participating in the physical rehabilitation programs intended to ameliorate their deficits. The purpose of this qualitative investigation was to explore the experience of physical rehabilitation as well as to identify recommendations for physical and occupational therapy practice from the perspective of the client undergoing therapy for breast cancer-related impairments. A phenomenological design was chosen and included a purposive sample of women (n = 10) undergoing physical rehabilitation for impairments related to breast cancer treatment. Data included semistructured interviews and artifact examination. Ten semistructured interviews were conducted at a setting of the participants' choice. Data collection continued until saturation was reached. Data analysis was cyclical and ongoing and involved all six researchers in analyzing and triangulating all pieces of data. Member checks and a peer review were conducted to confirm relevance and validity. Five themes emerged: 1) challenges with obtaining referrals, 2) challenges with patient education, 3) improvements in functional impairments, 4) emotional support, and 5) benefits of a specialized clinic environment. Consideration of the five themes led to four recommendations for physical and occupational therapist practice from the perspective of the client: 1) advocate for presurgical therapy consultations, 2) be competent in the management of all impairments and functional limitations associated with breast cancer treatment, 3) be aware of the emotional support the therapist has the capacity to provide or not provide, and 4) as much as possible, create an inviting, nonclinical environment.

  15. Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations.

    Science.gov (United States)

    Luauté, Jacques; Plantier, David; Wiart, Laurent; Tell, Laurence

    2016-02-01

    The agitation crisis in the awakening phase after traumatic brain injury (TBI) is one of the most difficult behavioral disorders to alleviate. Current treatment options are heterogeneous and may involve excessive sedation. Practice guidelines are required by professionals in charge of TBI patients. Few reviews were published but those are old and based on expert opinions. The purpose of this work is to propose evidence-based guidelines to treat the agitation crisis. The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and

  16. Current Trends in Malaysian Higher Education and the Effect on Education Policy and Practice: An Overview

    Science.gov (United States)

    Grapragasem, Selvaraj; Krishnan, Anbalagan; Mansor, Azlin Norhaini

    2014-01-01

    Malaysia has evolved from a production-based to knowledge-based economy in order to stay relevant and compete in the global marketplace. Thus, the purpose of this article is to discuss current trends in Malaysian higher education and how these affect education policies and practices. Four main trends are discussed in this study: Globalization,…

  17. Waste management and radiation protection overview of the practices in the NEA member countries

    International Nuclear Information System (INIS)

    Takahashi, M.; Riotte, H.; Ruegger, B.

    2000-01-01

    For many years the NEA has been reviewing waste management practices in Member States. Measures applied in the nuclear fuel cycle to reduce waste generation are outlined and characteristics of waste management in all steps of the nuclear fuel cycle are described. Views gained are discussed. (author)

  18. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice?

    Science.gov (United States)

    Peter, W F; Nelissen, R G H H; Vlieland, T P M Vliet

    2014-09-01

    In a Dutch guideline on physiotherapy (PT) in hip and knee osteoarthritis, a number of recommendations on post-acute (i.e. after discharge from hospital) PT following total hip (THA) and total knee (TKA) arthroplasty were included. Little is known about the uptake of these recommendations in daily clinical practice. The aim of the present study was to determine the extent to which the guideline recommendations regarding post-acute PT after THA and TKA are followed in daily clinical practice. An online pilot survey on the delivery of post-acute, postoperative PT was sent to a random sample of 957 Dutch physiotherapists. The survey included questions on the application of recommended, neither recommended nor advised against, and advised against treatment modalities and various treatment modalities for which there were no formulated recommendations. A total of 219 physiotherapists completed the questionnaire, with a mean age of 40 years (standard deviation 12.6), 55% female and 95% working in primary care. The vast majority reported the use of the recommended exercise modalities (muscle strengthening exercises (96%), and functional exercises (99%). Continuous passive motion, which was neither recommended nor advised against, and electrical muscle stimulation, which was not recommended, were provided by 1%. Reported treatment modalities for which there were no formulated recommendations included patient education (99%), gait training (95%), active range of motion (ROM) exercises (93%), balance exercises (86%), passive ROM exercises (58%), aerobic exercises (50%), massage (18%) and cold therapy (11%). The vast majority of physiotherapists reported adhering to recommendations on post-acute postoperative PT in THA and TKA patients after discharge from hospital. Although yet to be confirmed in a larger nationwide survey, the relatively high frequency of use of many other treatment modalities, for which there were no formulated recommendations, suggests the need to extend

  19. Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: International Consensus-based Recommendations for Monitoring Patients in Clinical Practice and Research Studies.

    Science.gov (United States)

    Stoustrup, Peter; Twilt, Marinka; Spiegel, Lynn; Kristensen, Kasper Dahl; Koos, Bernd; Pedersen, Thomas Klit; Küseler, Annelise; Cron, Randy Q; Abramowicz, Shelly; Verna, Carlalberta; Peltomäki, Timo; Alstergren, Per; Petty, Ross; Ringold, Sarah; Nørholt, Sven Erik; Saurenmann, Rotraud K; Herlin, Troels

    2017-03-01

    To develop international consensus-based recommendations for the orofacial examination of patients with juvenile idiopathic arthritis (JIA), for use in clinical practice and research. Using a sequential phased approach, a multidisciplinary task force developed and evaluated a set of recommendations for the orofacial examination of patients with JIA. Phase 1: A Delphi survey was conducted among 40 expert physicians and dentists with the aim of identifying and ranking the importance of items for inclusion. Phase 2: The task force developed consensus about the domains and items to be included in the recommendations. Phase 3: A systematic literature review was performed to assess the evidence supporting the consensus-based recommendations. Phase 4: An independent group of orofacial and JIA experts were invited to assess the content validity of the task force's recommendations. Five recommendations were developed to assess the following 5 domains: medical history, orofacial symptoms, muscle and temporomandibular joint function, orofacial function, and dentofacial growth. After application of data search criteria, 56 articles were included in the systematic review. The level of evidence for the 5 recommendations was derived primarily from descriptive studies, such as cross-sectional and case-control studies. Five recommendations are proposed for the orofacial examination of patients with JIA to improve the clinical practice and aid standardized data collection for future studies. The task force has formulated a future research program based on the proposed recommendations.

  20. An overview of quality control practices in Ontario with particular reference to cholesterol analysis.

    Science.gov (United States)

    Krishnan, S; Webb, S; Henderson, A R; Cheung, C M; Nazir, D J; Richardson, H

    1999-03-01

    The Laboratory Proficiency Testing Program (LPTP) assesses the analytical performance of all licensed laboratories in Ontario. The LPTP Enzymes, Cardiac Markers, and Lipids Committee conducted a "Patterns of Practice" survey to assess the in-house quality control (QC) practices of laboratories in Ontario using cholesterol as the QC paradigm. The survey was questionnaire-based seeking information on statistical calculations, software rules, review process and data retention, and so on. Copies of the in-house cholesterol QC graphs were requested. A total of 120 of 210 laboratories were randomly chosen to receive the questionnaires during 1995 and 1996; 115 laboratories responded, although some did not answer all questions. The majority calculate means and standard deviations (SD) every month, using anywhere from 4 to >100 data points. 65% use a fixed mean and SD, while 17% use means calculated from the previous month. A few use a floating or cumulative mean. Some laboratories that do not use fixed means use a fixed SD. About 90% use some form of statistical quality control rules. The most common rules used to detect random error are 1(3s)/R4s while 2(2s)/4(1s)/10x are used for systematic errors. About 20% did not assay any QC at levels >5.5 mmol/L. Quality control data are reviewed daily (technologists), weekly and monthly (supervisors/directors). Most laboratories retain their QC records for up to 3 years on paper and magnetic media. On some QC graphs the mean and SD, QC product lot number, or reference to action logs are not apparent. Quality control practices in Ontario are, therefore, disappointing. Improvement is required in the use of clinically appropriate concentrations of QC material and documentation on QC graphs.

  1. Medical negligence. An overview of legal theory and neurosurgical practice: causation.

    Science.gov (United States)

    Todd, Nicholas V

    2014-06-01

    This article discusses the principles of the law in relation to legal causation as applied to neurosurgical practice. Causation is a causal link between a breach of duty of care and the final harm. The fundamental "but-for" test for causation will be discussed, together with Chester v Afshar modified causation, prospective and retrospective probabilities of harm, loss of a chance, causation following breach of duty of care by omission, breaking the chain of causation, material contribution and the law in relation to multiple defendants, with neurosurgical examples.

  2. Financial Incentives to Enable Clean Energy Deployment: Policy Overview and Good Practices

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-02-24

    Financial incentives have been widely implemented by governments around the world to support scaled up deployment of renewable energy and energy efficiency technologies and practices. As of 2015, at least 48 countries have adopted financial incentives to support renewable energy and energy efficiency deployment. Broader clean energy strategies and plans provide a crucial foundation for financial incentives that often complement regulatory policies such as renewable energy targets, standards, and other mandates. This policy brief provides a primer on key financial incentive design elements, lessons from different country experiences, and curated support resources for more detailed and country-specific financial incentive design information.

  3. Forensic neuropsychology and expert witness testimony: An overview of forensic practice.

    Science.gov (United States)

    Leonard, Elizabeth L

    2015-01-01

    Neuropsychologists are frequently asked to serve as expert witnesses in an increasing number of legal contexts for civil and criminal proceedings. The skills required to practice forensic neuropsychology expand upon the knowledge, skills, and abilities developed by clinical neuropsychologists. Forensic neuropsychologists acquire expertise in understanding the roles and various functions of the legal system, as well as their role in addressing psycholegal questions to assist fact finders in making legal decisions. The required skills and the unique circumstances for clinical neuropsychologists pursing forensic work are reviewed. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  5. Performance analysis of dedicated short range communications technology and overview of the practicability for developing countries

    Directory of Open Access Journals (Sweden)

    Vandana Bassoo

    2015-12-01

    Full Text Available Vehicular communication is a widely researched field and aims at developing technologies that may complement systems such as the advanced driver assistance systems. It is therefore important to analyse and infer on the performance of vehicular technologies for different driving and on-road criteria. This study considers the dedicated short range communications technology and more precisely the IEEE 802.11p standard for a performance and practicability analysis. There is also the proposal of a new classification scheme for typical driving conditions, which includes the main categories of Emergency and Safety scenarios while sub-classifications of Critical and Preventive Safety also exist. The scheme is used to build up scenarios as well as related equations relevant to developing countries for practical network simulation. The results obtained indicate that the relative speed of nodes is a determining factor in the overall performance and effectiveness of wireless vehicular communication systems. Moreover, delay values of low order were observed while an effective communication range of about 800 m was calculated for highway scenarios. The research thus indicates suitability of the system for an active use in collision avoidance even though independent factors such as climatic conditions and driver behaviour may affect its effectiveness in critical situations.

  6. General Overview of Psychotherapeutic Practice in Poland. Results from a Nationwide Survey.

    Science.gov (United States)

    Suszek, Hubert; Grzesiuk, Lidia; Styła, Rafał; Krawczyk, Krzysztof

    2017-09-01

    A total of 1196 persons conducting psychotherapy in Poland fully completed a nationwide online survey (or, alternatively, a paper and pencil enquiry) concerning their education, training, experience, and clinical work (professional environment, patients treated). The results are described in detail and compared with findings of similar studies from other countries. Among the primary findings were: (1) psychotherapy in Poland is conducted mostly by women (80 %); (2) almost all participants have an MA degree (91 %), including 75.2 % having graduated in psychology; (3) the therapists are well trained (mean number of training hours is above 942) and established (average experience is about 9.8 years), however, more than half of the therapists have no type of certificate; (4) 54 % of respondents identify with the integrative or eclectic orientation and, simultaneously, for 48.6 % of the therapists the most important approach is either psychodynamic or psychoanalytic; (5) the most common form of therapy is individual psychotherapy in private practice; (6) the majority of the therapists treat adult patients with anxiety or personality disorders. In sum, the results show that psychotherapeutic practice is well established in Poland and many indices are similar to those found in Western countries.

  7. Overview of the Practical and Theoretical Approaches to the Estimation of Mineral Resources. A Financial Perspective

    Directory of Open Access Journals (Sweden)

    Leontina Pavaloaia

    2012-10-01

    Full Text Available Mineral resources represent an important natural resource whose exploitation, unless it is rational, can lead to their exhaustion and the collapse of sustainable development. Given the importance of mineral resources and the uncertainty concerning the estimation of extant reserves, they have been analyzed by several national and international institutions. In this article we shall present a few aspects concerning the ways to approach the reserves of mineral resources at national and international level, by considering both economic aspects and those aspects concerned with the definition, classification and aggregation of the reserves of mineral resources by various specialized institutions. At present there are attempts to homogenize practices concerning these aspects for the purpose of presenting correct and comparable information.

  8. Overview of concrete containment design practice in the U.S.A

    International Nuclear Information System (INIS)

    Stevenson, J.D.

    1976-01-01

    This paper presents a historical summary of the engineering practices and their evolution applied to the design of concrete containment structures in the U.S.A. during the period 1965 to 1974. It reviews the broad spectrum of concrete containment designs developed for the three major Nuclear Steam Supply Systems, Pressurized Water Reactor, Boiling Water Reactor and High Temperature Gas Reactor employed or planned in the U.S.A. during this period. The development of deformed rebar and one way prestress as well as fully prestressed reinforced concrete containment is discussed. Particular attention is paid to base mat-containment shell joint design details as well as the design of reinforcement around large penetrations and those penetrations subject to large pipe thrust loads. In addition to the historical summary, current trends in containment design are identified and projections of future developments are presented. Finally, potential innovations such as plastic liners are discussed. (author)

  9. Revision of the recommended international general standard for irradiated foods and of the recommended international code of practice for the operation of radiation facilities used for the treatment of foods

    International Nuclear Information System (INIS)

    1981-11-01

    In view of the findings and statements of the Joint FAO/IAEA/WHO Expert Committee on the Wholesomeness of Irradiated Food, convened in Geneva from 27 October to 3 November 1980, a Consultation Group, convened in Geneva from 1 to 3 July 1981 suggested the revision of the Recommended International General Standard for Irradiated Foods and of the Recommended International Code of Practice for the Operation of Radiation Facilities. The proposed changes are given and justified and the revised wording of the documents presented

  10. Practical implications of the ICRP recommendations (1977) and the revised IAEA basic safety standards for radiation protection

    International Nuclear Information System (INIS)

    1979-01-01

    Full text: The Seminar provided a forum for exchange of views concerning the practical problems associated with the implementation of the recommendations published in ICRP report No. 26 The papers presented and the discussions which followed will greatly help the IAEA, WHO, ILO and OECD/NEA to finalize the draft of the Basic Safety Standards for Radiation Protection. The papers and discussions centered mainly on three items - risk assessments and the associated detriment which might result from exposure to ionizing radiation as encountered in radiation work, optimization of protection; and some practical difficulties associated with the implementation of the recommendations Examples of the application of optimization were presented which helped clarify the methodology of optimizing protection. General and panel discussions helped to clarify the question of intuitive versus quantitative optimization. The consensus was that optimization of protection is mainly an intuitive operation, the quantitative tools being an aid to the process. These tools are more important in optimizing the design of installations and equipment, while the process is less quantitative in the case of optimization of operations. The value of the man-rem was discussed in a few papers and in panel and other discussions. It became clear that its value can be different in different cases of justification and different again in justification and optimization assessments. Therefore a range of values is needed rather than a single universal value. However, for optimization assessments where parts of the collective dose occur in different countries, the principal of geographical equity was advocated, implying the same value to the man-rem in all countries. Some papers and discussions centered around the identification and evaluation of detriment. Two types of detriment were identified, namely 'objective' detriment (composed of stochastic effects which could be assessed f r om knowledge of the

  11. State of affairs of tuberculosis in prison facilities: a systematic review of screening practices and recommendations for best TB control.

    Directory of Open Access Journals (Sweden)

    Natalie V S Vinkeles Melchers

    Full Text Available BACKGROUND: Prisoners are at high risk of developing tuberculosis (TB, causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide. METHODS: A systematic search of online databases (e.g., PubMed and Embase and conference abstracts was carried out. Research papers describing screening and diagnostic practices among prisoners were included. A total of 52 articles met the inclusion criteria. A meta-analysis of TB prevalence in prison facilities by screening and diagnostic tools was performed. RESULTS: The most common screening tool was symptom questionnaires (63·5%, mostly reporting presence of cough. Microscopy of sputum with Ziehl-Neelsen staining and solid culture were the most frequently combined diagnostic methods (21·2%. Chest X-ray and tuberculin skin tests were used by 73·1% and 50%, respectively, as either a screening and/or diagnostic tool. Median TB prevalence among prisoners of all included studies was 1,913 cases of TB per 100,000 prisoners (interquartile range [IQR]: 332-3,517. The overall annual median TB incidence was 7·0 cases per 1000 person-years (IQR: 2·7-30·0. Major limitations for successful TB control were inaccuracy of diagnostic algorithms and the lack of adequate laboratory facilities reported by 61·5% of studies. The most frequent recommendation for improving TB control and case detection was to increase screening frequency (73·1%. DISCUSSION: TB screening algorithms differ by income area and should be adapted to local contexts. In order to control TB, prison facilities must improve laboratory capacity and frequent use of effective screening and diagnostic tools. Sustainable political will and funding are critical to achieve this.

  12. An Overview of the Post-Harvest Grain Storage Practices of Smallholder Farmers in Developing Countries

    Directory of Open Access Journals (Sweden)

    Ashish Manandhar

    2018-04-01

    Full Text Available Grain storage loss is a major contributor to post-harvest losses and is one of the main causes of food insecurity for smallholder farmers in developing countries. Thus, the objective of this review is to assess the conventional and emerging grain storage practices for smallholder farmers in developing countries and highlight their most promising features and drawbacks. Smallholder farmers in developing countries use conventional grain storage structures and handling systems such as woven bags or cribs to store grain. However, they are ineffective against mold and insects already present in the grain before storage. Different chemicals are also mixed with grain to improve grain storability. Hermetic storage systems are effective alternatives for grain storage as they have minimal storage losses without using any chemicals. However, hermetic bags are prone to damage and hermetic metal silos are cost-prohibitive to most smallholder farmers in developing countries. Thus, an ideal grain storage system for smallholder farmers should be hermetically sealable, mechanically durable, and cost-effective compared to the conventional storage options. Such a storage system will help reduce grain storage losses, maintain grain quality and contribute to reducing food insecurity for smallholder farmers in developing countries.

  13. Clarification of vaccines: An overview of filter based technology trends and best practices.

    Science.gov (United States)

    Besnard, Lise; Fabre, Virginie; Fettig, Michael; Gousseinov, Elina; Kawakami, Yasuhiro; Laroudie, Nicolas; Scanlan, Claire; Pattnaik, Priyabrata

    2016-01-01

    Vaccines are derived from a variety of sources including tissue extracts, bacterial cells, virus particles, recombinant mammalian, yeast and insect cell produced proteins and nucleic acids. The most common method of vaccine production is based on an initial fermentation process followed by purification. Production of vaccines is a complex process involving many different steps and processes. Selection of the appropriate purification method is critical to achieving desired purity of the final product. Clarification of vaccines is a critical step that strongly impacts product recovery and subsequent downstream purification. There are several technologies that can be applied for vaccine clarification. Selection of a harvesting method and equipment depends on the type of cells, product being harvested, and properties of the process fluids. These techniques include membrane filtration (microfiltration, tangential-flow filtration), centrifugation, and depth filtration (normal flow filtration). Historically vaccine harvest clarification was usually achieved by centrifugation followed by depth filtration. Recently membrane based technologies have gained prominence in vaccine clarification. The increasing use of single-use technologies in upstream processes necessitated a shift in harvest strategies. This review offers a comprehensive view on different membrane based technologies and their application in vaccine clarification, outlines the challenges involved and presents the current state of best practices in the clarification of vaccines. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the International Society of Urological Pathology consensus conference.

    Science.gov (United States)

    Amin, Mahul B; Epstein, Jonathan I; Ulbright, Thomas M; Humphrey, Peter A; Egevad, Lars; Montironi, Rodolfo; Grignon, David; Trpkov, Kiril; Lopez-Beltran, Antonio; Zhou, Ming; Argani, Pedram; Delahunt, Brett; Berney, Daniel M; Srigley, John R; Tickoo, Satish K; Reuter, Victor E

    2014-08-01

    Members of the International Society of Urological Pathology (ISUP) participated in a half-day consensus conference to discuss guidelines and recommendations regarding best practice approaches to use of immunohistochemistry (IHC) in differential diagnostic situations in urologic pathology, including bladder, prostate, testis and, kidney lesions. Four working groups, selected by the ISUP leadership, identified several high-interest topics based on common or relevant challenging diagnostic situations and proposed best practice recommendations, which were discussed by the membership. The overall summary of the discussions and the consensus opinion forms the basis of a series of articles, one for each organ site. This Special Article summarizes the overall recommendations made by the four working groups. It is anticipated that this ISUP effort will be valuable to the entire practicing community in the appropriate use of IHC in diagnostic urologic pathology.

  15. Using mobile technology to promote safe sex and sexual health in adolescents: current practices and future recommendations

    Directory of Open Access Journals (Sweden)

    Cornelius JB

    2016-04-01

    Full Text Available Judith B Cornelius,1 Josephine A Appiah2 1School of Nursing, 2Health Services Research Doctoral Program, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA Abstract: Youth and young adults (19–24 years of age shoulder the burden of sexually transmitted infections accounting for nearly half of all new infections annually. Mobile technology is one way that we have reached this population with safer sex information but challenges exist with the delivery process. The literature between 2010 and 2015 was reviewed for data on safe sex and sexual health information delivered using mobile cell phone devices. A search for relevant databases revealed that 17 articles met our inclusion criteria. Findings suggest that mobile cell phone interventions are an effective mode for delivering safe sex and sexual health information to youth; those at the highest risk may not be able to access cell phones based on availability and cost of the text messages or data plans. Keywords: mobile, safe sex, sexual health, practices, recommendations

  16. Color coding of televised task elements in remote work: a literature review with practical recommendations for a fuel reprocessing facility

    International Nuclear Information System (INIS)

    Clarke, M.M.; Preston-Anderson, A.

    1981-11-01

    The experimental literature on the effects of color visual displays was reviewed with particular reference to the performance of remote work in a Hot Experimental Facility (HEF) using real scene closed-circult television systems. It was also reviewed with more general reference to the broader range of work-related issues of operator learning and preference, and display specifications. Color has been shown to enhance the performance of tasks requiring search and location and may also enhance tracking/transportation tasks. However, both HEF large-volume searching and tracking can be computer augmented, alleviating some of the necessity for a color code to assist an operator. Although color enhances long-term memory and is preferred to black and white displays, it has not been shown to have a specific advantage in the performance of unique tasks (where computer augmentation is more problematic and visual input to operator is critical). Practical display specifications are discussed with reference to hue and size of color code, target size, ambient illumination, multiple displays, and coatings. The authors conclude that the disadvantages to color television in the HEF far outweigh any possible advantages and recommend the use of high-resolution black and white systems, unless future experiments unequivocally indicate that (1) color is superior to black and white for in-situ task performance or (2) it is imperative in terms of long-range psychological well-being

  17. "One for Sorrow, Two for Joy?": American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients.

    Science.gov (United States)

    White, Pamela M

    2017-04-01

    In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple-birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father, went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multiple-embryo transfers in the context of US surrogacy arrangements. Offering an original analysis of data obtained from the US national-assisted reproduction registry, it examines single- and multiple-embryo transfer trends over a 12-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in fewer than 42% of the cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemented.

  18. Advancing Pre-Health Humanities as Intensive Research Practice: Principles and Recommendations from a Cross-Divisional Baccalaureate Setting.

    Science.gov (United States)

    Singer, Sarah Ann; Weed, Kym; Edwell, Jennifer; Jack, Jordynn; Thrailkill, Jane F

    2017-12-01

    This essay argues that pre-health humanities programs should focus on intensive research practice for baccalaureate students and provides three guiding principles for implementing it. Although the interdisciplinary nature of health humanities permits baccalaureate students to use research methods from the natural sciences, social sciences, and humanities, pre-health humanities coursework tends to force students to adopt only one of many disciplinary identities. Alternatively, an intensive research approach invites students to critically select and combine methods from multiple (and seemingly opposing) disciplines to ask and answer questions about health problems more innovatively. Using the authors' experiences with implementing health humanities baccalaureate research initiatives at The University of North Carolina at Chapel Hill, the authors contend that pre-health humanities programs should teach and study multiple disciplinary research methods and their values; examine how health humanities research might transfer across disciplines; and focus on mentoring opportunities for funding, presenting, and publishing research. These recommendations have the potential to create unprecedented research experiences for baccalaureate students as they prepare to enter careers within and beyond the allied health professions.

  19. Encapsulating the delivery of affordable housing: An overview of Malaysian practice

    Directory of Open Access Journals (Sweden)

    Jamaluddin Nor Baizura

    2016-01-01

    Full Text Available Urban population increases much faster than other geographical areas and this brings huge challenges to Malaysian government especially those responsible for the provision of housing. Moreover, the rise of living cost and pressure towards the current economic situation had inevitably led to huge demands for affordable housing. Thus, affordability and inaccessibility of people in owning a house has become one of the major issues in Malaysia. These issues are not only faced by the low-income group but mostly experienced by urban dwellers including the middle-income group whom are not eligible to apply for low-cost housing delivered by the government, yet cannot afford to buy a house. Hence, the Malaysian government had therefore established the Perumahan Rakyat 1 Malaysia (PR1MA as the catalyst in providing adequate, quality and affordable houses. Furthermore, the Syarikat Perumahan Negara Berhad (SPNB and the state governments also play their big role in providing affordable house at the state level. In trying to ensure smooth delivery of affordable housing, a systematic approach is required. This paper intends to examine the delivery of affordable housing in Malaysia. The objective was to assess the parties involved, and the various stages of the process. The methodology adopted for this study includes in-depth interviews with affordable housing agencies. Investigation showed that the major problem relates to a mismatch in the delivery of affordable housing. Moreover, the political and economic aspects, as well as the organization situation had also influenced the inefficiency of affordable housing delivery system. Additionally, the significant of this paper is expected to formulate an improved strategy and guidance in delivery system, thus ensuring that the method of practice is applicable throughout the country.

  20. Chemical Emergencies Overview

    Science.gov (United States)

    ... Address What's this? Submit What's this? Submit Button Chemical Emergencies Overview Recommend on Facebook Tweet Share Compartir ... themselves during and after such an event. What chemical emergencies are A chemical emergency occurs when a ...

  1. Practical recommendations for the implementation of health technologies to enhance physical fitness of students in extracurricular classes during non-traditional gymnastics

    Directory of Open Access Journals (Sweden)

    E.V. Fomenko

    2014-07-01

    Full Text Available Purpose : to develop practical recommendations for extracurricular classes nontraditional kinds of gymnastics to improve the organization of physical education teachers in schools. Material : in the experiment involved 358 students. Analyzed the available literature data. Results : a comparative analysis of physical fitness of students and practical recommendations for the non-traditional occupations gymnastics. Been a significant interest in physical education classes. Found that the main ways of improving physical education students may be the formation of the need for strengthening health facilities fitness aerobics, shaping, pilates. Conclusions : highlights the need to structure the problems they need and develop appropriate solutions.

  2. An overview of the national immunization policy making process: the role of the Korea expert committee on immunization practices

    Science.gov (United States)

    2012-01-01

    The need for evidence-based decision making in immunization programs has increased due to the presence of multiple health priorities, limited human resources, expensive vaccines, and limited funds. Countries should establish a group of national experts to advise their Ministries of Health. So far, many nations have formed their own National Immunization Technical Advisory Groups (NITAGs). In the Republic of Korea, the Korea Expert Committee on Immunization Practices (KECIP), established by law in the early 1990s, has made many important technical recommendations to contribute to the decline in vaccine preventable diseases and currently functions as a NITAG. It includes 13 core members and 2 non-core members, including a chairperson. Core members usually come from affiliated organizations in internal medicine, pediatrics, obstetrics, microbiology, preventive medicine, nursing and a representative from a consumer group, all of whom serve two year terms. Non-core members comprise two government officials belonging to the Korea Centers for Disease Control and Prevention (KCDC) and the Korea Food and Drug Administration. Meetings are held as needed, but at least twice a year, and sub-committees are formed as a resource for gathering, analyzing, and preparing information for the KECIP meetings. Once the sub-committees or the KCDC review the available data, the KECIP members discuss each issue in depth and develop recommendations, usually by a consensus in the meeting. The KECIP publishes national guidelines and immunization schedules that are updated regularly. KECIP's role is essentially consultative and the implementation of their recommendations may depend on the budget or current laws. PMID:22359523

  3. An overview of the national immunization policy making process: the role of the Korea expert committee on immunization practices

    Directory of Open Access Journals (Sweden)

    Hee Yeon Cho

    2012-01-01

    Full Text Available The need for evidence-based decision making in immunization programs has increased due to the presence of multiple health priorities, limited human resources, expensive vaccines, and limited funds. Countries should establish a group of national experts to advise their Ministries of Health. So far, many nations have formed their own National Immunization Technical Advisory Groups (NITAGs. In the Republic of Korea, the Korea Expert Committee on Immunization Practices (KECIP, established by law in the early 1990s, has made many important technical recommendations to contribute to the decline in vaccine preventable diseases and currently functions as a NITAG. It includes 13 core members and 2 non-core members, including a chairperson. Core members usually come from affiliated organizations in internal medicine, pediatrics, obstetrics, microbiology, preventive medicine, nursing and a representative from a consumer group, all of whom serve two year terms. Non-core members comprise two government officials belonging to the Korea Centers for Disease Control and Prevention (KCDC and the Korea Food and Drug Administration. Meetings are held as needed, but at least twice a year, and sub-committees are formed as a resource for gathering, analyzing, and preparing information for the KECIP meetings. Once the sub-committees or the KCDC review the available data, the KECIP members discuss each issue in depth and develop recommendations, usually by a consensus in the meeting. The KECIP publishes national guidelines and immunization schedules that are updated regularly. KECIP’s role is essentially consultative and the implementation of their recommendations may depend on the budget or current laws.

  4. Invited review: Practical feeding management recommendations to mitigate the risk of subacute ruminal acidosis in dairy cattle.

    Science.gov (United States)

    Humer, E; Petri, R M; Aschenbach, J R; Bradford, B J; Penner, G B; Tafaj, M; Südekum, K-H; Zebeli, Q

    2018-02-01

    Rumen health is of vital importance in ensuring healthy and efficient dairy cattle production. Current feeding programs for cattle recommend concentrate-rich diets to meet the high nutritional needs of cows during lactation and enhance cost-efficiency. These diets, however, can impair rumen health. The term "subacute ruminal acidosis" (SARA) is often used as a synonym for poor rumen health. In this review, we first describe the physiological demands of cattle for dietary physically effective fiber. We also provide background information on the importance of enhancing salivary secretions and short-chain fatty acid absorption across the stratified squamous epithelium of the rumen; thus, preventing the disruption of the ruminal acid-base balance, a process that paves the way for acidification of the rumen. On-farm evaluation of dietary fiber adequacy is challenging for both nutritionists and veterinarians; therefore, this review provides practical recommendations on how to evaluate the physical effectiveness of the diet based on differences in particle size distribution, fiber content, and the type of concentrate fed, both when the latter is part of total mixed ration and when it is supplemented in partial mixed rations. Besides considering the absolute amount of physically effective fiber and starch types in the diet, we highlight the role of several feeding management factors that affect rumen health and should be considered to control and mitigate SARA. Most importantly, transitional feeding to ensure gradual adaptation of the ruminal epithelium and microbiota; monitoring and careful management of particle size distribution; controlling feed sorting, meal size, and meal frequency; and paying special attention to primiparous cows are some of the feeding management tools that can help in sustaining rumen health in high-producing dairy herds. Supplementation of feed additives including yeast products, phytogenic compounds, and buffers may help attenuate SARA

  5. Towards a transnational system of supersites for forest monitoring and research in Europe - an overview on present state and future recommendations

    DEFF Research Database (Denmark)

    Fischer, R.; Aas, W.; De Vries, W.

    2011-01-01

    in October 2010 in Rome, reveal valuable results from different European forest monitoring and research networks. However, the need for closer integration of these activities is obvious. In this paper, representatives from major European networks recommend a new approach for forest monitoring and research...... in Europe, based on a reasonable number of highly instrumented “supersites” and a larger number of intensive monitoring plots linked to these. This system needs to be built on existing infrastructures but requires increased coordination, harmonisation and a joint long term platform for data exchange...

  6. Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues.

    Science.gov (United States)

    Müthing, Jannis; Jäschke, Thomas; Friedrich, Christoph M

    2017-10-18

    Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps used secure connections only for selected tasks

  7. Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues

    Science.gov (United States)

    Müthing, Jannis; Jäschke, Thomas

    2017-01-01

    Background Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. Objective The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Methods Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Results Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. Conclusions The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps

  8. Comparison of mRNA splicing assay protocols across multiple laboratories: recommendations for best practice in standardized clinical testing.

    Science.gov (United States)

    Whiley, Phillip J; de la Hoya, Miguel; Thomassen, Mads; Becker, Alexandra; Brandão, Rita; Pedersen, Inge Sokilde; Montagna, Marco; Menéndez, Mireia; Quiles, Francisco; Gutiérrez-Enríquez, Sara; De Leeneer, Kim; Tenés, Anna; Montalban, Gemma; Tserpelis, Demis; Yoshimatsu, Toshio; Tirapo, Carole; Raponi, Michela; Caldes, Trinidad; Blanco, Ana; Santamariña, Marta; Guidugli, Lucia; de Garibay, Gorka Ruiz; Wong, Ming; Tancredi, Mariella; Fachal, Laura; Ding, Yuan Chun; Kruse, Torben; Lattimore, Vanessa; Kwong, Ava; Chan, Tsun Leung; Colombo, Mara; De Vecchi, Giovanni; Caligo, Maria; Baralle, Diana; Lázaro, Conxi; Couch, Fergus; Radice, Paolo; Southey, Melissa C; Neuhausen, Susan; Houdayer, Claude; Fackenthal, Jim; Hansen, Thomas Van Overeem; Vega, Ana; Diez, Orland; Blok, Rien; Claes, Kathleen; Wappenschmidt, Barbara; Walker, Logan; Spurdle, Amanda B; Brown, Melissa A

    2014-02-01

    Accurate evaluation of unclassified sequence variants in cancer predisposition genes is essential for clinical management and depends on a multifactorial analysis of clinical, genetic, pathologic, and bioinformatic variables and assays of transcript length and abundance. The integrity of assay data in turn relies on appropriate assay design, interpretation, and reporting. We conducted a multicenter investigation to compare mRNA splicing assay protocols used by members of the ENIGMA (Evidence-Based Network for the Interpretation of Germline Mutant Alleles) consortium. We compared similarities and differences in results derived from analysis of a panel of breast cancer 1, early onset (BRCA1) and breast cancer 2, early onset (BRCA2) gene variants known to alter splicing (BRCA1: c.135-1G>T, c.591C>T, c.594-2A>C, c.671-2A>G, and c.5467+5G>C and BRCA2: c.426-12_8delGTTTT, c.7988A>T, c.8632+1G>A, and c.9501+3A>T). Differences in protocols were then assessed to determine which elements were critical in reliable assay design. PCR primer design strategies, PCR conditions, and product detection methods, combined with a prior knowledge of expected alternative transcripts, were the key factors for accurate splicing assay results. For example, because of the position of primers and PCR extension times, several isoforms associated with BRCA1, c.594-2A>C and c.671-2A>G, were not detected by many sites. Variation was most evident for the detection of low-abundance transcripts (e.g., BRCA2 c.8632+1G>A Δ19,20 and BRCA1 c.135-1G>T Δ5q and Δ3). Detection of low-abundance transcripts was sometimes addressed by using more analytically sensitive detection methods (e.g., BRCA2 c.426-12_8delGTTTT ins18bp). We provide recommendations for best practice and raise key issues to consider when designing mRNA assays for evaluation of unclassified sequence variants.

  9. Operationalising UN security council resolution 1540: an overview of select practical activities in the chemical and biological weapon-related areas

    International Nuclear Information System (INIS)

    Hart, J.

    2009-01-01

    The UN member states are continuing to take measures to inter alia establish and effectively implement controls to prevent the proliferation of nuclear, biological and chemical weapons and their means of delivery in accordance with United Nations Security Council Resolution 1540 (2004). The resolution also encourages enhanced international cooperation on such efforts, including by working through the 1540 Committee. Most analyses on the implementation of the resolution have focused on nuclear issues. This presentation provides an overview of select practical activities in the chemical and biological weapon-related areas, including chemical product classification and identification, biosafety and biosecurity practices and criminal prosecutions for unauthorised chemical transfers.(author)

  10. [Clinical recommendations for sport practice in diabetic patients (RECORD Guide). Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN)].

    Science.gov (United States)

    Gargallo-Fernández, Manuel; Escalada San Martín, Javier; Gómez-Peralta, Fernando; Rozas Moreno, Pedro; Marco Martínez, Amparo; Botella-Serrano, Marta; Tejera Pérez, Cristina; López Fernández, Judith

    2015-01-01

    Sporting activity is becoming a common practice in patients with diabetes mellitus (DM). This situation requires both a preliminary medical assessment and a wide range of changes in treatment which have scarcely been addressed in medical literature. To prepare a clinical guideline on the medical approach to patients with diabetes who practice sport regularly. An expert panel from the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) reviewed the most relevant literature in each of the sections. Based both on this review and on data from the experience of a number of athletes with DM, a number of recommendations were agreed within each section. Finally, the Working Group and representatives of the SEEN jointly discussed all these recommendations. The guideline provides recommendations ranging from medical assessment before patients with DM start to practice sport to actions during and after physical activity. Recommendations are also given on aspects such as the impact of sport on blood glucose control, training schemes, or special risk situations. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  11. Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history : Targeted HPV vaccine recommendation in France

    OpenAIRE

    Thierry , Pascale; Lasserre , Andrea; Rossignol , Louise; Kernéis , Solen; Blaizeau , Fanette; Stheneur , Chantal; Blanchon , Thierry; Levy-Bruhl , Daniel; Hanslik , Thomas

    2015-01-01

    International audience; IntroductionIn France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as “catch-up” vaccination for girls between 15-23 years of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. Patients and methodsA survey was proposed to 706 general...

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Application of the UNECE Recommendations on Monitoring and Response Procedures for Radioactive Scrap Metal: From Theory to Practice

    Energy Technology Data Exchange (ETDEWEB)

    Magold, M.; Mansourian-Stephenson, S., E-mail: stephanie.mansourian-stephenson@unece.org [United Nations Economic Council for Europe, Geneva (Switzerland)

    2011-07-15

    The work of the United Nations Economic Commission for Europe (UNECE) in addressing the issue of radioactive material appearing inadvertently in scrap metal is summarized. After hosting several meetings of national and international representatives of the scrap metal industry and radiation protection experts, the UNECE issued recommendations in 2006 on Monitoring and Response Procedures for Radioactive Scrap Metal. Since then, the UNECE has been exploring, with its Member States, the extent to which the Recommendations have been utilized - by means of a questionnaire. In this paper the results of the questionnaire are presented and, on the basis of the results of the questionnaire, conclusions are drawn and recommendations made for international action in this field for the future. (author)

  14. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

    DEFF Research Database (Denmark)

    Mandl, P; Navarro-Compán, V; Terslev, L

    2015-01-01

    of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy...... process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response...... to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce...

  15. Constrained physical therapist practice: an ethical case analysis of recommending discharge placement from the acute care setting.

    Science.gov (United States)

    Nalette, Ernest

    2010-06-01

    Constrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility-which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice. The case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States. An applied ethics approach was used for case analysis. The decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission. Constrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.

  16. Real Virtuality: A Code of Ethical ConductRecommendations for Good Scientific Practice and the Consumers of VR-Technology

    Directory of Open Access Journals (Sweden)

    Michael eMadary

    2016-02-01

    Full Text Available The goal of this article is to present a first list of ethical concerns that may arise from research and personal use of virtual reality (VR and related technology, and to offer concrete recommendations for minimizing those risks. Many of the recommendations call for focused research initiatives. In the first part of the article, we discuss the relevant evidence from psychology that motivates our concerns. In section 1.1, we cover some of the main results suggesting that one’s environment can influence one’s psychological states, as well as recent work on inducing illusions of embodiment. Then, in section 1.2, we go on to discuss recent evidence indicating that immersion in VR can have psychological effects that last after leaving the virtual environment. In the second part of the article we turn to the risks and recommendations. We begin, in section 2.1, with the research ethics of VR, covering six main topics: the limits of experimental environments, informed consent, clinical risks, dual-use, online research, and a general point about the limitations of a code of conduct for research. Then, in section 2.2, we turn to the risks of VR for the general public, covering four main topics: long-term immersion, neglect of the social and physical environment, risky content, and privacy. We offer concrete recommendations for each of these ten topics, summarized in Table 1.

  17. A well-started beginning elementary teacher's beliefs and practices in relation to reform recommendations about inquiry-based science

    NARCIS (Netherlands)

    Avraamidou, Lucy

    2017-01-01

    Given reform recommendations emphasizing scientific inquiry and empirical evidence pointing to the difficulties beginning teachers face in enacting inquiry-based science, this study explores a well-started beginning elementary teacher's (Sofia) beliefs about inquiry-based science and related

  18. Sailing From the seas of chaos Into the corridor of stability practical recommendations to increase the informational value of studies

    NARCIS (Netherlands)

    Lakens, D.; Evers, E.R.K.

    2014-01-01

    Recent events have led psychologists to acknowledge that the inherent uncertainty encapsulated in an inductive science is amplified by problematic research practices. In this article, we provide a practical introduction to recently developed statistical tools that can be used to deal with these

  19. Sailing from the seas of chaos into the corridor of stability : practical recommendations to increase the informational value of studies

    NARCIS (Netherlands)

    Lakens, D.; Evers, E.R.K.

    2014-01-01

    Recent events have led psychologists to acknowledge that the inherent uncertainty encapsulated in an inductive science is amplified by problematic research practices. This article provides a practical introduction to recently developed statistical tools that can be used to deal with these

  20. A Systematic Review of Clinical Practice Guidelines' Recommendations on Levothyroxine Therapy Alone versus Combination Therapy (LT4 plus LT3) for Hypothyroidism.

    Science.gov (United States)

    Kraut, Eyal; Farahani, Pendar

    2015-12-04

    Patients with hypothyroidism are increasingly enquiring about the benefit of using combination therapy of levothyroxine (LT4) and liothyronine (LT3) as a potential treatment for hypothyroidism. Combination therapy, however, remains controversial. The purpose of this study was to systematically review available hypothyroidism treatment recommendations from clinical practice guidelines from around the world to identify the consensus regarding combination therapy. Clinical practice guidelines were obtained from searches of PubMed, EMBASE, and MEDLINE, using several combinations of MeSH terms. The search was limited to clinical guidelines in English-language publications, published between January 1, 1990 and May 1, 2015. A quantitative approach was utilized for data synthesis. Thirteen guidelines were identified, including three regarding pregnancy, two regarding pediatric populations and eight regarding adult populations. There were six guidelines from North America, four guidelines from Europe and three guidelines from South America. Twelve of the guidelines were published after 2010. Nine guidelines addressed combination therapy of LT4 plus LT3, and all nine concluded that LT4 therapy alone is the standard of care, with insufficient evidence to recommend widespread combination therapy. Only the 2012 ETA Guidelines and the 2015 BTA Guidelines concluded that combination therapy could be used, although only in certain circumstances and as an experimental treatment. This systematic review illustrates that clinical practice guidelines worldwide do not recommend and do not support routine use of combination LT4 and LT3 therapy to treat hypothyroidism.

  1. Overview of the Belgian programme for the surveillance of the territory and the implications of the international recommendations or directives on the monitoring programme

    International Nuclear Information System (INIS)

    Sombre, L.; Lambotte, J.M.

    2004-01-01

    The Royal Decree of 20 th July has entrusted the Federal Agency for Nuclear Control (FANC) with the task of controlling the territorial radioactivity and the doses received by the population. Within this agenda, a monitoring programme has been developed over many years, in order to follow the main potential exposure pathways of the population. In practice, several potential vectors of contamination are controlled: air (and rain), surface water (including sediments and biota), soils around nuclear installations, food chain, drinking water etc. To carry out such work, the FANC has collaborated with public or private reputable organisations: The Centre of Nuclear Energy Studies of Mol, The National Institute of Radionuclides of Fleurus, and The Louis Pasteur Public Health Institute of Brussels. A synthesis of this monitoring programme will be presented and the most important deductions will be pointed out. For many years, the tendency has been for tighter control of artificial and natural radioactivity in the environment. This has been achieved by increasingly stringent regulations, regarding environmental monitoring efforts, from international organisations (EC, OSPAR, IAEA). In this context, the FANC in Belgium, is involved in a process that will lead to the adaptation of the Belgian monitoring programme. Different aspects of these adaptations and of their consequences will be presented for illustrative purposes

  2. Implementing falls prevention research into policy and practice: an overview of a new National Health and Medical Research Council Partnership Grant.

    Science.gov (United States)

    Lord, Stephen R; Delbaere, Kim; Tiedemann, Anne; Smith, Stuart T; Sturnieks, Daina L

    2011-06-01

    Preventing falls and fall-related injuries among older people is an urgent public health challenge. This paper provides an overview of the background to and research planned for a 5-year National Health and Medical Research Council Partnership Grant on implementing falls prevention research findings into policy and practice. This program represents a partnership between key Australian falls prevention researchers, policy makers and information technology companies which aims to: (1) fill gaps in evidence relating to the prevention of falls in older people, involving new research studies of risk factor assessment and interventions for falls prevention; (2) translate evidence into policy and practice, examining the usefulness of new risk-identification tools in clinical practice; and (3) disseminate evidence to health professionals working with older people, via presentations, new evidence-based guidelines, improved resources and learning tools, to improve the workforce capacity to prevent falls and associated injuries in the future.

  3. Recommendations for clinical practice and research in severe brain injury in intensive rehabilitation: the Italian Consensus Conference.

    Science.gov (United States)

    De Tanti, A; Zampolini, M; Pregno, S

    2015-02-01

    The paper reports the final statements of the jury of a National Consensus Conference organized in November 2010 at Salsomaggiore (Parma) to draw up recommendations on the rehabilitation programs for acquired brain injury (sABI) patients in the intensive hospital phase. Because of the few clinical studies of good quality found by means of the literature research we choose a mixed approach: a systematic review of the published studies and a consensus conference in order to obtain recommendations that come from the clinical evidence and the expert opinion. The final recommendations of the jury, based on the best available evidence combined with clinical expertise and the experience of persons with disabilities and other stakeholders, cover 13 topics: 1) Management of paroxysmal manifestations (sympathetic storms); 2) management of neuroendocrine problems; 3) nutrition; 4) swallowing; 5) ventilation/respiration, 6) clinical and instrument diagnosis and prognosis of vegetative state (VS) and minimally conscious state (MCS), 7) rehabilitative and pharmacological facilitation of renewed contact with surroundings; 8) neurosurgical complications and hydrocephalus; 9) sensorimotor impairment and disability; 10) rehabilitation methods; 11) assessment and treatment of cognitive-behavioural impairment and disability; 12) methodology and organization of care; 13) involving family and caregivers in rehabilitation.

  4. Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice.

    Science.gov (United States)

    Akhtar, Shamsuddin; Liu, Jia; Heng, Joseph; Dai, Feng; Schonberger, Robert B; Burg, Matthew M

    2016-09-01

    It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged >65. Retrospective chart review. Academic medical center. A total of 1869 adult patients receiving general anesthesia for GI surgical procedures from February 2013 to January 2014. Patients were divided into 3 age groups (age 80, which was still in less than the recommendations. An inverse relationship was observed between propofol dosing and ASA-PS class, but no consistent relationship was noted for fentanyl and midazolam. There were a significantly larger drop in mean arterial pressure and a greater likelihood of hypotension following induction in patients aged 65-79 years and >80 years as compared with those aged <65 years. This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Using pedagogical approaches to influence evidence-based practice integration - processes and recommendations: findings from a grounded theory study.

    Science.gov (United States)

    Malik, Gulzar; McKenna, Lisa; Griffiths, Debra

    2017-04-01

    The study aimed to explore the processes undertaken by nurse academics when integrating evidence-based practice (EBP) into their teaching and learning practices. This article focuses on pedagogical approaches employed by academics to influence evidence-based practice integration into undergraduate programs across Australian universities. Nursing academics are challenged to incorporate a variety of teaching and learning strategies to teach evidence-based practice and determine their effectiveness. However, literature suggests that there are limited studies available focusing on pedagogical approaches in evidence-based practice education. A constructivist grounded theory methodology, informed by Charmaz was used for this study. Data were collected during 2014 from 23 nurse academics across Australian universities through semi-structured interviews. Additionally, nine were observed during teaching of undergraduate students. Twenty subject outlines were also analysed following Charmaz's approach of data analysis. 'Influencing EBP integration' describes the pedagogical approaches employed by academics to incorporate EBP knowledge and skills into undergraduate curricula. With the use of various teaching and learning strategies, academics attempted to contextualize EBP by engaging students with activities aiming to link evidence to practice and with the EBP process. Although, some strategies appeared to be engaging, others were traditional and seemed to be disengaging for students due to the challenges experienced by participants that impeded the use of the most effective teaching methods. Study findings offer valuable insights into the teaching practices and identify some key challenges that require the adoption of appropriate strategies to ensure future nurses are well prepared in the paradigm of evidence-based practice. © 2016 John Wiley & Sons Ltd.

  6. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.

    Science.gov (United States)

    Keasberry, Justin; Scott, Ian A; Sullivan, Clair; Staib, Andrew; Ashby, Richard

    2017-12-01

    alert fatigue, increased technology interaction time, creation of disruptive workarounds and new prescribing errors. Conclusion eHealth technologies in hospital settings appear to improve efficiency and appropriateness of care, prescribing safety and disease control. Effects on mortality, readmissions, total costs and patient and provider experience remain uncertain. What is known about the topic? Healthcare systems internationally are undertaking large-scale digitisation programs with hospitals being a major focus. Although predictive analyses suggest that eHealth technologies have the potential to markedly transform health care delivery, contemporary peer-reviewed research evidence detailing their benefits and harms is limited. What does this paper add? This narrative overview of 19 systematic reviews and two reviews of systematic reviews published over the past 5 years provides a summary of cumulative evidence of clinical and organisational effects of contemporary eHealth technologies in hospital practice. EMRs have the potential to increase accuracy and completeness of clinical information, reduce documentation time and enhance information transfer and organisational efficiency. CPOE appears to improve laboratory turnaround times and decrease resource utilisation. ePrescribing significantly reduces medication errors and adverse drug events. CDSS, especially those used at the point of care and integrated into workflows, attract the strongest evidence for substantially increasing clinician adherence to guidelines, appropriateness of disease and treatment monitoring and optimal medication use. Evidence of effects of eHealth technologies on discrete clinical outcomes, such as morbid events, mortality and readmissions, is currently limited and conflicting. What are the implications for practitioners? eHealth technologies confer benefits in improving quality and safety of care with little evidence of major hazards. Whether EMRs and CPOE can affect clinical outcomes or

  7. Recommendations for the clinical practice: Standards, options and recommendations 2003 for the use of recombinant erythropoietin (alpha and beta epoetine, alpha darbepoetine, EPO) in the taking charge of anemia in oncology for the patients treated by radiotherapy, update

    International Nuclear Information System (INIS)

    Marchal, Ch.; Spaeth, C.; Casadevall, N.; Daouphars, M.; Marec-Berard, P.; Fabre, N.; Haugh, M.

    2004-01-01

    Standards, Options and Recommendations for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy - UPDATE 2003. Context. - 'The Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the twenty French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives. - To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy. Methods. - The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomized clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002. Results. - There is no standard attitude for use of rHuEPO in patients undergoing radiotherapy. There is no evidence to support use of rHuEPO in patients with ENT cancer receiving radiotherapy alone. In patients undergoing curative radiotherapy, it is recommended to correct anaemia under 10 g/dL using transfusion rather than rHuEPO. When the haemoglobin concentration is between 12 g/dL and 14 g/dL initial use of rHuEPO can be an option under certain conditions for radio-chemotherapy if the risk of anaemia is

  8. Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice: A microsimulation screening analysis

    NARCIS (Netherlands)

    S. Carlsson (Sigrid); T.M. de Carvalho Delgado Marques (Tiago); M.J. Roobol-Bouts (Monique); J. Hugosson (Jonas); A. Auvinen (Anssi); M. Kwiatkowski (Maciej); A. Villers (Arnoud); M. Zappa (Marco); V. Nelen (Vera); A. Páez (Alvaro); J.A. Eastham (James); H. Lilja (Hans); H.J. de Koning (Harry); A.J. Vickers (Andrew); E.A.M. Heijnsdijk (Eveline)

    2016-01-01

    textabstractBACKGROUND: Prostate-specific antigen (PSA) screening and concomitant treatment can be implemented in several ways. The authors investigated how the net benefit of PSA screening varies between common practice versus “good practice.”. METHODS: Microsimulation screening analysis (MISCAN)

  9. 2016 Updates to US Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use: Highlights for Adolescent Patients.

    Science.gov (United States)

    Hoopes, Andrea J; Simmons, Katharine B; Godfrey, Emily M; Sucato, Gina S

    2017-04-01

    The US Medical Eligibility Criteria for Contraceptive Use (MEC) and US Selected Practice Recommendations for Contraceptive Use (SPR) provide evidence-based guidance to safely provide contraception counseling and services. Both documents were updated in 2016 and are endorsed by the North American Society for Pediatric and Adolescent Gynecology. The purpose of this mini-review is to highlight updates to the US MEC and US SPR that are most relevant to health care providers of adolescents to support dissemination and implementation of these evidence-based best practices. This document is intended to highlight these changes and to complement, not replace, the detailed practice guidance within the US MEC and US SPR. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  10. Somatosensory evoked potentials in the assessment of peripheral neuropathies: Commented results of a survey among French-speaking practitioners and recommendations for practice.

    Science.gov (United States)

    Morizot-Koutlidis, R; André-Obadia, N; Antoine, J-C; Attarian, S; Ayache, S S; Azabou, E; Benaderette, S; Camdessanché, J-P; Cassereau, J; Convers, P; d'Anglejean, J; Delval, A; Durand, M-C; Etard, O; Fayet, G; Fournier, E; Franques, J; Gavaret, M; Guehl, D; Guerit, J-M; Krim, E; Kubis, N; Lacour, A; Lozeron, P; Mauguière, F; Merle, P-E; Mesrati, F; Mutschler, V; Nicolas, G; Nordine, T; Pautot, V; Péréon, Y; Petiot, P; Pouget, J; Praline, J; Salhi, H; Trébuchon, A; Tyvaert, L; Vial, C; Zola, J-M; Zyss, J; Lefaucheur, J-P

    2015-05-01

    Somatosensory evoked potentials (SSEPs) are increasingly performed for the assessment of peripheral neuropathies, but no practical guidelines have yet been established in this specific application. To determine the relevant indication criteria and optimal technical parameters for SSEP recording in peripheral neuropathy investigation. A survey was conducted among the French-speaking practitioners with experience of SSEP recording in the context of peripheral neuropathies. The results of the survey were analyzed and discussed to provide recommendations for practice. SSEPs appear to be a second-line test when electroneuromyographic investigation is not sufficiently conclusive, providing complementary and valuable information on central and proximal peripheral conduction in the somatosensory pathways. Guidelines for a standardized recording protocol, including the various parameters to be measured, are proposed. We hope that these proposals will help to recognize the value of this technique in peripheral neuropathy assessment in clinical practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Good practices according to WHO's recommendation for normal labor and birth and women's assessment of the care received: the "birth in Brazil" national research study, 2011/2012.

    Science.gov (United States)

    Baldisserotto, Marcia Leonardi; Theme Filha, Mariza Miranda; da Gama, Silvana Granado Nogueira

    2016-10-17

    The World Health Organization recommends good practices for the conduct of uncomplicated labor and birth, with the aim of improving the quality of and assessment by women of childbirth care. The aim of this study was to evaluate the association between adoption of good practices according to WHO's recommendation for normal labor and birth and assessment by women of the care received. Birth in Brazil is a national hospital-based study with countrywide representation consisting of 23,894 mothers and their newborns, conducted between February 2011 and October 2012. The present study analysed a subsample of this national survey. Postpartum women classified as low risk during pregnancy who had experienced either spontaneous or induced labor were included in this study, totalling 4102 mothers. To estimate the association between assessment by women of the childbirth care received (dependent variable) and good practices according to WHO's recommendation during normal labor and birth (independent variables), a multinomial logistic regression analysis was used and crude and adjusted odds ratios calculated with their 95 % confidence intervals. The good practices associated with positive assessment of the care received by women during labor and birth included the partner's presence, privacy in the birthing place, time available to ask questions, clarity of information received, and empathic support from caregivers during labor and birth. Freedom of movement, free nutrition offered, choice of companions, nonpharmacological analgesia, skin-to-skin contact and breastfeeding in the childbirth room were not associated with the assessment by women of the care received. Our findings reveal the importance to mothers of their relationship with the team of caregivers during labor and birth. Therefore, caregiver teams must be qualified within a more humanistic vision of childbirth health care.

  12. Do health workers’ preferences influence their practices? Assessment of providers’ attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania

    Directory of Open Access Journals (Sweden)

    Masanja Irene M

    2012-11-01

    Full Text Available Abstract Background Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ was replaced by sulfadoxine-pyrimethamine (SP for management of uncomplicated malaria and by late 2006, SP was replaced by artemether-lumefantrine (AL. We assessed health workers’ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Methods Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: i children below 5; ii older children and adults; and iii pregnant women. Practice was ascertained by asking which antimalarial was used in the last malaria episode by the health worker him/herself and/or dependants. Univariate and multivariate logistic regression was used to identify factors associated with reported attitudes and practices towards the new treatment recommendations. Results A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. SP was less preferred antimalarial in hospitals and private health facilities (p Conclusion Following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that, other factors than providers’ attitude may have more influence in their personal treatment practices.

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

    Science.gov (United States)

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

    2014-07-01

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

  14. Clinical practice guideline: 2006 update of recommendations for the radiotherapeutic management of patients with soft tissue sarcoma (sarcoma of the extremity, uterine sarcoma and retroperitoneal sarcoma)

    International Nuclear Information System (INIS)

    Le Pechoux, C.; Pautier, P.; Le Cesne, A.; Delannes, M.; Bui, B.N.; Blay, J.Y.; Bonichon, F.; Bonvalot, S.; Morice, P.; Chevalier-Place, A.; Taieb, S.; Coindre, J.M.; Ray-Coquard, I.; Stoeckle, E.

    2006-01-01

    Context. - The National French Federation of Comprehensive Cancer Centres (FNCLCC) initiated the update of clinical practice guideline for the management of patients with soft tissue sarcoma in collaboration with the French Sarcoma Group (GSF-GETO), specialists from French public universities, general hospitals and private clinics and with the French National Cancer Institute. This work is based on the methodology developed in the 'Standards, Options and Recommendations' (SOR) project. Objectives - To update SOR guidelines for the management of patients with oft tissue sarcoma previously validated in 1995. Methods. -The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers. Results. - This article presents the updated recommendations for radiotherapeutic management. The main recommendations are: 1) irradiation before or after surgical treatment is the standard for soft tissue sarcoma of the extremity and uterine sarcoma; 2) no systematic irradiation should be done in case of retroperitoneal sarcoma. (author)

  15. State of affairs of tuberculosis in prison facilities: a systematic review of screening practices and recommendations for best TB control

    NARCIS (Netherlands)

    Vinkeles Melchers, Natalie V. S.; van Elsland, Sabine L.; Lange, Joep M. A.; Borgdorff, Martien W.; van den Hombergh, Jan

    2013-01-01

    Prisoners are at high risk of developing tuberculosis (TB), causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison

  16. The Value of Applied Research: Retrieval Practice Improves Classroom Learning and Recommendations from a Teacher, a Principal, and a Scientist

    Science.gov (United States)

    Agarwal, Pooja K.; Bain, Patrice M.; Chamberlain, Roger W.

    2012-01-01

    Over the course of a 5-year applied research project with more than 1,400 middle school students, evidence from a number of studies revealed that retrieval practice in authentic classroom settings improves long-term learning (Agarwal et al. 2009; McDaniel et al., "Journal of Educational Psychology" 103:399-414, 2011; McDaniel et al.…

  17. IMPACT 2002+, ReCiPe 2008 and ILCD’s recommended practice for characterization modelling in life cycle impact assessment: a case study-based comparison

    DEFF Research Database (Denmark)

    Owsianiak, Mikolaj; Laurent, Alexis; Bjørn, Anders

    2014-01-01

    Purpose The European Commission has launched a recommended set of characterization models and factors for application in life cycle impact assessment (LCIA). However, it is not known how this recommended practice, referred to as the ILCD 2009, performs relative to some of the most frequently used...... and ecosystems, all studied methodologies consistently identify the same window option as having the lowest and the highest environmental impact. This is mainly because few processes, associated with production of heat, dominate the total impacts, and there is a large difference in demand for heat between...... categories. The differences are somewhat smaller (within 1 order of magnitude) for the impact categories respiratory inorganics and photochemical ozone formation, and are within a factor of 3 for the remaining impact categories. The differences in impact scores in our case study are brought about...

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

    Directory of Open Access Journals (Sweden)

    Jakub Taradaj

    2017-03-01

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

  19. The Healthy Lifestyles Programme (HeLP)--an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families.

    Science.gov (United States)

    Lloyd, Jenny; Wyatt, Katrina

    2015-01-20

    Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.

  20. The Healthy Lifestyles Programme (HeLP — An Overview of and Recommendations Arising from the Conceptualisation and Development of an Innovative Approach to Promoting Healthy Lifestyles for Children and Their Families

    Directory of Open Access Journals (Sweden)

    Jenny Lloyd

    2015-01-01

    Full Text Available Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.

  1. Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: Recommendations for clinical practice from the French Chronic Myeloid Leukemia Study Group.

    Science.gov (United States)

    Rea, Delphine; Ame, Shanti; Berger, Marc; Cayuela, Jean-Michel; Charbonnier, Aude; Coiteux, Valérie; Cony-Makhoul, Pascale; Dubruille, Viviane; Dulucq, Stéphanie; Etienne, Gabriel; Legros, Laurence; Nicolini, Franck; Roche-Lestienne, Catherine; Escoffre-Barbe, Martine; Gardembas, Martine; Guerci-Bresler, Agnès; Johnson-Ansah, Hyacinthe; Rigal-Huguet, Françoise; Rousselot, Philippe; Mahon, François-Xavier

    2018-05-03

    The ultimate goal of chronic myeloid leukemia management in the tyrosine kinase inhibitor (TKI) era for patients who obtain deep molecular responses is maintaining a durable off-treatment response after treatment discontinuation; this situation is called treatment-free remission (TFR). Knowledge accumulated during the last 10 years justifies moving TFR strategies from research to clinical practice. Twenty experts from the French Chronic Myeloid Leukemia Study Group (France Intergroupe des Leucémies Myéloïdes Chroniques), including 17 hematologists, 2 molecular biologists, and 1 cytogeneticist, critically reviewed published data with the goal of developing evidence-based recommendations for TKI discontinuation in clinical practice. Clinically relevant questions were addressed, including the selection of candidate patients (with known prognostic factors for outcomes taken into account), detailed monitoring procedures during the treatment-free phase, a definition of relapse requiring therapy resumption, and monitoring after treatment reintroduction. This work presents consensus statements with the aim of guiding physicians and biologists by means of pragmatic recommendations for safe TKI discontinuation in daily practice. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  2. Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations.

    Science.gov (United States)

    Friedman, Audrey Jusko; Cosby, Roxanne; Boyko, Susan; Hatton-Bauer, Jane; Turnbull, Gale

    2011-03-01

    The objective of this study was to determine effective teaching strategies and methods of delivery for patient education (PE). A systematic review was conducted and reviews with or without meta-analyses, which examined teaching strategies and methods of delivery for PE, were included. Teaching strategies identified are traditional lectures, discussions, simulated games, computer technology, written material, audiovisual sources, verbal recall, demonstration, and role playing. Methods of delivery focused on how to deliver the teaching strategies. Teaching strategies that increased knowledge, decreased anxiety, and increased satisfaction included computer technology, audio and videotapes, written materials, and demonstrations. Various teaching strategies used in combination were similarly successful. Moreover, structured-, culturally appropriate- and patient-specific teachings were found to be better than ad hoc teaching or generalized teaching. Findings provide guidance for establishing provincial standards for the delivery of PE. Recommendations concerning the efficacy of the teaching strategies and delivery methods are provided.

  3. Management of HIV Infection during Pregnancy in the United States: Updated Evidence-Based Recommendations and Future Potential Practices

    Directory of Open Access Journals (Sweden)

    Bassam H. Rimawi

    2016-01-01

    Full Text Available All HIV-infected women contemplating pregnancy should initiate combination antiretroviral therapy (cART, with a goal to achieve a maternal serum HIV RNA viral load beneath the laboratory level of detection prior to conceiving, as well as throughout their pregnancy. Successfully identifying HIV infection during pregnancy through screening tests is essential in order to prevent in utero and intrapartum transmission of HIV. Perinatal HIV transmission can be less than 1% when effective cART, associated with virologic suppression of HIV, is given during the ante-, intra-, and postpartum periods. Perinatal HIV guidelines, developed by organizations such as the World Health Organization, American College of Obstetricians and Gynecologists, and the US Department of Health and Human Services, are constantly evolving, and hence the aim of our review is to provide a useful concise review for medical providers caring for HIV-infected pregnant women, summarizing the latest and current recommendations in the United States.

  4. Protection of the public in a radiological emergency: International recommendations and actual practice in the USSR and Russia after the Chernobyl accident

    International Nuclear Information System (INIS)

    Konstantinov, Yu.

    1997-01-01

    Whilst the basic principles for protection of the public in radiological emergency are well discussed and widely accepted, application of these principles in real intervention practices face problems. Radiological information is most complicated to understand and interpret for decision-makers. The paper deals with some of these points when establishing intervention levels, which need careful attention to reduce misunderstanding in the decision-making process. The points listed below are considered on the basis of analysis of international recommendations (ICRP, IAEA, CEC et al.) as well as experience gained via the post-Chernobyl intervention policy in Russia. The latter is briefly summarized here to introduce the following discussion

  5. A Global Assessment on Climate Research Engaging Indigenous Knowledge Systems and Recommendations for Quality Standards of Research Practice in Indigenous Communities

    Science.gov (United States)

    Davíd-Chavez, D. M.; Gavin, M. C.

    2017-12-01

    . This study also draws from the researcher's experiences as an Indigenous scientist and includes recommendations for quality research practice. This global assessment provides an evidence base to inform our understanding of broader impacts related to research design.

  6. Renewable Energy Services For Developing Countries - In support of the millennium development goals: recommended practice and key lessons

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    Almost 1.6 billion people currently live without electricity in developing countries. These people live in either remote rural areas that have no connection to electrical power grids, or urban areas with inadequate utility systems. The demand for energy in these countries is expected to grow with increases in population and living standards. The International Energy Agency (IEA) estimates that developing countries will need to double their electrical power output by 2020. Despite the growth in energy consumption, the number of people disadvantaged by a lack of modern energy services has remained relatively unchanged. The focus of the international donor community is clearly aimed at poverty alleviation in general, and specifically at achieving the targets known as the Millennium Development Goals (MDGs). Renewable energy technologies have a tremendous potential in providing energy services to developing countries and in helping achieve the MDGs. This document highlights how meeting the MDGs can be facilitated through a sustainable energy supply, and provides case studies from around the world to demonstrate that these technologies are applicable in real-life situations. Based on these cumulative experiences and in order for energy services to be delivered effectively, key lessons and recommendations are put forward with regard to policy, finance and implementation. (author)

  7. Limitations and information needs for engineered nanomaterial-specific exposure estimation and scenarios: recommendations for improved reporting practices

    Science.gov (United States)

    Clark, Katherine; van Tongeren, Martie; Christensen, Frans M.; Brouwer, Derk; Nowack, Bernd; Gottschalk, Fadri; Micheletti, Christian; Schmid, Kaspar; Gerritsen, Rianda; Aitken, Rob; Vaquero, Celina; Gkanis, Vasileios; Housiadas, Christos; de Ipiña, Jesús María López; Riediker, Michael

    2012-09-01

    The aim of this paper is to describe the process and challenges in building exposure scenarios for engineered nanomaterials (ENM), using an exposure scenario format similar to that used for the European Chemicals regulation (REACH). Over 60 exposure scenarios were developed based on information from publicly available sources (literature, books, and reports), publicly available exposure estimation models, occupational sampling campaign data from partnering institutions, and industrial partners regarding their own facilities. The primary focus was on carbon-based nanomaterials, nano-silver (nano-Ag) and nano-titanium dioxide (nano-TiO2), and included occupational and consumer uses of these materials with consideration of the associated environmental release. The process of building exposure scenarios illustrated the availability and limitations of existing information and exposure assessment tools for characterizing exposure to ENM, particularly as it relates to risk assessment. This article describes the gaps in the information reviewed, recommends future areas of ENM exposure research, and proposes types of information that should, at a minimum, be included when reporting the results of such research, so that the information is useful in a wider context.

  8. Limitations and information needs for engineered nanomaterial-specific exposure estimation and scenarios: recommendations for improved reporting practices

    Energy Technology Data Exchange (ETDEWEB)

    Clark, Katherine, E-mail: katherine.clark@lkc-ltd.com [LKC (Switzerland); Tongeren, Martie van, E-mail: martie.vantongeren@iom-world.org [Institute of Occupational Medicine (IOM) (United Kingdom); Christensen, Frans M., E-mail: fmch@cowi.dk [COWI (Denmark); Brouwer, Derk, E-mail: dick.brouwer@tno.nl [TNO (Netherlands); Nowack, Bernd, E-mail: nowack@empa.ch; Gottschalk, Fadri, E-mail: Fadri.Gottschalk@empa.ch [EMPA-Swiss Federal Laboratories for Materials Science and Technology (Switzerland); Micheletti, Christian, E-mail: Christian.micheletti@gmail.com [Veneto NanoTech S.C.p.A (Italy); Schmid, Kaspar, E-mail: kasparschmid@alumni.ethz.ch [Institute of Occupational Medicine (IOM) (United Kingdom); Gerritsen, Rianda, E-mail: rianda.gerritsen@tno.nl [TNO (Netherlands); Aitken, Rob, E-mail: rob.aitken@iom-world.org [Institute of Occupational Medicine (IOM) (United Kingdom); Vaquero, Celina, E-mail: celina.vaquero@tecnalia.com [TECNALIA Research and Innovation (Spain); Gkanis, Vasileios, E-mail: v_gkanis@hotmail.com; Housiadas, Christos, E-mail: christos@ipta.demokritos.gr [National Center for Scientific Research ' Demokritos' (Greece); Ipina, Jesus Maria Lopez de, E-mail: jesus.lopezdeipina@tecnalia.com [TECNALIA Research and Innovation (Spain); Riediker, Michael, E-mail: michael.riediker@hospvd.ch [Institute for Work and Health (IST) (Switzerland)

    2012-09-15

    The aim of this paper is to describe the process and challenges in building exposure scenarios for engineered nanomaterials (ENM), using an exposure scenario format similar to that used for the European Chemicals regulation (REACH). Over 60 exposure scenarios were developed based on information from publicly available sources (literature, books, and reports), publicly available exposure estimation models, occupational sampling campaign data from partnering institutions, and industrial partners regarding their own facilities. The primary focus was on carbon-based nanomaterials, nano-silver (nano-Ag) and nano-titanium dioxide (nano-TiO{sub 2}), and included occupational and consumer uses of these materials with consideration of the associated environmental release. The process of building exposure scenarios illustrated the availability and limitations of existing information and exposure assessment tools for characterizing exposure to ENM, particularly as it relates to risk assessment. This article describes the gaps in the information reviewed, recommends future areas of ENM exposure research, and proposes types of information that should, at a minimum, be included when reporting the results of such research, so that the information is useful in a wider context.

  9. Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research.

    Science.gov (United States)

    Goldhahn, Jörg; Beaton, Dorcas; Ladd, Amy; Macdermid, Joy; Hoang-Kim, Amy

    2014-02-01

    Lack of standardization of outcome measurement has hampered an evidence-based approach to clinical practice and research. We adopted a process of reviewing evidence on current use of measures and appropriate theoretical frameworks for health and disability to inform a consensus process that was focused on deriving the minimal set of core domains in distal radius fracture. We agreed on the following seven core recommendations: (1) pain and function were regarded as the primary domains, (2) very brief measures were needed for routine administration in clinical practice, (3) these brief measures could be augmented by additional measures that provide more detail or address additional domains for clinical research, (4) measurement of pain should include measures of both intensity and frequency as core attributes, (5) a numeric pain scale, e.g. visual analogue scale or visual numeric scale or the pain subscale of the patient-reported wrist evaluation (PRWE) questionnaires were identified as reliable, valid and feasible measures to measure these concepts, (6) for function, either the Quick Disability of the arm, shoulder and hand questionnaire or PRWE-function subscale was identified as reliable, valid and feasible measures, and (7) a measure of participation and treatment complications should be considered core outcomes for both clinical practice and research. We used a sound methodological approach to form a comprehensive foundation of content for outcomes in the area of distal radius fractures. We recommend the use of symptom and function as separate domains in the ICF core set in clinical research or practice for patients with wrist fracture. Further research is needed to provide more definitive measurement properties of measures across all domains.

  10. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

    Directory of Open Access Journals (Sweden)

    Luca Busetto

    2017-12-01

    Full Text Available Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

  11. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

    Science.gov (United States)

    Busetto, Luca; Dicker, Dror; Azran, Carmil; Batterham, Rachel L.; Farpour-Lambert, Nathalie; Fried, Martin; Hjelmesæth, Jøran; Kinzl, Johann; Leitner, Deborah R.; Makaronidis, Janine M.; Schindler, Karin; Toplak, Hermann; Yumuk, Volkan

    2018-01-01

    Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations. PMID:29207379

  12. The RANZCP guidelines for Schizophrenia: Why is our practice so far short of our recommendations, and what can we do about it?

    Science.gov (United States)

    Nielssen, Olav; McGorry, Patrick; Castle, David; Galletly, Cherrie

    2017-07-01

    The new RANZCP guidelines for the treatment of schizophrenia and related disorders highlights what we know works. In this paper, we examine why patients so often fail to benefit from this knowledge and why clinical practice falls so far short of the recommended standard. Instead of the continuous improvement that we expect of health care in general, in psychiatry we face an accelerating decline in systems of care. There has been a sustained underinvestment in public mental health care and a shared failure by State and Federal governments to construct and commit to a governance and funding model that can deliver the standard of care that is available in other major non-communicable diseases, and which we know is equally possible for severe mental illness. This paper sets out some of the reasons for the poor quality of care received by many people with schizophrenia and related disorders in Australia, and describes ways that care could be improved. In particular, we recommend an explicit statement of what constitutes an adequate standard of care, for people at all stages of these illnesses. This would help provide transparency about whether the care provided by mental health services achieves these benchmarks, and enable publication of results comparing the performance of different states and regional services. Patients and families, as well as professional, consumer and carer organizations would then be able to see clearly where the deficits are and demand resources and care that match the recommendations.

  13. Codex general standard for irradiated foods and recommended international code of practice for the operation of radiation facilities used for the treatment of foods

    International Nuclear Information System (INIS)

    1990-06-01

    The FAO/WHO Codex Alimentarius Commission was established to implement the Joint FAO/WHO Food Standards Programme. The purpose of this programme is to protect the health of consumers and to ensure fair practices in the food trade. At its 15th session, held in July 1983, the Commission adopted a Codex General Standard for Irradiated Foods and a Recommended International Code of Practice for the Operation of Radiation Facilities used for the Treatment of Foods. This Standard takes into account the recommendations and conclusions of the Joint FAO/IAEA/WHO Expert Committees convened to evaluate all available data concerning the various aspects of food irradiation. This Standard refers only to those aspects which relate to the processing of foods by ionising energy. The Standard recognizes that the process of food irradiation has been established as safe for general application to an overall average level of absorbed dose of 10 KGy. The latter value shold not be regarded as a toxicological upper limit above which irradiated foods become unsafe; it is simply the level at or below which safety has been established. The Standard provides certain mandatory provisions concerning the facilities used and for the control of the process in the irradiation plants. The present Standard requires that shipping documents accompanying irradiated foods moving in trade should indicate the fact of irradiation. The labelling of prepackaged irradiated foods intended for direct sale to the consumer is not covered in this Standard

  14. Codex general standard for irradiated foods and recommended international code of practice for the operation of radiation facilities used for the treatment of foods

    International Nuclear Information System (INIS)

    1984-01-01

    The FAO/WHO Codex Alimentarius Commission was established to implement the Joint FAO/WHO Food Standards Programme. The purpose of this programme is to protect the health of consumers and to ensure fair practices in the food trade. At its 15th session, held in July 1983, the Commission adopted a Codex General Standard for Irradiated Foods and a Recommended International Code of Practice for the Operation of Radiation Facilities used for the Treatment of Foods. This Standard takes into account the recommendations and conclusions of the Joint FAO/IAEA/WHO Expert Committees convened to evaluate all available data concerning the various aspects of food irradiation. This Standard refers only to those aspects which relate to the processing of foods by ionising energy. The Standard recognizes that the process of food irradiation has been established as safe for general application to an overall average level of absorbed dose of 10 kGy. The latter value should not be regarded as a toxicological upper limit above which irradiated foods become unsafe; it is simply the level at or below which safety has been established. The Standard provides certain mandatory provisions concerning the facilities used and for the control of the process in the irradiation plants. The present Standard requires that shipping documents accompanying irradiated foods moving in trade should indicate the fact of irradiation. The labelling of prepackaged irradiated foods intended for direct sale to the consumer is not covered in this Standard

  15. International recommendations

    International Nuclear Information System (INIS)

    Lindell, Bo

    1986-01-01

    , provided that, in what may be a multi-stage process, additional modifying factors ('promotors') are at hand. The postulated assumption for stochastic effects is that the risk (probability of cancer) from a small dose increment is proportional to the dose increment, irrespective of previous or later radiation exposures. No dose increment can then be said to be entirely 'safe' although the risk would be very small if the dose increment is small. For normal operation of practices that cause radiation exposures, individuals are protected by dose limits recommended by ICRP. The dose limits guarantee that the radiation risk will not dominate the individual's risk situation. However, the dose limits are supplemented by the further recommendation that all radiation exposures should be kept as low as reasonably achievable, 'economic and social factors being taken into account'. This recommendation is also referred to as the recommendation on optimizing radiation protection. Various methods for this have been used, for example differential cost/benefit analysis. For accidental situations, the ICRP dose limits do not apply. The situation of persons who are at risk of being exposed, e.g. from radioactive substances in the environment or in food-stuffs, can only be improved by remedial actions. The purpose of remedial actions is to eliminate high risks, if possible, and to reduce any radiation risk as far as reasonably achievable. An obvious requirement is that the remedial action must not put individuals in a worse situation than if the action had not been taken. It follows the dose that must be avoided by remedial action, and the dose reduction which would be reasonably achievable by the action, will depend on the type of action and the risks and other consequences of the action. It is therefore not possible to give universally applicable action levels of dose. However, for certain identified actions in described situations, action levels may be given in beforehand. In its

  16. [Consensus clinical practice guidelines of the Andalusian Epilepsy Society: therapeutic recommendations when dealing with a first epileptic seizure and in epileptic status].

    Science.gov (United States)

    Mercadé-Cerda, J M; Sánchez-Alvarez, J C; Galán-Barranco, J M; Moreno-Alegre, V; Serrano-Castro, P J; Cañadillas-Hidalgo, F M

    Most epileptic seizures are brief and self-limiting, but sometimes they can last longer than expected and this entails (in the case of generalised seizures) a high risk of morbidity and mortality, which increases as they get longer. This severity justifies the need to draw up a set of consensus-based practice guidelines based on implicit evidence, to use Liberati's nomenclature, concerning aspects related to the recommended therapeutic management of a patient with prolonged seizures who is being attended in an emergency department. A selective search was conducted on PubMed-Medline for scientific information related to the subject using scientific evidence filters. This search was completed in other scientific evidence search engines, such as Tripdatabase, Biblioteca Cochrane Plus or DARE. The selected references were analysed and discussed by the authors, and the available evidence and any recommendations that could be drawn from it were collected. The search revealed the existence of 33 primary documents and six practice guidelines or protocols related with the topic under study. The recommendations were inserted in the text explicitly. The therapeutic protocol must be started when faced with any seizures that last more than five minutes. First, steps must be taken to ensure proper respiratory and cardiocirculatory functioning, and then fast-acting antiepileptic drugs are administered intravenously and in high doses until the cause is identified and controlled. Due to their lower level of morbidity and mortality, prolonged non-convulsive seizures do not generally require therapy that is so vigorous and with such a high risk of complications.

  17. Opioid Therapy for Chronic Pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline.

    Science.gov (United States)

    Rosenberg, Jack M; Bilka, Brandon M; Wilson, Sara M; Spevak, Christopher

    2018-05-01

    The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids. This Opioid Therapy CPG was developed for VA-DoD service members, veterans, and their families. The VA/DoD Evidence-Based Practice Work Group convened a VA/DoD guideline renewal development effort and conformed to the guidelines established by the VA/DoD Joint Executive Council (JEC) and VA/DoD Health Executive Council (HEC). The panel developed questions, searched and evaluated the literature, developed recommendations using GRADE methodology, and developed algorithms. Passage of the CARA Act by Congress compelled consideration and comparison with the CDC opioid therapy guideline mid-development. There were 18 recommendations made. This article focuses on guideline development and key recommendations with CDC comparisons taken from four major areas, including: initiation and continuation of opioids;type, dose, follow-up, and taper of opioids;risk mitigation;acute pain. Guideline development and recommendations are presented. There was substantial overlap with the CDC opioid guideline. Additionally, there were items particularly relevant to the VA-DoD, including risk mitigation, suicide prevention, and preventing opioid use disorder in young patients. Our guideline highlights avoiding opioid therapy longer than 90 days as a critical juncture.

  18. Does audit and feedback improve the adoption of recommended practices? Evidence from a longitudinal observational study of an emerging clinical network in Kenya

    Science.gov (United States)

    Gachau, Susan; Ayieko, Philip; Gathara, David; Mwaniki, Paul; Ogero, Morris; Akech, Samuel; Maina, Michuki; Agweyu, Ambrose; Oliwa, Jacquie; Julius, Thomas; Malla, Lucas; Wafula, James; Mbevi, George; Irimu, Grace; English, Mike

    2017-01-01

    Background Audit and feedback (A&F) is widely used in healthcare but there are few examples of how to deploy it at scale in low-income countries. Establishing the Clinical Information Network (CIN) in Kenya provided an opportunity to examine the effect of A&F delivered as part of a wider set of activities to promote paediatric guideline adherence. Methods We analysed data collected from medical records on discharge for children aged 2–59 months from 14 Kenyan hospitals in the CIN. Hospitals joined CIN in phases and for each we analysed their initial 25 months of participation that occurred between December 2013 and March 2016. A total of 34 indicators of adherence to recommendations were selected for evaluation each classified by form of feedback (passive, active and none) and type of task (simple or difficult documentation and those requiring cognitive work). Performance change was explored graphically and using generalised linear mixed models with attention given to the effects of time and use of a standardised paediatric admission record (PAR) form. Results Data from 60 214 admissions were eligible for analysis. Adherence to recommendations across hospitals significantly improved for 24/34 indicators. Improvements were not obviously related to nature of feedback, may be related to task type and were related to PAR use in the case of documentation indicators. There was, however, marked variability in adoption and adherence to recommended practices across sites and indicators. Hospital-specific factors, low baseline performance and specific contextual changes appeared to influence the magnitude of change in specific cases. Conclusion Our observational data suggest some change in multiple indicators of adherence to recommendations (aspects of quality of care) can be achieved in low-resource hospitals using A&F and simple job aides in the context of a wider network approach. PMID:29104769

  19. Recommendation Report: EJournals/EBooks A-Z Management System

    KAUST Repository

    Ramli, Rindra M.

    2014-01-01

    This is a recommendation report for KAUST Library on the Ejournals / EBooks AZ Management systems project. It briefly described the issues faced by the ERM Team, project plan overview and the project findings as well as the recommendation(s).

  20. Green Remediation Best Management Practices: Overview of EPA's Methodology to Address the Environmental Footprint of Site Cleanup

    Science.gov (United States)

    Contaminated site cleanups involving complex activities may benefit from a detailed environmental footprint analysis to inform decision-making about application of suitable best management practices for greener cleanups.

  1. Social media guidelines and best practices: recommendations from the Council of Residency Directors Social Media Task Force.

    Science.gov (United States)

    Pillow, Malford T; Hopson, Laura; Bond, Michael; Cabrera, Daniel; Patterson, Leigh; Pearson, David; Sule, Harsh; Ankel, Felix; Fernández-Frackelton, Madonna; Hall, Ronald V; Kegg, Jason A; Norris, Donald; Takenaka, Katrin

    2014-02-01

    Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and "brand" the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence.

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

    Directory of Open Access Journals (Sweden)

    Baiju Ahemmed

    2017-01-01

    Full Text Available Purpose. To improve success of in vitro fertilization (IVF, assisted reproductive technology (ART experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS. Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index.

  3. 2015 Oman Heart Association guidelines for the management of hypertension : practical recommendations from the Oman Heart Association (OHA).

    Science.gov (United States)

    El-Deeb, Mohammed H; Sulaiman, Kadhim J; Al-Riyami, Abdullah A; Mohsin, Nabil; Al-Mukhaini, Mohamed; Al-Lamki, Mohamed; Al-Busaidi, Noor; Al-Salmi, Issa; Al-Lawati, Jawad; Al-Rawahi, Najib; Al-Riyami, Mohamed B; Abdul-Rahman, Said; Al-Hinai, Said; Jaffer, Batool; Al-Wahaebi, Ahmed; Al-Khalili, Hanan; Al-Zadjali, Matllooba

    2015-03-01

    Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.

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

    Science.gov (United States)

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

    2017-01-01

    Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index. PMID:28246628

  5. Conducting a Discrete-Choice Experiment Study Following Recommendations for Good Research Practices: An Application for Eliciting Patient Preferences for Diabetes Treatments.

    Science.gov (United States)

    Janssen, Ellen M; Hauber, A Brett; Bridges, John F P

    2018-01-01

    To consolidate and illustrate good research practices in health care to the application and reporting of a study measuring patient preferences for type 2 diabetes mellitus medications, given recent methodological advances in stated-preference methods. The International Society for Pharmacoeconomics and Outcomes Research good research practices and other recommendations were used to conduct a discrete-choice experiment. Members of a US online panel with type 2 diabetes mellitus completed a Web-enabled, self-administered survey that elicited choices between treatment pairs with six attributes at three possible levels each. A D-efficient experimental design blocked 48 choice tasks into three 16-task surveys. Preference estimates were obtained using mixed logit estimation and were used to calculate choice probabilities. A total of 552 participants (51% males) completed the survey. Avoiding 90 minutes of nausea was valued the highest (mean -10.00; 95% confidence interval [CI] -10.53 to -9.47). Participants wanted to avoid low blood glucose during the day and/or night (mean -3.87; 95% CI -4.32 to -3.42) or one pill and one injection per day (mean -7.04; 95% CI -7.63 to -6.45). Participants preferred stable blood glucose 6 d/wk (mean 4.63; 95% CI 4.15 to 5.12) and a 1% decrease in glycated hemoglobin (mean 5.74; 95% CI 5.22 to 6.25). If cost increased by $1, the probability that a treatment profile would be chosen decreased by 1%. These results are consistent with the idea that people have strong preferences for immediate consequences of medication. Despite efforts to produce recommendations, ambiguity surrounding good practices remains and various judgments need to be made when conducting stated-preference studies. To ensure transparency, these judgments should be described and justified. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. [Surveillance system for adverse events following immunization against yellow fever in Burkina Faso in 2008. Good practice recommendations].

    Science.gov (United States)

    Yaméogo, T M; Breugelmans, J G; Kambou, J L; Badolo, O; Tiendrebéogo, S; Traoré, E; Avokey, F; Yactayo, S

    2009-08-01

    -duty hospital staff were interviewed. The Ministry of Health appointed an 11-member National Expert Committee (NEC) to investigate and judge the status of reported cases. After eliminating coincidental events, program errors, and undetermined cases, vaccination was established as the suspected cause. Suspected cases were classified as viserotrophic or neurotrophic AEFI and recorded as probable cases pending confirmation by virologic studies. An AEFI center with a duly mandated coordinator was designated to coordinate the activities of the different teams involved and to serve as an interface for the expert committee. Detection and investigation teams were formed at each of the hospital locations. A national laboratory as well as an international virology laboratory were designated as reference centers for performance of further testing. Results. Between November 28, 2008, and December 9, 2008, a total 7,566,218 people (aged 9 months and older) excluding pregnant women, critically ill patients, and individuals allergic to eggs, were immunized in 37 of the 63 districts in Burkina Faso. Administrative vaccination coverage was 102.3%. Systematic line-listing at the 3 hospital centers accounted for most of the suspected serious AEFIs identified from reported cases. During the AEFI surveillance period, the NEC met once a week to discuss the suspected serious AEFI. Some cases were excluded and others were designated for further testing. At least one biological specimen was available for all retained cases. Each case benefited from laboratory testing to achieve differential clinical diagnosis as well as from virological testing (results pending). Conclusion. Experiences in Burkina Faso demonstrates the value of active surveillance and of systematic line listing. However, the duration of case investigation and data management was at least six months. To improve AEFI surveillance in future campaigns, several measures can be recommended. Planning should begin well in advance with

  7. Health Technology Assessment for Molecular Diagnostics: Practices, Challenges, and Recommendations from the Medical Devices and Diagnostics Special Interest Group.

    Science.gov (United States)

    Garfield, Susan; Polisena, Julie; S Spinner, Daryl; Postulka, Anne; Y Lu, Christine; Tiwana, Simrandeep K; Faulkner, Eric; Poulios, Nick; Zah, Vladimir; Longacre, Michael

    2016-01-01

    Health technology assessments (HTAs) are increasingly used to inform coverage, access, and utilization of medical technologies including molecular diagnostics (MDx). Although MDx are used to screen patients and inform disease management and treatment decisions, there is no uniform approach to their evaluation by HTA organizations. The International Society for Pharmacoeconomics and Outcomes Research Devices and Diagnostics Special Interest Group reviewed diagnostic-specific HTA programs and identified elements representing common and best practices. MDx-specific HTA programs in Europe, Australia, and North America were characterized by methodology, evaluation framework, and impact. Published MDx HTAs were reviewed, and five representative case studies of test evaluations were developed: United Kingdom (National Institute for Health and Care Excellence's Diagnostics Assessment Programme, epidermal growth factor receptor tyrosine kinase mutation), United States (Palmetto's Molecular Diagnostic Services Program, OncotypeDx prostate cancer test), Germany (Institute for Quality and Efficiency in Healthcare, human papillomavirus testing), Australia (Medical Services Advisory Committee, anaplastic lymphoma kinase testing for non-small cell lung cancer), and Canada (Canadian Agency for Drugs and Technologies in Health, Rapid Response: Non-invasive Prenatal Testing). Overall, the few HTA programs that have MDx-specific methods do not provide clear parameters of acceptability related to clinical and analytic performance, clinical utility, and economic impact. The case studies highlight similarities and differences in evaluation approaches across HTAs in the performance metrics used (analytic and clinical validity, clinical utility), evidence requirements, and how value is measured. Not all HTAs are directly linked to reimbursement outcomes. To improve MDx HTAs, organizations should provide greater transparency, better communication and collaboration between industry and HTA

  8. [Sex- and gender-aspects in regard to clinical practice recommendations for pre-diabetes and diabetes].

    Science.gov (United States)

    Kautzky-Willer, Alexandra; Abrahamian, Heidemarie; Weitgasser, Raimund; Fasching, Peter; Hoppichler, Fritz; Lechleitner, Monika

    2016-04-01

    Metabolic diseases dramatically affect life of men and women from infancy up to old age and are a major challenge for clinicians. Health professionals are confronted with different needs of women and men. This article aims at an increase of gender awareness and the implementation of current knowledge of gender medicine in daily clinical practice with regard to pre-diabetes and diabetes. Sex and gender affect screening and diagnosis of metabolic diseases as well as treatment strategies and outcome. Impaired glucose and lipid metabolism, regulation of energy balance and body fat distribution are related to steroid hormones and therefore impose their influence on cardiovascular health in both men and women. Furthermore, education, income and psychosocial factors relate to development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at younger age and at lower BMI compared to women, but women feature a dramatic increase of their cardiometabolic risk after menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with higher increase of vascular death in women, but higher increase of cancer death in men. In women pre-diabetes or diabetes are more distinctly associated with a higher number of vascular risk factors, such as inflammatory parameters, unfavourable changes of coagulation and blood pressure. Pre-diabetic and diabetic women are at much higher relative risk for vascular disease. Women are more often obese and less physically active, but may even have greater benefit from increased physical activity than males. Whereas men predominantly feature impaired fasting glucose, women often show impaired glucose tolerance. A history of gestational diabetes or the presence of a PCOS or increased androgen levels in women, on the other hand the presence of erectile dysfunction (ED) or decreased testosterone levels in men are sex specific risk factors for diabetes development

  9. Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer. Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

    International Nuclear Information System (INIS)

    Panje, Cedric; Andratschke, Nikolaus; Guckenberger, Matthias; Brunner, Thomas B.; Niyazi, Maximilian

    2016-01-01

    This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer. A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation. Data on renal and pancreatic SBRT are limited, but show promising rates of local control for both treatment sites. For pancreatic cancer, fractionated SBRT should be preferred to single-dose treatment to reduce the risk of gastrointestinal toxicity. Motion-compensation strategies and image guidance are paramount for safe SBRT delivery in both tumor entities. SBRT for renal cancer and pancreatic cancer have been successfully evaluated in phase I and phase II trials. Pancreatic SBRT should be practiced carefully and only within prospective protocols due to the risk of severe gastrointestinal toxicity. SBRT for primary renal cell cancer appears a viable option for medically inoperable patients but future research needs to better define patient selection criteria and the detailed practice of SBRT. (orig.) [de

  10. Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB.

    Science.gov (United States)

    Hermans, C; Klamroth, R; Richards, M; de Moerloose, P; Garrido, R P

    2017-03-01

    This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided. © 2016 John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

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

  12. Eastside forest management practices: historical overview, extent of their application, and their effects on sustainability of ecosystems.

    Science.gov (United States)

    Chadwick D. Oliver; Larry L. Irwin; Walter H. Knapp

    1994-01-01

    Forest management of eastern Oregon and Washington began in the late 1800s as extensive utilization of forests for grazing, timber, and irrigation water. With time, protection of these values developed into active management for these and other values such as recreation. Silvicultural and administrative practices, developed to solve problems at a particular time have...

  13. Evaluation of the validity of treatment decisions based on surrogate country models before introduction of the Polish FRAX and recommendations in comparison to current practice.

    Science.gov (United States)

    Glinkowski, Wojciech M; Narloch, Jerzy; Glinkowska, Bożena; Bandura, Małgorzata

    2018-03-01

    Patients diagnosed before the Polish FRAX was introduced may require re-evaluation and treatment changes if the diagnosis was established according to a surrogate country FRAX score. The aim of the study was to evaluate the validity of treatment decisions based on the surrogate country model before introduction of the Polish FRAX and to provide recommendations based on the current practice. We evaluated a group of 142 postmenopausal women (70.7 ±8.9 years) who underwent bone mineral density measurements. We used 22 country-specific FRAX models and compared these to the Polish model. The mean risk values for hip and major osteoporotic fractures within 10 years were 4.575 (from 0.82 to 8.46) and 12.47% (from 2.18 to 21.65), respectively. In the case of a major fracture, 94.4% of women would receive lifestyle advice, and 5.6% would receive treatment according to the Polish FRAX using the guidelines of the National Osteoporosis Foundation (NOF). Polish treatment thresholds would implement pharmacotherapy in 32.4% of the study group. In the case of hip fractures, 45% of women according to the NOF would require pharmacotherapy but only 9.8% of women would qualify according to Polish guidelines. Nearly all surrogate FRAX calculator scores proved significantly different form Polish ( p > 0.05). More patients might have received antiresorptive medication before the Polish FRAX. This study recommends re-evaluation of patients who received medical therapy before the Polish FRAX was introduced and a review of the recommendations, considering the side effects of antiresorptive medication.

  14. [Definition and specification requirements for PAC-systems (picture archiving and communication system). A performance index with reference to the standard "IEEE Recommended Practice for Software Requirement Specifications"].

    Science.gov (United States)

    König, H; Klose, K J

    1999-04-01

    The formulation of requirements is necessary to control the goals of a PACS project. Furthermore, in this way, the scope of functionality necessary to support radiological working processes becomes clear. Definitions of requirements and specification are formulated independently of systems according to the IEEE standard "Recommended Practice for Software Requirements Specifications". Definitions are given in the Request for Information, specifications in the Request for Proposal. Functional and non-functional requirements are distinguished. The solutions are rated with respect to scope, appropriateness and quality of implementation. A PACS checklist was created according to the methods described above. It is published on the homepage of the "Arbeitsgemeinschaft Informationstechnologie" (AGIT) within the "Deutsche Röntgengesellschaft" (DRG) (http://www.uni-marburg.de/mzr/agit). The checklist provides a discussion forum which should contribute to an agreement on accepted basic PACS functionalities.

  15. Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice.

    Science.gov (United States)

    Yuzawa, Mitsuko; Fujita, Kyoko; Tanaka, Erika; Wang, Edward C Y

    2013-01-01

    The importance of incorporating quality-of-life (QoL) assessments into medical practice is growing as health care practice shifts from a "disease-based" to a "patient-centered" model. The prevalence of age-related macular degeneration (AMD) is increasing in today's aging population. The purpose of this paper is: (1) to discuss, by reviewing the current literature, the impact of AMD on patients' QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2) to make a recommendation for incorporating QoL into clinical practice. We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected. AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA). QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients' valued activities, which are not captured by a single, numerical VA score. The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease-specific instruments for measuring QoL, such as the NEI VFQ-25, have shown a significant correlation of QoL decrement with measures of disease severity, as well as significant QoL improvement with treatment. The NEI VFQ-25 and other validated instruments provide a wide-ranging assessment of vision-related functioning that is important to

  16. Overview and technical and practical aspects for use of geostatistics in hazardous-, toxic-, and radioactive-waste-site investigations

    International Nuclear Information System (INIS)

    Bossong, C.R.; Karlinger, M.R.; Troutman, B.M.; Vecchia, A.V.

    1999-01-01

    Technical and practical aspects of applying geostatistics are developed for individuals involved in investigation at hazardous-, toxic-, and radioactive-waste sites. Important geostatistical concepts, such as variograms and ordinary, universal, and indicator kriging, are described in general terms for introductory purposes and in more detail for practical applications. Variogram modeling using measured ground-water elevation data is described in detail to illustrate principles of stationarity, anisotropy, transformations, and cross validation. Several examples of kriging applications are described using ground-water-level elevations, bedrock elevations, and ground-water-quality data. A review of contemporary literature and selected public domain software associated with geostatistics also is provided, as is a discussion of alternative methods for spatial modeling, including inverse distance weighting, triangulation, splines, trend-surface analysis, and simulation

  17. Complementary Feeding: Review of Recommendations, Feeding Practices and Adequacy of Homemade Complementary Food Preparations in Developing Countries – lessons from Ethiopia

    Directory of Open Access Journals (Sweden)

    Motuma A Abeshu

    2016-10-01

    Full Text Available Breastfeeding provides the ideal food during the first 6 months of life. Complementary feeding is the process starting when breast milk alone is no longer sufficient, the target age being between 6 to 23 months. The gap between nutritional requirement and amount obtained from breast milk increases with age. For energy, 200kcal, 300kcal and 550kcal per day is expected to be covered by complementary foods at 6-8, 9-11 and 12-23 months, respectively. In addition, the complementary foods must provide relatively large proportions of micronutrients such as: iron, zinc, phosphorus, magnesium, calcium and vitamin B6. In several parts of the developing world, complementary feeding continues as a challenge to good nutrition in children. In Ethiopia, only 4.2% of breastfed children of 6–23 months of age have a minimum acceptable diet. The gaps are mostly attributed to either poor dietary quality or poor feeding practices, if not both. Commercial fortified foods are often beyond the reach of the poor. Thus, homemade complementary foods remain commonly used. However, unfortified complementary foods that are predominantly plant-based provide insufficient amounts of key nutrients (particularly iron, zinc and calcium during the age of 6 – 23 months even, when based on an improved recipe. This review thus assessed complementary feeding practice and recommendation and reviewed the level of adequacy of homemade complementary foods.

  18. Comparison of nutrition standards and other recommended procurement practices for improving institutional food offerings in Los Angeles County, 2010-2012.

    Science.gov (United States)

    Robles, Brenda; Wood, Michelle; Kimmons, Joel; Kuo, Tony

    2013-03-01

    National, state, and local institutions that procure, distribute, sell, and/or serve food to employees, students, and the public are increasingly capitalizing on existing operational infrastructures to create healthier food environments. Integration of healthy nutrition standards and other recommended practices [e.g., energy (kilocalories) postings at point-of-purchase, portion size restrictions, product placement guidelines, and signage] into new or renewing food service and vending contracts codifies an institution's commitment to increasing the availability of healthful food options in their food service venues and vending machines. These procurement requirements, in turn, have the potential to positively influence consumers' food-purchasing behaviors. Although these strategies are becoming increasingly popular, much remains unknown about their context, the processes required to implement them effectively, and the factors that facilitate their sustainability, especially in such broad and diverse settings as schools, county government facilities, and cities. To contribute to this gap in information, we reviewed and compared nutrition standards and other best practices implemented recently in a large school district, in a large county government, and across 10 municipalities in Los Angeles County. We report lessons learned from these efforts.

  19. Overview of improvements in work practices and instrumentation for CANDU primary heat transport feeders in-service inspections

    Energy Technology Data Exchange (ETDEWEB)

    Marcotte, O., E-mail: olivier@nucleom.ca [Nucleom Inc., Quebec, Quebec (Canada); Rousseau, G., E-mail: rousseau.gilles.a@hydro.qc.ca [Hydro Quebec, Becancour, Quebec (Canada); Rochefort, E., E-mail: erochfort@zetec.com [Zetec Canada, Quebec, Quebec (Canada)

    2013-01-15

    The Canadian nuclear industry has developed many advanced non-destructive inspection techniques to be applied safely in hazardous environments in recent years. Automated systems, manual tooling and specialized software modules have been designed since early 2000s to provide complete and very efficient fitness for service inspection of primary heat transport system carbon steel feeder pipes. These techniques deal with complex geometries, difficult access and, radioactive environment. Complementary NDE techniques, namely Ultrasounds, eddy current, phased-array UT and automated scanners are used. This presentation describes the improvements in inspection practices and the advanced data analysis features. (author)

  20. Teaching Evidence-Based Practice across Curricula-An Overview of a Professional Development Course for Occupational Therapy Educators.

    Science.gov (United States)

    Daly, Marta M; DeAngelis, Tina M

    2017-01-01

    A professional development course for occupational therapy educators about teaching evidence-based practice (EBP) was developed and piloted. The course was developed to promote increased awareness of resources and methods for teaching EBP that are applicable across entry-level curricula. Participants included full-time faculty (n = 7) from one entry-level occupational therapy program in the New York City area. The results of the pilot informed refinement of the course in preparation for delivery to a wider audience of educators. This paper provides a description of the course, results of the pilot, and implications for future delivery of the course.

  1. What do we think we are doing? How might a clinical information network be promoting implementation of recommended paediatric care practices in Kenyan hospitals?

    Science.gov (United States)

    English, Mike; Ayieko, Philip; Nyamai, Rachel; Were, Fred; Githanga, David; Irimu, Grace

    2017-02-02

    The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our 'insider' interpretation of how the network is functioning as an intervention. We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context-mechanism-outcome configuration. We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway. We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised

  2. Spent fuel storage and transport cask decontamination and modification. An overview of management requirements and applications based on practical experience

    International Nuclear Information System (INIS)

    1999-04-01

    A large increase in the number of casks required for transport and/or storage of spent fuel is forecast into the next century. The principal requirement will be for increased number of storage and dual purpose (transport/storage) casks for interim storage of spent fuel prior to reprocessing or permanent disposal in both on-site and off-site storage facilities. Through contact with radioactive materials spent fuel casks will be contaminated on both internal and external surfaces. In broad terms, cask contamination management can be defined by three components: minimisation, prevention and decontamination. This publication is a compilation of international experience with cask contamination problems and decontamination practices. The objective is to present current knowledge and experience as well as developments, trends and potential for new applications in this field. Furthermore, the report may assist in new design or modification of existing casks, cask handling systems and decontamination equipment

  3. Physics Survey Overview

    International Nuclear Information System (INIS)

    2002-01-01

    An overview of a series of assignments of the branches of physics carried out by the Board on Physics and Astronomy of the National Research Council. It identifies further theories in physics and makes recommendations on preventive priorities. The Board on Physics and Astronomy (BPA) has conducted a new decadal survey of physics entitled ''Physics in a New Era''. The survey includes assessments of the main branches of physics as well as certain selected emerging areas. The various elements of the survey were prepared by separately-appointed National Research Council (NRC) committees. The BPA formed the Physics Survey Overview Committee (PSOVC) to complete the survey by preparing an overview of the field of physics to summarize and synthesize the results of the various assessments and to address cross-cutting issues that concern physics as a whole

  4. Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice

    Directory of Open Access Journals (Sweden)

    Yuzawa M

    2013-07-01

    Full Text Available Mitsuko Yuzawa,1 Kyoko Fujita,1 Erika Tanaka,2 Edward C Y Wang21Department of Ophthalmology, Nihon University School of Medicine, Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan; 2Health Economics and Outcomes Research, Bayer Yakuhin Ltd, Marunouchi, Chiyoda-ku, Tokyo, JapanBackground: The importance of incorporating quality-of-life (QoL assessments into medical practice is growing as health care practice shifts from a “disease-based” to a “patient-centered” model. The prevalence of age-related macular degeneration (AMD is increasing in today’s aging population. The purpose of this paper is: (1 to discuss, by reviewing the current literature, the impact of AMD on patients’ QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2 to make a recommendation for incorporating QoL into clinical practice.Methods: We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected.Results: AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25 is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA. QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients’ valued activities, which are not captured by a single, numerical VA score.Conclusion: The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease

  5. Food for Thought: A Critical Overview of Current Practical and Conceptual Challenges in Trace Element Analysis in Natural Waters

    Directory of Open Access Journals (Sweden)

    Montserrat Filella

    2013-07-01

    Full Text Available The practical and conceptual challenges faced by the analysis of trace elements present in natural waters are not merely, as is often thought, an endless race towards lower detection limits or to the development of techniques allowing the determination of any possible chemical species formed by all chemical elements. Rather, as discussed in this paper, they include the development of (i robust, cheap, and reliable methods that could also be used by laypeople (the experience gained in the development of field kits for As is discussed as an example from which similar developments for other elements may be drawn; (ii more environmentally-friendly methods (the current guiding criteria probably being too simplistic; and (iii methods making it possible to follow diel concentration changes and sharp concentration variations caused by the probable increase of heavy rainfall events. This paper also claims that neither the measurement of total concentrations (reliable methods are lacking for many elements of the periodic table of trace elements, as illustrated through the cases of Bi, Te, and Sb, nor chemical speciation analysis, are as mature as often thought. In particular, chemical speciation studies demand the development of a better, comprehensive conceptual framework. A trial is carried out to lay the basis of such a framework.

  6. Overview of religions.

    Science.gov (United States)

    Brooks, Nicky

    2004-01-01

    This article provides a brief overview of 9 religions: Christianity, Judaism, Jehovah's Witnesses, The Church of Jesus Christ of Latter-Day Saints, Christian Science, Islam, Hinduism, Sikhism, and Buddhism. Basic information on the origins, language, naming practices, diet, personal hygiene, and dress requirements is provided. For additional information, Web sites for each of these religions are also provided.

  7. Recommender systems

    CERN Document Server

    Kembellec, Gérald; Saleh, Imad

    2014-01-01

    Acclaimed by various content platforms (books, music, movies) and auction sites online, recommendation systems are key elements of digital strategies. If development was originally intended for the performance of information systems, the issues are now massively moved on logical optimization of the customer relationship, with the main objective to maximize potential sales. On the transdisciplinary approach, engines and recommender systems brings together contributions linking information science and communications, marketing, sociology, mathematics and computing. It deals with the understan

  8. Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice – study rationale and protocol of DIALOGUE

    Directory of Open Access Journals (Sweden)

    Gitt Anselm K

    2012-12-01

    Full Text Available Abstract Background Patients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD. Methods DIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1 individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2 individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE and the rate of hospitalizations are the most important. Conclusion The registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti

  9. Electronic Resources Management System: Recommendation Report 2017

    KAUST Repository

    Ramli, Rindra M.

    2017-01-01

    This recommendation report provides an overview of the selection process for the new Electronic Resources Management System. The library has decided to move away from Innovative Interfaces Millennium ERM module. The library reviewed 3 system

  10. Overview of the international legal framework governing the safe and peaceful uses of nuclear energy - Some practical steps

    International Nuclear Information System (INIS)

    Rautenbach, J.; Tonhauser, W.; Wetherall, A.

    2006-01-01

    and the background leading to their respective development. More importantly, however, this paper highlights some of the practical steps taken since the accident, both by the IAEA and the international community, which underpin this framework. In addition, the paper identifies some of the current challenges and, in a brief outlook, considers some recent multilateral initiatives in the nuclear domain and their possible impact on future developments in nuclear law

  11. Recommender Systems for Learning

    CERN Document Server

    Manouselis, Nikos; Verbert, Katrien; Duval, Erik

    2013-01-01

    Technology enhanced learning (TEL) aims to design, develop and test sociotechnical innovations that will support and enhance learning practices of both individuals and organisations. It is therefore an application domain that generally covers technologies that support all forms of teaching and learning activities. Since information retrieval (in terms of searching for relevant learning resources to support teachers or learners) is a pivotal activity in TEL, the deployment of recommender systems has attracted increased interest. This brief attempts to provide an introduction to recommender systems for TEL settings, as well as to highlight their particularities compared to recommender systems for other application domains.

  12. INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

    Science.gov (United States)

    Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

    2015-11-01

    The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

  13. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older - Advisory Committee on Immunization Practices (ACIP), 2012.

    Science.gov (United States)

    2012-06-29

    Since 2005, the Advisory Committee on Immunization Practices (ACIP) has recommended a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine booster dose for all adolescents aged 11 through 18 years (preferred at 11 through 12 years) and for those adults aged 19 through 64 years who have not yet received a dose. In October 2010, despite the lack of an approved Tdap vaccine for adults aged 65 years and older, ACIP recommended that unvaccinated adults aged 65 years and older be vaccinated with Tdap if in close contact with an infant, and that other adults aged 65 years and older may receive Tdap. In July 2011, the Food and Drug Administration (FDA) approved expanding the age indication for Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium) to aged 65 years and older. In February 2012, ACIP recommended Tdap for all adults aged 65 years and older. This recommendation supersedes previous Tdap recommendations regarding adults aged 65 years and older.

  14. Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use.

    Science.gov (United States)

    Godfrey, Emily M

    2015-08-01

    The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. All rights reserved.

  15. Contact Dermatitis for the Practicing Allergist.

    Science.gov (United States)

    Bernstein, David I

    2015-01-01

    This article provides an overview of important practice recommendations from the recently updated Contact Dermatitis Practice Parameter. This updated parameter provides essential recommendations pertaining to clinical history, physical examination, and patch testing evaluation of patients suspected of allergic contact dermatitis. In addition to providing guidance for performing and interpreting closed patch testing, the updated parameter provides concrete recommendations for assessing metal hypersensitivity in patients receiving prosthetic devices, for evaluating workers with occupational contact dermatitis, and also for addressing allergic contact dermatitis in children. Finally, the document provides practical recommendations useful for educating patients regarding avoidance of exposure to known contact sensitizers in the home and at work. The Contact Dermatitis Parameter is designed as a practical, evidence-based clinical tool to be used by allergists and dermatologists who routinely are called upon to evaluate patients with skin disorders. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  16. [Historical overview and the current practice of intracavitary treatment of cervical and endometrial cancer in the Oncoradiology Center of Budapest].

    Science.gov (United States)

    Sinkó, Dániel; Nemeskéri, Csaba; Pallinger, Ágnes; Weisz, Csaba; Naszály, Attila; Landherr, László

    2015-06-01

    The aims of our study were to describe the history and development of intracavitary brachytherapy in the treatment of gynecological tumors, to introduce our current practice for intracavitary brachytherapy treatments based on CT planning. Gynecological intracavitary brachytherapy has been applied in our department since the early 1930s. After a long development it has been completely renewed by 2014. In our center definitive and/or preoperative gynecological HDR-AL brachytherapy treatments were given to 25 patients (13 corpus uterine cancer patients and 12 cervical cancer patients) during the period of 01. 01. 2014-31. 01. 2015. In each case, target volumes were planned by CT images, DVH (dose volume histogram) analysis was performed in order to calculate the radiation tolerance dose of rectum and urinary bladder. Evaluation was performed by the EclipseTM 11.0.47. brachytherapy treatment planning system. During the definitive treatments of the 13 uterine cancer patients the D2cc value related to rectum tolerance was 66.3 GyEQD2 (46-91 Gy). The average D2cc value of urinary bladder tolerance was 76.5 GyEQD2 (30-112 Gy). CI was 0.72 (0.6-0.95). Average value of COIN was 0.57 (0.35-0.78). Compared to the prescribed dose D100 and D90 values were given in ratios. Compared to the volume which receives 100% of reference dose V150 and V200 values were also given in ratios. D100 and D90 were calculated to be 0.66 (0.47-0.97) and 0.91 (0.8-1.25). V150 and V200 volumes were 0.11 (0.04-0.18) and 0.06 (0.02-0.1). During the definitive treatments of 12 cervical cancer patients the D2cc value related to rectum tolerance calculated by DVH was 75.2 GyEQD2 (60-82 Gy). The average D2cc value of urinary bladder tolerance was 85 GyEQD2 based on DVH. CI was 0.66 (0.42-0.76). Average value of COIN was 0.52 (0.32-0.78). Mean value of DHI was 0.46 (0.27-0.54). D100 and D90 were calculated to be 0.72 (0.57-0.89) and 0.91 (0.84-1.11). V150 and V200 volumes were 0.057 (0.02-0.13) and 0.02 (0

  17. Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.

    Science.gov (United States)

    Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Mullins, C Daniel

    2017-09-01

    Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. Copyright © 2017. Published by Elsevier Inc.

  18. Benchmark study on glyphosate-resistant cropping systems in the United States. Part 7: Effects of weed management strategy (grower practices versus academic recommendations) on the weed soil seedbank over 6 years.

    Science.gov (United States)

    Gibson, David J; Young, Bryan G; Owen, Micheal D K; Gage, Karla L; Matthews, Joseph L; Jordan, David L; Shaw, David R; Weller, Stephen C; Wilson, Robert G

    2016-04-01

    Shifts in weed species composition and richness resulting from near-exclusive reliance on herbicides in glyphosate-resistant (GR) cropping systems has necessitated the implementation of alternative weed management tactics to reduce selection pressures of herbicides. We contrasted the response of the weed soil seedbank to effects of weed management strategy, comparing grower practices with academic recommendations for best management practices (BMPs) over 6 years and across five weed hardiness zones in the US Midwest at sites subject to GR cropping systems. Total weed population density and species richness varied according to cropping system, location and prior year's crop, but less so to weed management strategy. The seedbank population density for 11 of the 14 most frequent weed species was affected by weed management strategy either alone or in an interaction with hardiness zone or year, or both. In only 29% of comparisons was weed population density lower following academic recommendations, and this depended upon prior crop and cropping system. The population density of high-risk weed species was reduced by academic recommendations, but only in two of six years and under continuous GR maize. Overall, the weed population density was decreasing in field halves subject to the BMPs in the academic recommendations relative to grower practices. The soil seedbank is slow to respond to academic recommendations to mitigate glyphosate-resistant weeds, but represents a biological legacy that growers need to keep in mind even when management practices reduce emerged field weed population densities. © 2015 Society of Chemical Industry.

  19. Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer. Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Panje, Cedric; Andratschke, Nikolaus; Guckenberger, Matthias [Zurich University Hospital, Department of Radiation Oncology, Zurich (Switzerland); Brunner, Thomas B. [Freiburg University Hospital, Department of Radiation Oncology, Freiburg (Germany); Niyazi, Maximilian [University of Munich, Department of Radiation Oncology, Munich (Germany)

    2016-12-15

    This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer. A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation. Data on renal and pancreatic SBRT are limited, but show promising rates of local control for both treatment sites. For pancreatic cancer, fractionated SBRT should be preferred to single-dose treatment to reduce the risk of gastrointestinal toxicity. Motion-compensation strategies and image guidance are paramount for safe SBRT delivery in both tumor entities. SBRT for renal cancer and pancreatic cancer have been successfully evaluated in phase I and phase II trials. Pancreatic SBRT should be practiced carefully and only within prospective protocols due to the risk of severe gastrointestinal toxicity. SBRT for primary renal cell cancer appears a viable option for medically inoperable patients but future research needs to better define patient selection criteria and the detailed practice of SBRT. (orig.) [German] Die Arbeitsgruppe ''Stereotaktische Radiotherapie'' der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) legt eine Zusammenfassung der aktuellen Literatur und daraus resultierende Empfehlungen zur Durchfuehrung der stereotaktischen Strahlentherapie (SBRT) beim Nierenzellkarzinom und beim Pankreaskarzinom vor. Es erfolgte eine Literaturrecherche zur Evidenz der SBRT beim Nierenzell- und Pankreaskarzinom, wobei der Schwerpunkt auf prospektive Studien und technische Aspekte fuer die klinische Umsetzung gelegt wurde. Fuer die SBRT beim Pankreaskarzinom und Nierenzellkarzinom sind bisher nur wenige Studien veroeffentlicht worden, die jedoch konsistent eine hohe Rate an lokaler Tumorkontrolle

  20. Program overview

    International Nuclear Information System (INIS)

    Anon.

    1977-01-01

    The program overview describes the following resources and facilities; laser facilities, main laser room, target room, energy storage, laboratory area, building support systems, general plant project, and the new trailer complex

  1. Disability Overview

    Science.gov (United States)

    ... About CDC.gov . Disability & Health Home Disability Overview Disability Inclusion Barriers to Inclusion Inclusion Strategies Inclusion in Programs & Activities Resources Healthy Living Disability & Physical Activity Disability & Obesity Disability & Smoking Disability & Breast ...

  2. Vulvovaginitis - overview

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000897.htm Vulvovaginitis - overview To use the sharing features on this page, please enable JavaScript. Vulvovaginitis or vaginitis is swelling or infection of the ...

  3. It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North-South collaborative trials.

    Science.gov (United States)

    Ravinetto, Raffaella; Tinto, Halidou; Diro, Ermias; Okebe, Joseph; Mahendradhata, Yodi; Rijal, Suman; Gotuzzo, Eduardo; Lutumba, Pascal; Nahum, Alain; De Nys, Katelijne; Casteels, Minne; Boelaert, Marleen

    2016-01-01

    The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global

  4. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices.

    Science.gov (United States)

    Stéfan, Angélique; Mathé, Jean-François

    2016-02-01

    Behavioral disorders are major sequelae of severe traumatic brain injury. Before considering care management of these disorders, and in the absence of a precise definition for TBI-related behavioral disorder, it is essential to refine, according to the data from the literature, incidence, prevalence, predictive factors of commonly admitted disruptive symptoms. Systematic review of the literature targeting epidemiological data related to behavioral disorders after traumatic brain injury in order to elaborate good practice recommendations according to the methodology established by the French High Authority for Health. Two hundred and ninety-nine articles were identified. The responsibility of traumatic brain injury (TBI) in the onset of behavioral disorders is unequivocal. Globally, behavioral disorders are twice more frequent after TBI than orthopedic trauma without TBI (Masson et al., 1996). These disorders are classified into disruptive primary behaviors by excess (agitation 11-70%, aggression 25-39%, irritability 29-71%, alcohol abuse 7-26% drug abuse 2-20%), disruptive primary behaviors by default (apathy 20-71%), affective disorders - anxiety - psychosis (depression 12-76%, anxiety 0.8-24,5%, posttraumatic stress 11-18%, obsessive-compulsive disorders 1.2-30%, psychosis 0.7%), suicide attempts and suicide 1%. The improvement of care management for behavioral disorders goes through a first step of defining a common terminology. Four categories of posttraumatic behavioral clinical symptoms are defined: disruptive primary behaviors by excess, by default, affective disorders-psychosis-anxiety, suicide attempts and suicide. All these symptoms yield a higher prevalence than in the general population. They impact all of life's domains and are sustainable over time. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States

    Science.gov (United States)

    Deyell, Marc W.; Buller, Christopher E.; Miller, Louis H.; Wang, Tracy Y.; Dai, David; Lamas, Gervasio A.; Srinivas, Vankeepuram S.; Hochman, Judith S.

    2013-01-01

    Background The Occluded Artery Trial (OAT) was a large, randomized controlled trial published in 2006 that demonstrated no benefit to routine percutaneous coronary intervention (PCI) of persistently totally occluded infarct-related arteries (IRA) identified a minimum of 24 hours (on calendar days 3–28) after myocardial infarction (MI). The purpose of this study was to determine the impact of OAT results and consequent change in guideline recommendations for PCI for treatment of persistently occluded IRAs. Methods We identified all patients enrolled in the CathPCI Registry, from 2005 to 2008, undergoing catheterization more than 24 hours after MI with a totally occluded native coronary artery and no major OAT exclusion criteria. We examined trends in monthly rates of PCI for occlusions after OAT publication and after guideline revisions. Because reporting of diagnostic catheterizations was not mandatory, we examined trends among hospitals in the highest quartile for reporting of diagnostic procedures. Results A total of 28 780 patient visits from 896 hospitals were included. Overall, we found no significant decline in the adjusted monthly rate of PCI of occlusions after publication of OAT (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.989–1.006) or after guideline revisions (OR, 1.007; 95% CI, 0.992–1.022). Among hospitals consistently reporting diagnostic catheterizations, there was no significant decline after OAT publication (OR, 1.018; 95% CI, 0.995–1.042), and there was a trend toward decline after guideline revisions (OR, 0.963; 95% CI, 0.920–1.000). Conclusion These findings suggest that the results of OAT and consequent guideline revisions have not, to date, been fully incorporated into clinical practice in a large cross-section of hospitals in the United States. PMID:21747002

  6. Privacy in Recommender Systems

    NARCIS (Netherlands)

    Jeckmans, Arjan; Beye, Michael; Erkin, Zekeriya; Erkin, Zekeriya; Hartel, Pieter H.; Lagendijk, Reginald; Tang, Qiang; Ramzan, Naeem; van Zwol, Roelof; Lee, Jong-Seok; Clüver, Kai; Hua, Xian-Sheng

    In many online applications, the range of content that is offered to users is so wide that a need for automated recommender systems arises. Such systems can provide a personalized selection of relevant items to users. In practice, this can help people find entertaining movies, boost sales through

  7. PRACTICAL PERIODONTAL SURGERY: AN OVERVIEW

    OpenAIRE

    Krishna; Chandrashekar; Anuroopa; Senthil; Syed; Sandeep S; Kumuda; Ashwini

    2014-01-01

    The efficacy of periodontal surgery in the treatment of periodontal diseases not yet been systematically evaluated. The objective of this review was to systematically evaluate the efficacy of periodontal surgical procedures in the various treatment modalities. Periodontal disease is multifaceted in nature and scope. The problems created due to this inflammatory condition are different eg. gingival enlargement, osseous deformities, mucogingival problem which ultimately may ...

  8. Overview of current chelation practices

    Directory of Open Access Journals (Sweden)

    Y. Aydinok

    2011-12-01

    Full Text Available Deferoxamine (DFO is reference standard therapy for transfusional iron overload since the 1980s. Although it is a highly effective iron chelator, the compliance problem to subcutaneous administration of DFO remains as the major problem. The oral chelator Deferiprone (DFP has no marketing licence in North America, however, it has been licensed in India since 1994 and the European Union (EU granted marketing approval for DFP in 1999, specifically for patients with thalassemia major when DFO is inadequate, intolerable or unacceptable. There are still limited data available on the use of DFP in children between 6 and 10 years of age, and no data on DFP use in children under 6 years of age. Subsequently the oral chelator Deferasirox (DFX was approved by FDA and EMA for the treatment of patients with transfusional iron overload -older than 2 years of age- as first line therapy, in 2005 and 2006 respectively. The primary objective of iron chelation is to maintain body iron at safe levels at all times but once iron is accumulated, the objective of iron chelation is to reduce tissue iron to safe levels which is a slow process. The chelation regimen, dose and frequency of administration, of the chelator(s are mainly determined based on body iron burden, presence of myocardial iron and the transfusional iron loading rate. A proper monitoring of chelation is of importance for measuring the response rate to a particular regimen and providing dose adjustments to enhance chelation efficacy and to avoid toxicity. Efficacy of a chelation regimen may exhibit individual variability resulting from factors such as absorbtion and metabolism of the chelator. Tolerability and compliance are also individual variables effecting the response to chelation. Understand