Sample records for reduce unnecessary testing
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How to save costs by reducing unnecessary testing: Lean thinking in clinical practice
Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.
2012-01-01
Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic
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Reducing unnecessary lab testing in the ICU with artificial intelligence.
Cismondi, F; Celi, L A; Fialho, A S; Vieira, S M; Reti, S R; Sousa, J M C; Finkelstein, S N
2013-05-01
To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1-3]. Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the likely information to be gained from proposed future
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Reducing unnecessary lab testing in the ICU with artificial intelligence
Cismondi, F.; Celi, L.A.; Fialho, A.S.; Vieira, S.M.; Reti, S.R.; Sousa, J.M.C.; Finkelstein, S.N.
2017-01-01
Objectives To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Design Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Patients Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Main results Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1–3]. Conclusions Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the
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[Unnecessary routine laboratory tests in patients referred for surgical services].
Mata-Miranda, María del Pilar; Cano-Matus, Norberto; Rodriguez-Murrieta, Margarita; Guarneros-Zapata, Idalia; Ortiz, Mario
2016-01-01
To question the usefulness of the lab analysis considered routine testing for the identification of abnormalities in the surgical care. To determine the percentage of unnecessary laboratory tests in the preoperative assessment as well as to estimate the unnecessary expenses. A descriptive, cross-sectional study of patients referred for surgical evaluation between January 1st and March 31st 2013. The database of laboratory testing and electronic files were reviewed. Reference criteria from surgical services were compared with the tests requested by the family doctor. In 65% of the patients (n=175) unnecessary examinations were requested, 25% (n=68) were not requested the tests that they required, and only 10% of the patients were requested laboratory tests in accordance with the reference criteria (n=27). The estimated cost in unnecessary examinations was $1,129,552 in a year. The results were similar to others related to this theme, however, they had not been revised from the perspective of the first level of attention regarding the importance of adherence to the reference criteria which could prevent major expenditures. It is a priority for leaders and operational consultants in medical units to establish strategies and lines of action that ensure compliance with institutional policies so as to contain spending on comprehensive services, and which in turn can improve the medical care. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.
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Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R
2016-10-15
The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.
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Effective diagnostic DAQ systems to reduce unnecessary data in KSTAR
Energy Technology Data Exchange (ETDEWEB)
Lee, Taegu, E-mail: glory@nfri.re.kr; Lee, Woongryol; Hong, Jaesic; Park, Kaprai
2016-11-15
Highlights: • When plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. • To overcome this problem, some KSTAR’s library were upgraded to monitor the plasma status in real-time. • With the real-time information of plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. • We were able to reduce the refuse data of approximately 698 GByte in the KSTAR 7th campaign. • It was a very effective way to store useful data, and it was helpful to analysts after shot. - Abstract: The plasma status of Korea Superconducting Tokamak Advanced Research (KSTAR) is measured by various diagnostics systems. The measured data size has been increasing every year due to increasing plasma pulse lengths, higher diagnostics operating frequencies, the additions of new diagnostic systems, and an increasing number of diagnostics channels. At times, when plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. In addition, the analysis time was affected, as these data need to be separated from the relevant data set. To overcome this problem, KSTAR’s Standard Framework (SFW), Real Time Monitoring (RTMON), and Pulse Automation and Scheduling System (PASS) were upgraded to monitor the plasma status in real-time. When the plasma current is less than 200kA, RTMON sends the plasma status information every second to the SFW via EPICS Channel Access. With the real-time information on plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. This paper describes a method for reducing the storage of unnecessary data and its results in the KSTAR 7th campaign.
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Montejo Fernández, Marta; Benito Manrique, Iñaki; Montiel Eguía, Arantza; Benito Fernández, Javier
2018-05-23
Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries. Copyright © 2018. Publicado por Elsevier España, S.L.U.
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Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun
2018-06-01
The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.
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Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M
2016-03-01
To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.
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Escalating Health Care Cost due to Unnecessary Diagnostic Testing
Directory of Open Access Journals (Sweden)
MUHAMMAD AZAM ISHAQUE CHAUDHARY
2017-07-01
Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.
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Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.
Malmartel, A; Dutron, M; Ghasarossian, C
2017-09-01
About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.
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International Nuclear Information System (INIS)
Cho, Joon Hyung; Cho, Jae Ho; Ahn, Jay Hong; Chang, Jay Chun
2001-01-01
To establish the criteria which can safely reduce the number of unnecessary biopsies by comparing the transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and prostate specific antigen density (PSAD) in the decision of criteria for the prostatic biopsy using TRUS. Two hundred and twenty patients underwent TRUS- guided prostate biopsy due to elevated PSA and/or focal nodule on TRUS were included. Sixty five (27.5%) patients were confirmed as prostate cancer, and remained 155 (70.5%) patients were reported as benign diseases including benign prostate hyperplasia. The sensitivity, specificity and accuracy of TRUS, PSA and PSAD were evaluated and the single criterion or the combination of the criteria which can safely reduce the unnecessary biopsies without missing prostatic cancer were investigated. The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4 ng/ml) and PSAD (cut-off level, 0.2 ng/ml/cm 3 ) were 78.5%/95.4%/95.4%/27.8%/51.6%/64/5%, 42.7%/64.5%/73.6%, respectively. PSAD cut-off level 0.2 ng/ml/cm 3 was the most excellent single criterion for the decision of prostatic biopsy and the number of unnecessary biopsies was 100 cases. But 3 cases of prostatic cancer which the PSAD level was below 0.2 ng/ml/cm 3 were included and in all these 3 cases, a focal nodule was detected on TRUS. Therefore, we applied these two criteria at once and the biopsies of 30 cases (13.6%) are unnecessary. With the single criterion, we could not obtain the satisfactory results but by the combinations of criteria (TRUS and PSAD), 30 (13.6%) cases are unnecessary biopsies without missing cancer. We think that the short term follow-up may be a substitute for the immediate when nodular lesion is suspicious on TRUS and serum PSAD level is below 0.2 ng/ml/cm 3 .
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Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami
2018-03-01
Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.
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Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M
2018-01-01
Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.
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Energy Technology Data Exchange (ETDEWEB)
Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)
2015-05-01
To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)
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Madden, Gregory R; German Mesner, Ian; Cox, Heather L; Mathers, Amy J; Lyman, Jason A; Sifri, Costi D; Enfield, Kyle B
2018-06-01
We hypothesized that a computerized clinical decision support tool for Clostridium difficile testing would reduce unnecessary inpatient tests, resulting in fewer laboratory-identified events. Census-adjusted interrupted time-series analyses demonstrated significant reductions of 41% fewer tests and 31% fewer hospital-onset C. difficile infection laboratory-identified events following this intervention.Infect Control Hosp Epidemiol 2018;39:737-740.
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MacMillan, Thomas E; Gudgeon, Patrick; Yip, Paul M; Cavalcanti, Rodrigo B
2018-05-02
Red blood cell folate is a laboratory test with limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate, have resulted in only modest success. The objective of this study was to assess the effectiveness and impacts of restricting red blood cell folate ordering in the electronic health record. This was a retrospective observational study from January 2010 to December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients and outpatients who underwent at least 1 red blood cell folate or vitamin B12 test during the study period were included. Red blood cell folate ordering was restricted to clincians in gastroenterology and hematology and was removed from other physicians' computerized order entry screen in the electronic health record in June 2013. Red blood cell folate testing decreased by 94.4% during the study, from a mean of 493.0 (SD 48.0) tests/month before intervention to 27.6 (SD 10.3) tests/month after intervention (P<.001). Restricting red blood cell folate ordering in the electronic health record resulted in a large and sustained reduction in red blood cell folate testing. Significant cost savings estimated at over a quarter-million dollars (CAD) over three years were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency. Copyright © 2018. Published by Elsevier Inc.
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Emrich, Stephen M; Busseri, Michael A
2015-09-01
The amount of task-irrelevant information encoded in visual working memory (VWM), referred to as unnecessary storage, has been proposed as a potential mechanism underlying individual differences in VWM capacity. In addition, a number of studies have provided evidence for additional activity that initiates the filtering process originating in the frontal cortex and basal ganglia, and is therefore a crucial step in the link between unnecessary storage and VWM capacity. Here, we re-examine data from two prominent studies that identified unnecessary storage activity as a predictor of VWM capacity by directly testing the implied path model linking filtering-related activity, unnecessary storage, and VWM capacity. Across both studies, we found that unnecessary storage was not a significant predictor of individual differences in VWM capacity once activity associated with filtering was accounted for; instead, activity associated with filtering better explained variation in VWM capacity. These findings suggest that unnecessary storage is not a limiting factor in VWM performance, whereas neural activity associated with filtering may play a more central role in determining VWM performance that goes beyond preventing unnecessary storage.
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International Nuclear Information System (INIS)
Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.
2017-01-01
Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)
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Otto, Caitlin C; Shuptar, Susan L; Milord, Philippe; Essick, Connor J; Nevrekar, Reshma; Granovsky, Svetlana L; Seo, Susan K; Babady, N Esther; Martin, Steven C; Tang, Yi-Wei; Pessin, Melissa S
2015-08-01
We implemented hospital information system (HIS) alerts to deter unnecessary test orders for ovum and parasite (O&P) exams and Clostridium difficile PCR. The HIS alerts decreased noncompliant O&P orders (orders after >72 h of hospitalization) from 49.8% to 30.9%, an overall decrease of 19%, and reduced noncompliant C. difficile PCR orders (orders <7 days after a previous positive result) from 30.6% to 19.2%, an overall decrease of 31.9%. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
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Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J.; Main, Cheryl; Mertz, Dominik
2015-01-01
Background Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. Objective To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Design Quasi-experimental study with a control group. Setting Two tertiary teaching adult care hospitals. Participants Consec...
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Kahvecioglu, Dilek; Erdeve, Omer; Alan, Serdar; Cakir, Ufuk; Yildiz, Duran; Atasay, Begum; Arsan, Saadet
2014-11-01
Almost 95% of the platelet transfusions (PTs) conducted in the neonatal intensive care unit (NICU) are prophylactic transfusions. Guidelines for prophylactic PTs are based on platelet counts, but not on platelet functions. Nowadays, in order to reduce unnecessary transfusions, utilizing platelet mass index (PMI) was investigated. The aim of study is to find out whether PTs performed in our NICU during last 2 years were in accordance with the current guideline and to evaluate whether the frequency of PTs should be reduced if PMI was considered. Forty-three infants who received 96 prophylactic PTs were enrolled in the study. The guideline utilized in our NICU advocate keeping the platelet count: (a) >100 000 in pre/post-operative, (b) >50 000 in unstable and (c) >20 000 in stable patients. According to PMI criteria, PT should be performed if PMI: (a) platelet functions into account may yield lower transfusion rate, lower costs and better conservation of blood bank resources.
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Unnecessary work tasks and mental health
DEFF Research Database (Denmark)
Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne
2014-01-01
OBJECTIVES: According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated...... with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association...... is modified by sex, age, occupational position, and baseline mental health status. METHODS: The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed...
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Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J; Main, Cheryl; Mertz, Dominik
2015-01-01
Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Quasi-experimental study with a control group. Two tertiary teaching adult care hospitals. Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention). In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control. During the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7). A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.
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Directory of Open Access Journals (Sweden)
Neal Irfan
Full Text Available Asymptomatic bacteriuria (ABU should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.Quasi-experimental study with a control group.Two tertiary teaching adult care hospitals.Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline and January 30th and April 30th, 2013 (intervention.In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly on one clinical teaching unit (CTU at one hospital site, with the CTU of the other hospital serving as the control.During the baseline period, 160/341 (46.9% positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8% were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3, absence of a catheter (OR 2.5, 1.2-5, bacteriuria versus candiduria (OR 10.6, 3.8-29.4, pyuria (OR 2.0, 1.1-3.8, and positive nitrites (OR 2.2, 1.1-4.5. In 2013, only 2/24 (8% of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52% on the control CTU (OR 0.10; 95% CI 0.02-0.49. A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7 with no significant change noted on the control CTU (OR 0.47, 0.13-1.7.A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.
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Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay
2014-04-01
Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, pSMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; pSMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.
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[For active dermatocosmetics and free of unnecessary animal experimentation].
Piérard, G E; Piérard-Franchimont, C
1998-06-01
At the dawn of this century, dermocosmetology is at cross-roads because new European regulations are changing its face. The proof of claims must be given and the entire composition of the product must be released. In addition, animal testing is about to be banned. Such new regulations incite to search for and validate predictive tests aiming at the objective evaluation of the activity and tolerance claimed by dermocosmetic products. Such tests must be an alternative to unnecessary animal experimentation. These aspects are scrutinized scientifically by the EEMCO experts in combination with the ECVAM and COLIPA organizations.
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Reducing duplicate testing: a comparison of two clinical decision support tools.
Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert
2015-05-01
Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.
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33 CFR 117.11 - Unnecessary opening of the draw.
2010-07-01
... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Unnecessary opening of the draw. 117.11 Section 117.11 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS General Requirements § 117.11 Unnecessary opening of the draw. No...
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[The unnecessary application of central venous catheterization in surgical patients].
Uemura, Keiko; Inoue, Satoki; Kawaguchi, Masahiko
2018-04-06
Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement. Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement. In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021-4.359), low surgical risk (OR=1.729, 95% CI 1.038-2.881), short duration of anesthesia (OR=0.961/10min increase, 95% CI 0.945-0.979), and postoperative care outside of the intensive care unit (OR=2.197, 95% CI 1.402-3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p=0.032, OR=2.282, 95% CI 1.076-4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p=0.0536, OR=2.115, 95% CI 0.988-4.526). More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on
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Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay
2014-01-01
Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850
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Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique
2015-03-01
is to reduce the size of questionnaires because they are too long and cannot be used in a routine practice. But an analysis performed on a single question is quite risky: in psychometrics, redundancy is used to confirm a measurement. We lose precision on what exactly we are testing by asking a single question. Madsen et al's results show that among workers saying they are always or often performing unnecessary tasks, the MHI mean score was 74.00 versus 78.20 for people who never or almost never perform unnecessary tasks (P=0.0038). Even though it is a statistically significant result, its clinical relevance is never questioned. What is the impact of losing 4.20 points at MHI test instead of losing 20 points for instance? Statistical difference does not mean clinical relevance. These results show a statistical association, not a causality relationship. The authors did not show that performing unnecessary tasks lowers the level of mental health. It may be the exact opposite. Maybe having poorer mental health (eg, depression, with anhedonia) may make the workers think that what they're doing is useless. In their conclusion, Madsen et al suggest that the elimination of unnecessary work tasks may be beneficial for employees' mental health. To our mind, on the contrary, it may increase psychic suffering. If we suggest to fight unnecessary tasks in workplaces, this may encourage reduction of the margin of manoeuvre (3). The principle of removing unnecessary tasks is part of a Taylorized organization. Some tasks may seem unnecessary or bothersome, but may correspond to work periods that allow for temporary rest. Concretely, in the workplace, managers rather than the employee will be the ones to decide whether a task is useless or not. To improve well-being in the workplace, a global vision of work organization is required. From our point of view, the conclusion drawn from this study should not be that we must eliminate unnecessary tasks, but that we should focus on what
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Gasparini, Maurizio; Lunati, Maurizio G; Proclemer, Alessandro; Arenal, Angel; Kloppe, Axel; Martínez Ferrer, Josè B; Hersi, Ahmad S; Gulaj, Marcin; Wijffels, Maurits C E; Santi, Elisabetta; Manotta, Laura; Varma, Niraj
2017-11-01
This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial. Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs. A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length functions enabled. Therapies delivered were compared using a negative binomial regression model. A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm. Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175). Copyright © 2017 The Authors. Published by Elsevier Inc. All
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Removing Unnecessary Variables from Horn Clause Verification Conditions
Directory of Open Access Journals (Sweden)
Emanuele De Angelis
2016-07-01
Full Text Available Verification conditions (VCs are logical formulas whose satisfiability guarantees program correctness. We consider VCs in the form of constrained Horn clauses (CHC which are automatically generated from the encoding of (an interpreter of the operational semantics of the programming language. VCs are derived through program specialization based on the unfold/fold transformation rules and, as it often happens when specializing interpreters, they contain unnecessary variables, that is, variables which are not required for the correctness proofs of the programs under verification. In this paper we adapt to the CHC setting some of the techniques that were developed for removing unnecessary variables from logic programs, and we show that, in some cases, the application of these techniques increases the effectiveness of Horn clause solvers when proving program correctness.
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Directory of Open Access Journals (Sweden)
Yurika Ganaha
2015-06-01
Full Text Available The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis, requiring medical documentation at the start only (Single Diagnosis, and with no medical documentation (Non-Diagnosis. Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis. This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.
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Directory of Open Access Journals (Sweden)
Hunziker Roger
2011-05-01
Full Text Available Abstract Background Physicians fear missing cases of pneumonia and treat many patients with signs of respiratory infection unnecessarily with antibiotics. This is an avoidable cause for the increasing worldwide problem of antibiotic resistance. We developed a user-friendly decision aid to rule out pneumonia and thus reduce the rate of needless prescriptions of antibiotics. Methods This was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool. Results A total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5% of patients. Antibiotics were prescribed to 234 (48.3% of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI: 6.4 to 11.8. Conclusions Following validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumonia
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Energy Technology Data Exchange (ETDEWEB)
Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)
2017-09-15
To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)
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REDUCING GONAD IRRADIATION IN PEDIATRIC DIAGNOSIS
Bishop, Harry A.; Webber, Milo; O'Loughlin, Bernard J.
1959-01-01
The greatest danger of carcinogenesis and of genetic damage through diagnostic radiologic procedures is in children, whose smaller bodies are more vulnerable and who have a longer life span in which this damage can be realized. Film badges placed on the gonad area during radiologic studies indicated widely varying degrees of gonad irradiation from similar procedures. These results emphasize the importance of technique in protecting children from unnecessary exposure. Such exposure can be reduced by greater beam filtration, use of higher tube potentials, careful beam collimation and centering, closer coning and shielding of the gonads. A new film tested reduced exposure time by 50 per cent. Further reduction was obtained by high-speed screens. A most important measure is avoidance of unnecessary, repetitious and undiagnostic studies. Fluoroscopy should be avoided if possible. If not, the operator must dark-adapt his eyes, use the smallest possible current, the narrowest beam, and the shortest exposure time. Image intensification promotes these aims. Modern equipment, properly shielded, assures against unsuspected exposure. PMID:13618739
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"Unnecessary suffering": the cornerstone of animal protection legislation considered.
Radford, M
1999-09-01
Causing "unnecessary suffering" has been widely adopted in legislation to define criminal liability in respect of the treatment of animals. This article examines the way in which the term has been interpreted and applied by the courts, and considers its effectiveness in affording animals protection from abuse.
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Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers.
Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne; Rugulies, Reiner
2014-11-01
According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association is modified by sex, age, occupational position, and baseline mental health status. The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed mental health using the 5-item mental health inventory from the Short form 36 questionnaire. We analyzed data using multi-level modeling, adjusting for potential confounding by sex, age, cohabitation, occupational position, and baseline mental health. Unnecessary work tasks were prospectively associated with a decreased level of mental health. This association was stronger for employees with poor baseline mental health and tended to be more pronounced among older employees. Among participants with poor baseline mental health, the association was explained by neither psychological demands nor decision latitude. Our findings suggest that the prevention of unnecessary work tasks may benefit employee mental health, particularly among employees with pre-existing mental health problems.
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Madsen, Ida Eh; Rugulies, Reiner
2015-03-01
unnecessary or bothersome, but may correspond to work periods that allow for temporary rest". We find this suggestion curious and are not aware of any empirical studies to support this claim. Consequently, we encourage the authors of the commentary to test their hypothesis empirically. Any such empirical evidence would be a welcome advancement to the scientific knowledge concerning the mental health consequences of unnecessary work tasks. As the results of our study do not indicate that unnecessary work tasks could be beneficial to mental health, but indeed that they could be harmful, we find no reason to modify the conclusions of our article. References 1. Durand-Moreau Q, Loddé B, Dewitte J-D. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers". Scand J Work Environ Health - online first. http://dx.doi.org/10.5271/sjweh.3473. 2. Madsen IEH, Tripathi M, Borritz M, Rugulies R, Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers, Scand J Work Environ Health. 2014;40(6):631-8. http://dx.doi.org/10.5271/sjweh.3453. 3. Semmer NK, Tschan F, Meier LL, Facchin S, Jacobshagen N, Illegitimate tasks and counterproductive work behavior, Appl Psychol. 2010;59:70-96. http://dx.doi.org/10.1111/j.1464-0597.2009.00416.x. 4. Durand MJ, Vézina N, Baril R, Loisel P, Richard MC, Ngomo S, Margin of manoeuvre indicators in the workplace during the rehabilitation process: a qualitative analysis, J Occup Rehab. 2009;19:194-202. http://dx.doi.org/10.1007/s10926-009-9173-4.
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Sigaloff, Kim C E; Hamers, Raph L; Wallis, Carole L; Kityo, Cissy; Siwale, Margaret; Ive, Prudence; Botes, Mariette E; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Stevens, Wendy S; van Vugt, Michèle; de Wit, Tobias F Rinke
2011-09-01
This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M or K65R/K70E). Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa.
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[Allergy testing in atopic dermatitis: often unnecessary
Thijs, J.L.; Damoiseaux, R.A.; Lucassen, P.L.; Pasmans, S.G.; Bruin-Weller, M. de; Bruijnzeel-Koomen, C.A.
2013-01-01
Atopic dermatitis (AD) is a chronic inflammatory skin disease from which many children and adults suffer. In the Netherlands, the majority of patients with AD are treated in the primary health care setting. There is no clear consensus about whether or not to conduct allergy testing in patients with
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Bahl, Manisha; Barzilay, Regina; Yedidia, Adam B; Locascio, Nicholas J; Yu, Lili; Lehman, Constance D
2018-03-01
Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer. Traditional features such as age and HRL histologic results were used in the model, as were text features from the biopsy pathologic report. Results One thousand six HRLs were identified, with a cancer upgrade rate of 11.4% (115 of 1006). A machine learning random forest model was developed with 671 HRLs and tested with an independent set of 335 HRLs. Among the most important traditional features were age and HRL histologic results (eg, atypical ductal hyperplasia). An important text feature from the pathologic reports was "severely atypical." Instead of surgical excision of all HRLs, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% (37 of 38) of malignancies would have been diagnosed at surgery, and 30.6% (91 of 297) of surgeries of benign lesions could have been avoided. Conclusion This study provides proof of concept that a machine learning model can be applied to predict the risk of upgrade of HRLs to cancer. Use of this model could decrease unnecessary surgery by nearly one-third and could help guide clinical decision making with regard to surveillance versus surgical excision of HRLs. © RSNA, 2017.
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Castro, Hugo A Socrates; Iared, Wagner; Santos, José Eduardo Mourão; Solha, Raphael Sandes; Shigueoka, David Carlos; Ajzen, Sergio Aron
2018-04-10
To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0,806) (PPSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies. Copyright® by the International Brazilian Journal of Urology.
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Huh, Jong-Ki; Shin, Su-Jung
2013-08-01
This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.
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77 FR 29579 - Removing Unnecessary Office on Violence Against Women Regulations
2012-05-18
... now unnecessary STOP VAIW Program regulations. Higher Education Amendments of 1998 Violence against... Office on Violence Against Women Regulations AGENCY: Office on Violence Against Women, Justice. ACTION: Proposed rule. SUMMARY: This rule proposes to remove the regulations for the STOP Violence Against Indian...
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Investigation of Stress Indices and Directional Loading of Eccentric Reducers
International Nuclear Information System (INIS)
Carter, R.; Wais, E.A.; Rodabaugh, E.C.
2003-01-01
OAK- B135 Engineering for fatigue is an essential concern in piping systems. Addressing this concern, the ASME Section III and ANSI B31.1 Codes provide stress indices and stress intensification factors (SIFs) to be used in the design and evaluation of Class 1, 2 and 3 systems. In recent research cosponsored by EPRI and the U.S. DOE, new test data have been developed for comparison with the ASME stress indices and SIFs. This report presents the results of fatigue tests on eccentric reducers, taking into account the directionality of the loading. As detailed in the report, the results can help to improve the evaluation of reducers and can help to reduce unnecessary conservatism in piping system design
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Thoracic splenosis. Know it-avoid unnecessary investigations, interventions, and thoracotomy
International Nuclear Information System (INIS)
Khan, A.M.; Manzoor, K.; Malik, Z.; Yasim, A.; Shim, C.
2011-01-01
Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99m Tc-sulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy. (author)
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DEFF Research Database (Denmark)
Nielsen, L. H.; Markenvard, John; Jensen, Jesper Møller
2011-01-01
It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patie...... prospective trials are needed in order to define the most cost-effective diagnostic use of CTA relative to conventional ischemia testing....
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Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I
2017-03-01
The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.
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Avolio, Luigi; Fusillo, Mario; Ferrari, Giovanna; Chiara, Alberto; Bragheri, Romano
2002-04-01
Neonatal adrenal hemorrhage presenting as scrotal swelling has been reported in 17 cases, with unnecessary surgical exploration in 7. We report 2 new cases, emphasizing the knowledge of this clinical association and the role of ultrasonography in the differential diagnosis for this specific condition and in all cases of neonatal acute scrotum.
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Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M
2012-06-09
(delay or cancel patients' surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation). We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.
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Ibraheem, Kareem; Khan, Muhammad; Rhee, Peter; Azim, Asad; O'Keeffe, Terence; Tang, Andrew; Kulvatunyou, Narong; Joseph, Bellal
2018-01-01
The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach. An 8-year retrospective analysis of all adult trauma patients with penetrating neck trauma (PNT) was performed. We included all patients in whom the platysma was violated. Patients were classified into three groups as follows: hard signs, soft signs, and asymptomatic. CTA use, positive CTA (contrast extravasation, dissection, or intimal flap) and operative details were reported. Primary outcomes were positive CTA and therapeutic neck exploration (TNE) (defined by repair of major vascular or aero-digestive injuries). A total of 337 patients with PNT met the inclusion criteria. Eighty-two patients had hard signs and all of them went to the operating room, of which 59 (72%) had TNE. One hundred fifty-six patients had soft signs, of which CTA was performed in 121 (78%), with positive findings in 12 (10%) patients. The remaining 35 (22%) underwent initial neck exploration, of which 14 (40%) were therapeutic yielding a high rate of negative exploration. Ninty-nine patients were asymptomatic, of which CTA was performed in 79 (80%), with positive findings in 3 (4%), however, none of these patients required TNE. On sub analysis based on symptoms, there was no difference in the rate of TNE between the neck zones in patients with hard signs (P = 0.23) or soft signs (P = 0.51). Regardless of the zone of injury, asymptomatic patients did not require a TNE. Physical examination regardless of the zone of injury should be the primary guide to CTA or TNE in patients with PNT. Following traditional zone-based guidelines can result in unnecessary negative explorations in patients with soft signs and may need rethinking. Copyright © 2017 Elsevier Inc. All rights reserved.
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Miyamoto, Mihoko; Kimura, Yuichiro; Hosoda, Junya; Matsumoto, Katsumi; Matsushita, Kohei; Ishikawa, Toshiyuki; Umemura, Satoshi
2012-01-01
Ventricular desynchronization imposed by ventricular pacing causes regional disturbances of adrenergic innervation in the left ventricular myocardium and increases the risk of heart failure and atrial fibrillation (AF) in patients with sinus node disease (SND). As a result, decreased iodine-123 metaiodobenzylguanidine (I-(123 )MIBG) uptake occurs in patients with an implanted permanent pacemaker. Fourteen SND patients with an implanted pacemaker equipped with an algorithm for reducing unnecessary right ventricular pacing (RURVP) were enrolled. Pacemakers were programmed to RURVP mode for the first 12 weeks, and then reprogrammed to DDD for the last 12 weeks. At the end of each mode, data on cumulative percent ventricular pacing (%Vp), atrial high rate episodes (%AHR), I-(123 )MIBG myocardial scintigraphy, brain natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and myocardial damage indices typified by troponin T and C-reactive protein (CRP) were collected. %Vp was lower in RURVP than in DDD (0.2% versus 95.7%, P = 0.00098). BNP, hANP, troponin T, and CRP did not differ significantly between the pacing modes. However, I-(123 )MIBG findings of patients with full ventricular pacing in DDD improved in RURVP. In contrast, among patients without full ventricular pacing in DDD, their I-(123 )MIBG findings did not differ significantly between the pacing modes. In SND patients with normal cardiac function and intact atrioventricular conduction, the reduction of %Vp in RURVP was due to the reduction of ineffective pacing and fusion pacing in DDD. Therefore, these 2 types of pacing do not affect cardiac pump function.
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Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?
Directory of Open Access Journals (Sweden)
Mahmoud F. Sakr
2012-08-01
Results: Sixty-seven patients (65.9% were female and 35 (34.1% were male. Their ages ranged between 16 and 49 years (mean 27.5 years. Most patients (87.3% had their symptoms for 12-36 hours before hospital admission. The mean values for TLC, NP, and CRP were 7,573/ and micro;L, 54.53%, and 0.61 mg/L, respectively. Of the 102 patients with NTT, 101 (99% proved not to have appendiceal inflammation (NPV=99%. Only 39 patients were operated upon, of whom 38 (97.4% had a normal appendix, and the remaining 63 patients were either discharged (n=47 or referred to other specialties (n=16. There were significantly more women (76.3%, 29/38 with negative appendectomy than men (24.7%, 9/38 (X2= 21.1, p=0.0001. Gynecological causes were the most common (60.5%, 23/38 and in 11 cases, the exact etiology could not be identified. Conclusions: From the data presented, it may be concluded that TLC, NP and CRP blood levels (triple test should be measured upon hospital admission of adult patients with clinically suspected acute appendicitis. If used judiciously, they may spare the group of patients with an NTT an unnecessary surgical operation, hence markedly reducing the NAR with its potential risks. [Arch Clin Exp Surg 2012; 1(4.000: 229-236
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Assessing social values for California's efforts to reduce the overuse of unnecessary medical care.
Perez, Susan L; Backman, Desiree; Ginsburg, Marge
2018-04-01
A partnership of large health-care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost-sharing or taking no definitive action. Five themes were identified, including strong support for physicians' leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost-sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator. Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health-care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision-making. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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Impact of Laboratory Test Use Strategies in a Turkish Hospital.
Directory of Open Access Journals (Sweden)
Fatma Meriç Yılmaz
Full Text Available Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH and calculate potential savings in costs.A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0% was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.
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Directory of Open Access Journals (Sweden)
Patey Andrea M
2012-06-01
consequences associated with reducing testing, from negative (delay or cancel patients’ surgeries, to indifference (little or no change in patient outcomes, to positive (save money, avoid unnecessary investigations (Beliefs about consequences. Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals, there was still a report of a gap between their motivation and practice (Behavioural regulation. Conclusion We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.
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Lin, Marie
2006-01-01
The high frequency of RhD (D) antigen among Taiwanese persons (99.67%) often imposes unnecessary risks of under-transfusion on D- patients awaiting D- blood. Also because of the rare occurrence of anti-D among Taiwanese persons, routine pretransfusion D typing has been discontinued in the Mackay Memorial Hospital since 1988. This report is the retrospective evaluation of the outcome of abolishing RhD typing for Taiwanese. More than 10 years of alloantibody data at Mackay Memorial Hospital Blood Bank were reviewed. The cases with anti-D were further used to analyze the potency of D antigen and to observe whether there were differences in the incidence of anti-D before and after discontinuation of routine D typing among Taiwanese individuals. The incidence of anti-D before and after discontinuation of routine pretransfusion D typing has remained unchanged. The immunogenicity of D and "Mi(a)" in Taiwanese persons is found to be similar. In terms of opportunity for immunization, however, the "Mi(a)" antigen (phenotype frequency 7.3% in Taiwanese persons) has become the most important blood group antigen in Taiwan. The results strongly support the exclusion of D typing from routine compatibility testing for individuals of Taiwanese origin. Because the low incidence of D- and relatively high incidence of "Mi(a)"+ phenotypes are common findings throughout southeast Asia, and because a population genetic study revealed that the Taiwanese people are genetically related to southern Asian populations, it is suggested that RhD typing for blood transfusion is unnecessary among southeast Asian populations.
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Short, John; Sharp, Benjamin; Elliot, Nikki; McEwing, Rachael; McGeoch, Graham; Shand, Brett; Holland, Kieran
2016-08-01
This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
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Zhang, Yi; Zhou, Zhongliang; Si, Yafei
2017-03-09
children's health care use was more prominent among younger children. Chinese children whose parents were high health care users were more likely to overuse health care services, holding other factors constant. Parents can play an important role in reducing children's unnecessary outpatient visits, infusion use, and inpatient visits. The results suggest that interventions aimed at affecting patterns of parental use may be helpful in improving appropriate health care utilization for children.
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Duplicate laboratory test reduction using a clinical decision support tool.
Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice
2014-05-01
Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.
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Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert
2015-05-06
Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.
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Reduced Interference from Memory Testing: A Postretrieval Monitoring Account
Pierce, Benton H.; Gallo, David A.; McCain, Jason L.
2017-01-01
Initial learning can interfere with subsequent learning (proactive interference [PI]), but recent work indicates initial testing can reduce PI. Here, we tested 2 alternative hypotheses of this effect: Does testing reduce PI by constraining retrieval to the target list, or by facilitating a postretrieval monitoring process? Participants first…
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Corkill, David
2012-02-01
Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED. A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff. Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period. This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.
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Hartley, Suzanne; Foy, Robbie; Walwyn, Rebecca E A; Cicero, Robert; Farrin, Amanda J; Francis, Jill J; Lorencatto, Fabiana; Gould, Natalie J; Grant-Casey, John; Grimshaw, Jeremy M; Glidewell, Liz; Michie, Susan; Morris, Stephen; Stanworth, Simon J
2017-07-03
Blood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of healthcare, including appropriate use of blood. However, its effects are often inconsistent, indicating the need for coordinated research including more head-to-head trials comparing different ways of delivering feedback. A programmatic series of research projects, termed the 'Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE' (AFFINITIE) programme, aims to test different ways of developing and delivering feedback within an existing national audit structure. The evaluation will comprise two linked 2×2 factorial, cross-sectional cluster-randomised controlled trials. Each trial will estimate the effects of two feedback interventions, 'enhanced content' and 'enhanced follow-on support', designed in earlier stages of the AFFINITIE programme, compared to current practice. The interventions will be embedded within two rounds of the UK National Comparative Audit of Blood Transfusion (NCABT) focusing on patient blood management in surgery and use of blood transfusions in patients with haematological malignancies. The unit of randomisation will be National Health Service (NHS) trust or health board. Clusters providing care relevant to the audit topics will be randomised following each baseline audit (separately for each trial), with stratification for size (volume of blood transfusions) and region (Regional Transfusion Committee). The primary outcome for each topic will be the proportion of patients receiving a transfusion coded as unnecessary. For each audit topic a linked, mixed-method fidelity assessment and cost-effectiveness analysis will be conducted in parallel to the trial. AFFINITIE involves a series of studies to explore how A
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Automotive RF immunity test set-up analysis : why test results can't compare
Coenen, Mart; Pues, H.; Bousquet, T.
2011-01-01
Though the automotive RF emission and RF immunity requirements are highly justifiable, the application of those requirements in an non-intended manner leads to false conclusions and unnecessary redesigns for the electronics involved. When the test results become too dependent upon the test set-up
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Moore, Nouerand and Lincoln, in concert with other employees of FBK Products, LLC., knowingly participated in a scheme to fraudulently market and sell an unnecessary and unneeded septic treatment product to residents of various states across the country.
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Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N
2018-03-01
Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in
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Carney, Patricia A; Abraham, Linn; Cook, Andrea; Feig, Stephen A; Sickles, Edward A; Miglioretti, Diana L; Geller, Berta M; Yankaskas, Bonnie C; Elmore, Joann G
2012-09-01
The aim of this study was to describe the impact of a tailored Web-based educational program designed to reduce excessive screening mammography recall. Radiologists enrolled in one of four mammography registries in the United States were invited to take part and were randomly assigned to receive the intervention or to serve as controls. The controls were offered the intervention at the end of the study, and data collection included an assessment of their clinical practice as well. The intervention provided each radiologist with individual audit data for his or her sensitivity, specificity, recall rate, positive predictive value, and cancer detection rate compared to national benchmarks and peer comparisons for the same measures; profiled breast cancer risk in each radiologist's respective patient populations to illustrate how low breast cancer risk is in population-based settings; and evaluated the possible impact of medical malpractice concerns on recall rates. Participants' recall rates from actual practice were evaluated for three time periods: the 9 months before the intervention was delivered to the intervention group (baseline period), the 9 months between the intervention and control groups (T1), and the 9 months after completion of the intervention by the controls (T2). Logistic regression models examining the probability that a mammogram was recalled included indication of intervention versus control and time period (baseline, T1, and T2). Interactions between the groups and time period were also included to determine if the association between time period and the probability of a positive result differed across groups. Thirty-one radiologists who completed the continuing medical education intervention were included in the adjusted model comparing radiologists in the intervention group (n = 22) to radiologists who completed the intervention in the control group (n = 9). At T1, the intervention group had 12% higher odds of positive mammographic results
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Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test
Energy Technology Data Exchange (ETDEWEB)
Vladutiu, A.O.; Sulewski, J.M.; Pudlak, K.A.; Stull, C.G.
1982-11-19
A young woman with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of ..beta..-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment.
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Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test
International Nuclear Information System (INIS)
Vladutiu, A.O.; Sulewski, J.M.; Pudlak, K.A.; Stull, C.G.
1982-01-01
A young woman with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of #betta#-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment
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Directory of Open Access Journals (Sweden)
Robert Redwood
2018-01-01
Full Text Available Abstract Background Inappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB. Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices. Methods We conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS framework. We used iterative categorization (directed content analysis followed by summative content analysis to code and analyze the data both deductively (using SEIPS domains and inductively (emerging themes. Results Factors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues. Conclusions We identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.
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Xu, Ning; Wu, Yu-Peng; Chen, Dong-Ning; Ke, Zhi-Bin; Cai, Hai; Wei, Yong; Zheng, Qing-Shui; Huang, Jin-Bei; Li, Xiao-Dong; Xue, Xue-Yi
2018-05-01
To explore the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) for predicting prostate biopsy results in patients with prostate specific antigen (PSA) levels of 4-10 ng/ml. We retrospectively reviewed multi-parameter magnetic resonance images from 528 patients with PSA levels of 4-10 ng/ml who underwent transrectal ultrasound-guided prostate biopsies between May 2015 and May 2017. Among them, 137 were diagnosed with prostate cancer (PCa), and we further subdivided them according to pathological results into the significant PCa (S-PCa) and insignificant significant PCa (Ins-PCa) groups (121 cases were defined by surgical pathological specimen and 16 by biopsy). Age, PSA, percent free PSA, PSA density (PSAD), prostate volume (PV), and PI-RADS score were collected. Logistic regression analysis was performed to determine predictors of pathological results. Receiver operating characteristic curves were constructed to analyze the diagnostic value of PI-RADS v2 in PCa. Multivariate analysis indicated that age, PV, percent free PSA, and PI-RADS score were independent predictors of biopsy findings, while only PI-RADS score was an independent predictor of S-PCa (P PSA, and PI-RADS score were 0.570, 0.430, 0.589 and 0.836, respectively. The area under the curve for diagnosing S-PCa with respect to PI-RADS score was 0.732. A PI-RADS score of 3 was the best cutoff for predicting PCa, and 4 was the best cutoff for predicting S-PCa. Thus, 92.8% of patients with PI-RADS scores of 1-2 would have avoided biopsy, but at the cost of missing 2.2% of the potential PCa cases. Similarly, 83.82% of patients with a PI-RADS score ≤ 3 would have avoided biopsy, but at the cost of missing 3.3% of the potential S-PCa cases. PI-RADS v2 could be used to reduce unnecessary prostate biopsies in patients with PSA levels of 4-10 ng/ml.
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Keller, Sara C; Feldman, Leonard; Smith, Janessa; Pahwa, Amit; Cosgrove, Sara E; Chida, Natasha
2018-06-01
Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. The objective of this study was to design an intervention to reduce unnecessary urinalysis and urine culture (UC) orders as well as the treatment of ASB. We performed a quasiexperimental study among adult inpatients at a single academic institution. We implemented a bundled intervention, including information broadcast in newsletters, hospitalwide screensavers, and passive CDS messages in the EHR. We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy. © 2018 Society of Hospital Medicine.
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Energy Technology Data Exchange (ETDEWEB)
Wang Weizheng; Kuang Jishun; You Zhiqiang; Liu Peng, E-mail: jshkuang@163.com [College of Information Science and Engineering, Hunan University, Changsha 410082 (China)
2011-07-15
This paper presents a new test scheme based on scan block encoding in a linear feedback shift register (LFSR) reseeding-based compression environment. Meanwhile, our paper also introduces a novel algorithm of scan-block clustering. The main contribution of this paper is a flexible test-application framework that achieves significant reductions in switching activity during scan shift and the number of specified bits that need to be generated via LFSR reseeding. Thus, it can significantly reduce the test power and test data volume. Experimental results using Mintest test set on the larger ISCAS'89 benchmarks show that the proposed method reduces the switching activity significantly by 72%-94% and provides a best possible test compression of 74%-94% with little hardware overhead. (semiconductor integrated circuits)
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Strategies to reduce blood product utilization in obstetric practice.
Neb, Holger; Zacharowski, Kai; Meybohm, Patrick
2017-06-01
Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.
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Radtke, Jan Philipp; Wiesenfarth, Manuel; Kesch, Claudia; Freitag, Martin T; Alt, Celine D; Celik, Kamil; Distler, Florian; Roth, Wilfried; Wieczorek, Kathrin; Stock, Christian; Duensing, Stefan; Roethke, Matthias C; Teber, Dogu; Schlemmer, Heinz-Peter; Hohenfellner, Markus; Bonekamp, David; Hadaschik, Boris A
2017-12-01
Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated based on resampling methods. PSA, prostate volume, digital-rectal examination, and PI-RADS were significant sPC predictors and included in the RMs together with age. The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 (0.83 vs 0.84) but larger compared with ERSPC-RC3 (0.81), refitted RC3 (0.80), and PI-RADS (0.76). For postbiopsy men, the novel RM's discrimination (0.81) was higher, compared with PI-RADS (0.78), ERSPC-RC4 (0.66), refitted RC4 (0.76), and ERSPC-RC4 plus PI-RADSv1.0 (0.78). Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies. Limitations include a monocentric design and a lack of PI-RADSv2.0. The novel RMs, incorporating clinical parameters and PI-RADS, performed significantly better
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Automotive RF immunity test set-up analysis
Coenen, M.J.; Pues, H.; Bousquet, T.; Gillon, R.; Gielen, G.; Baric, A.
2011-01-01
Though the automotive RF emission and RF immunity requirements are highly justifiable, the application of those requirements in an non-intended manner leads to false conclusions and unnecessary redesigns for the electronics involved. When the test results become too dependent upon the test set-up
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Shirasaka, Takashi; Funama, Yoshinori; Hayashi, Mutsukazu; Awamoto, Shinichi; Kondo, Masatoshi; Nakamura, Yasuhiko; Hatakenaka, Masamitsu; Honda, Hiroshi
2012-01-01
Our purpose in this study was to assess the radiation dose reduction and the actual exposed scan length of over-range areas using a spiral dynamic z-collimator at different beam pitches and detector coverage. Using glass rod dosimeters, we measured the unilateral over-range scan dose between the beginning of the planned scan range and the beginning of the actual exposed scan range. Scanning was performed at detector coverage of 80.0 and 40.0 mm, with and without the spiral dynamic z-collimator. The dose-saving ratio was calculated as the ratio of the unnecessary over-range dose, with and without the spiral dynamic z-collimator. In 80.0 mm detector coverage without the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 108, 120, and 126 mm, corresponding to a beam pitch of 0.60, 0.80, and 0.99, respectively. With the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 48, 66, and 84 mm with a beam pitch of 0.60, 0.80, and 0.99, respectively. The dose-saving ratios with and without the spiral dynamic z-collimator for a beam pitch of 0.60, 0.80, and 0.99 were 35.07, 24.76, and 13.51%, respectively. With 40.0 mm detector coverage, the dose-saving ratios with and without the spiral dynamic z-collimator had the highest value of 27.23% with a low beam pitch of 0.60. The spiral dynamic z-collimator is important for a reduction in the unnecessary over-range dose and makes it possible to reduce the unnecessary dose by means of a lower beam pitch.
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Medical innovation laws: an unnecessary innovation.
Richards, Bernadette
2016-06-01
Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position
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Reduced enrichment for research and test reactors: Proceedings
International Nuclear Information System (INIS)
1993-07-01
The 15th annual Reduced Enrichment for Research and Test Reactors (RERTR) international meeting was organized by Ris oe National Laboratory in cooperation with the International Atomic Energy Agency and Argonne National Laboratory. The topics of the meeting were the following: National Programs, Fuel Fabrication, Licensing Aspects, States of Conversion, Fuel Testing, and Fuel Cycle. Individual papers have been cataloged separately
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Reduced enrichment for research and test reactors: Proceedings
Energy Technology Data Exchange (ETDEWEB)
1993-07-01
The 15th annual Reduced Enrichment for Research and Test Reactors (RERTR) international meeting was organized by Ris{o} National Laboratory in cooperation with the International Atomic Energy Agency and Argonne National Laboratory. The topics of the meeting were the following: National Programs, Fuel Fabrication, Licensing Aspects, States of Conversion, Fuel Testing, and Fuel Cycle. Individual papers have been cataloged separately.
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Ho, Jonathan Ka-Ming; Chau, Janita Pak-Chun; Cheung, Nancy Man-Ching
2016-11-01
The Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries. The use of the Ottawa Ankle Rules by emergency nurses has been suggested to minimise unnecessary radiographic-test requests and reduce patients' length of stay in emergency departments. However, the findings of studies in this area are inconsistent. A systematic review was conducted to synthesise the most accurate evidence available on the extent to which emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries. The systematic review attempted to identify all relevant published and unpublished studies in English and Chinese from databases such as Ovid MEDLINE, EMBASE, ProQuest Health and Medical Complete, EBM Reviews, SPORTDiscus, CINAHL Plus, the British Nursing Index, Scopus, the Chinese Biomedical Literature Database, China Journal Net, WanFang Data, the National Central Library Periodical Literature System, HyRead, the Digital Dissertation Consortium, MedNar and Google Scholar. Two reviewers independently assessed the eligibility of all of the studies identified during the search, based on their titles and abstracts. If a study met the criteria for inclusion, or inconclusive information was available in its title and abstract, the full text was retrieved for further analysis. The methodological quality of all of the eligible studies was assessed independently by the two reviewers. The search of databases and other sources yielded 1603 records. The eligibility of 17 full-text articles was assessed, and nine studies met the inclusion criteria. All nine studies were subjected to narrative analysis, and five were meta-analysed. All of the studies investigated the use of the refined Ottawa Ankle Rules. The results indicated that emergency nurses' use of the refined Ottawa Ankle Rules minimised unnecessary radiographic-test requests
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Optimizing urine drug testing for monitoring medication compliance in pain management.
Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D
2013-12-01
It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.
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Experiences of the REACH testing proposals system to reduce animal testing.
Taylor, Katy; Stengel, Wolfgang; Casalegno, Carlotta; Andrew, David
2014-01-01
In order to reduce animal testing, companies registering chemical substances under the EU REACH legislation must propose rather than conduct certain tests on animals. Third parties can submit 'scientifically valid information' relevant to these proposals to the Agency responsible, the European Chemicals Agency (ECHA), who are obliged to take the information into account. The European Coalition to End Animal Experiments (ECEAE) provided comments on nearly half of the 817 proposals for vertebrate tests on 480 substances published for comment for the first REACH deadline (between 1 August 2009 and 31 July 2012). The paper summarises the response by registrants and the Agency to third party comments and highlights issues with the use of read across, in vitro tests, QSAR and weight of evidence approaches. Use of existing data and evidence that testing is legally or scientifically unjustified remain the most successful comments for third parties to submit. There is a worrying conservatism within the Agency regarding the acceptance of alternative approaches and examples of where registrants have also failed to maximise opportunities to avoid testing.
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Effectiveness of Structured Psychodrama and Systematic Desensitization in Reducing Test Anxiety.
Kipper, David A.; Giladi, Daniel
1978-01-01
Students with examination anxiety took part in study of effectiveness of two kinds of treatment, structured psychodrama and systematic desensitization, in reducing test anxiety. Results showed that subjects in both treatment groups significantly reduced test-anxiety scores. Structured psychodrama is as effective as systematic desensitization in…
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First tests of a traveling-wave chopper for the ATLAS positive ion linac
International Nuclear Information System (INIS)
Pardo, R. C.
1998-01-01
A ten segment traveling-wave chopper has been constructed and successfully tested at 5% of the design 12 MHz repetition rate. The chopper must remove unbunched tails from a partially bunched heavy-ion beam in order to avoid undue emittance growth in the linac and the production of undesirable satellite beam bunches. When poorly bunched beams traverse the traditional sine-wave chopper, it produces unacceptable transverse emittance growth and unnecessary beam loss. These effects are expected to be much reduced in the traveling wave chopper. First tests have confirmed the validity of these claims, clearly showing much reduced transverse emittance growth as compared to the original sine wave chopper and excellent selectivity for the desired beam. Details of these tests will be presented and compared to calculations. Operation of the new chopper at the full 12 MHz rate is the next goal. Development of a driver power supply capable of full CW operation will also be described
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Directory of Open Access Journals (Sweden)
Jaanus Suumann
2018-02-01
Full Text Available Abstract Background To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS in pre-operative assessment of patients referred for bariatric surgery. Methods Sixty-five obese patients with a mean age of 43 years (range: 21–65 and a mean body mass index (BMI of 44 (range: 36–59 were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated, and Helicobacter pylori (HP antibodies (GastroPanel®, Biohit Oyj, Finland. On the basis of the biomarker test, the patients were classified into the HS (healthy stomach group (n = 22 with the normal biomarker profile and the NHS (non-healthy stomach group (n = 43. The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies. Results The concordance (Cohen’s kappa between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%. In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA of moderate severity. In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65 had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms. Conclusions The normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.
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International Nuclear Information System (INIS)
Marx, Christiane; Malich, Ansgar; Facius, Mirjam; Grebenstein, Uta; Sauner, Dieter; Pfleiderer, Stefan O.R.; Kaiser, Werner A.
2004-01-01
Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look [reg] , CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid
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Directory of Open Access Journals (Sweden)
Bréart Gérard
2008-07-01
Full Text Available Abstract Background Numerous short-statured children are evaluated for growth hormone (GH deficiency (GHD. In most patients, GH provocative tests are normal and are thus in retrospect unnecessary. Methods A retrospective cohort study was conducted to identify predictors of growth hormone (GH deficiency (GHD in children seen for short stature, and to construct a very sensitive and fairly specific predictive tool to avoid unnecessary GH provocative tests. GHD was defined by the presence of 2 GH concentration peaks Results The initial study included 167 patients, 36 (22% of whom had GHD, including 5 (3% with certain GHD. Independent predictors of GHD were: growth rate Conclusion We have derived and performed an internal validation of a highly sensitive decision rule that could safely help to avoid more than 2/3 of the unnecessary GH tests. External validation of this rule is needed before any application.
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Rodriguez-Borja, Enrique; Corchon-Peyrallo, Africa; Barba-Serrano, Esther; Villalba Martínez, Celia; Carratala Calvo, Arturo
2018-02-03
We assessed the impact of several "send & hold" clinical decision support rules (CDSRs) within the electronical request system for vitamins A, E, K, B1, B2, B3, B6 and C for all outpatients at a large health department. When ordered through electronical request, providers (except for all our primary care physicians who worked as a non-intervention control group) were always asked to answer several compulsory questions regarding main indication, symptomatology, suspected diagnosis, vitamin active treatments, etc., for each vitamin test using a drop-down list format. After samples arrival, tests were later put on hold internally by our laboratory information system (LIS) until review for their appropriateness was made by two staff pathologists according to the provided answers and LIS records (i.e. "send & hold"). The number of tests for each analyte was compared between the 10-month period before and after CDSRs implementation in both groups. After implementation, vitamins test volumes decreased by 40% for vitamin A, 29% for vitamin E, 42% for vitamin K, 37% for vitamin B1, 85% for vitamin B2, 68% for vitamin B3, 65% for vitamin B6 and 59% for vitamin C (all p values 0.03 or lower except for vitamin B3), whereas in control group, the majority increased or remained stable. In patients with rejected vitamins, no new requests and/or adverse clinical outcome comments due to this fact were identified. "Send & hold" CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist's leadership role as tests specialist.
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DEFF Research Database (Denmark)
Lindell, Johanna
care may influence decisions on antibiotic use. Based on video-and audio recordings of physician-patient consultations it is investigated how treatment recommendations are presented, can be changed, are forecast and explained, and finally, how they seemingly meet resistance and how this resistance......Antibiotic resistance is a growing public health problem both nationally and internationally, and efficient strategies are needed to reduce unnecessary use. This dissertation presents four research studies, which examine how communication between general practitioners and patients in Danish primary...... is responded to.The first study in the dissertation suggests that treatment recommendations on antibiotics are often done in a way that encourages patient acceptance. In extension of this, the second study of the dissertation examines a case, where acceptance of such a recommendation is changed into a shared...
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Plan for Reducing Unnecessary use of Social Security Numbers
Recognizing that training and awareness are critical to protecting agency Personally Identifiable Information (PII), the EPA is developing online training for privacy contacts in its programs and regions.
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Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles
2016-11-01
Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.
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An improved brine shrimp larvae lethality microwell test method.
Zhang, Yi; Mu, Jun; Han, Jinyuan; Gu, Xiaojie
2012-01-01
This article described an improved brine shrimp larvae lethality microwell test method. A simply designed connecting vessel with alternative photoperiod was used to culture and collect high yield of active Artemia parthenogenetica nauplii for brine shrimp larvae lethality microwell test. Using this method, pure A. parthenogenetica nauplii suspension was easily cultured and harvested with high density about 100-150 larvae per milliliter and the natural mortality was reduced to near zero by elimination of unnecessary artificial disturbance. And its sensitivity was validated by determination of LC(50)-24 h of different reference toxicants including five antitumor agents, two pesticides, three organic pollutants, and four heavy metals salts, most of which exhibited LC(50)-24 h between 0.07 and 58.43 mg/L except for bleomycin and mitomycin C with LC(50)-24 h over 300 mg/L.
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Efficacy test of a toothpaste in reducing extrinsic dental stain
Agustanti, A.; Ramadhani, S. A.; Adiatman, M.; Rahardjo, A.; Callea, M.; Yavuz, I.; Maharani, D. A.
2017-08-01
This clinical trial compared the external dental stain reduction achieved by tested toothpaste versus placebo in adult patients. In this double-blind, parallel, randomised clinical trial, 45 female volunteers with a mean age of 20 years old were included. All study subjects front teeth were topically applicated with Silver Diamine Fluoride (SDF) to create external dental stains. Subjects were randomized into test (n=22) and control (n=23) groups. Toothpastes were used for two days to analyse the effects of removing external stains on the labial surfaces of all anterior teeth. VITA Easyshade Advance 4.0 was used to measure dental extrinsic stains changes. The analysis showed statistically significant efficacy of the tested toothpaste in reducing external dental stain caused by SDF, comparing to the placebo toothpaste, after one and two days of usage. The tested toothpaste was effective in reducing dental stain.
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Design and test of aircraft engine isolators for reduced interior noise
Unruh, J. F.; Scheidt, D. C.
1982-01-01
Improved engine vibration isolation was proposed to be the most weight and cost efficient retrofit structure-borne noise control measure for single engine general aviation aircraft. A study was carried out the objectives: (1) to develop an engine isolator design specification for reduced interior noise transmission, (2) select/design candidate isolators to meet a 15 dB noise reduction design goal, and (3) carry out a proof of concept evaluation test. Analytical model of the engine, vibration isolators and engine mount structure were coupled to an empirical model of the fuselage for noise transmission evaluation. The model was used to develop engine isolator dynamic properties design specification for reduced noise transmission. Candidate isolators ere chosen from available product literature and retrofit to a test aircraft. A laboratory based test procedure was then developed to simulate engine induced noise transmission in the aircraft for a proof of concept evaluation test. Three candidate isolator configurations were evaluated for reduced structure-borne noise transmission relative to the original equipment isolators.
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Directory of Open Access Journals (Sweden)
Clinton M Hasenour
Full Text Available AMPK is an energy sensor that protects cellular energy state by attenuating anabolic and promoting catabolic processes. AMPK signaling is purported to regulate hepatic gluconeogenesis and substrate oxidation; coordination of these processes is vital during nutrient deprivation or pathogenic during overnutrition. Here we directly test hepatic AMPK function in regulating metabolic fluxes that converge to produce glucose and energy in vivo. Flux analysis was applied in mice with a liver-specific deletion of AMPK (L-KO or floxed control littermates to assess rates of hepatic glucose producing and citric acid cycle (CAC fluxes. Fluxes were assessed in short and long term fasted mice; the latter condition is a nutrient stressor that increases liver AMP/ATP. The flux circuit connecting anaplerosis with gluconeogenesis from the CAC was unaffected by hepatic AMPK deletion in short and long term fasting. Nevertheless, depletion of hepatic ATP was exacerbated in L-KO mice, corresponding to a relative elevation in citrate synthase flux and accumulation of branched-chain amino acid-related metabolites. L-KO mice also had a physiological reduction in flux from glycogen to G6P. These results demonstrate AMPK is unnecessary for maintaining gluconeogenic flux from the CAC yet is critical for stabilizing liver energy state during nutrient deprivation.
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International Nuclear Information System (INIS)
Centner, Terence J.
2016-01-01
While the public and governments debate the advisability of engaging in shale gas production, the United States has proceeded to develop its resources with an accompanying remarkable increase in natural gas production. The development of shale gas has not been without problems, and some countries have decided that shale gas production should not proceed until more is known about the accompanying health issues and environmental damages. From experiences in the United States, careful consideration of five critical points relating to shale gas production can form the basis for developing strategies for reducing discharges of pollutants: (1) casing and cementing, (2) handling wastewater, (3) venting and flaring, (4) equipment with air emissions, and (5) seismic events. For each strategy, institutional responses to markedly reduce the risks of harm to people and the environment are identified. These responses offer state and local governments ideas for enabling shale gas resources to be developed without sacrificing public health and environmental quality. - Highlights: •Shale gas development involves releases of unnecessary pollutants. •Major sources of unnecessary pollutants can be identified. •For major pollutant sources, strategies can be developed to reduce releases of contaminants. •Alternative strategies can offer firms and governments ways to reduce pollutant releases.
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Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R
2018-05-08
We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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International Nuclear Information System (INIS)
Baldwin, D.H.
1984-08-01
Moisture depletion in HTGR materials testing rigs has been empirically studied in the GE High Temperature Reactor Materials Testing Laboratory (HTRMTL). Tests have shown that increased helium flow rates and reduction in reactive (oxidizable) surface area are effective means of reducing depletion. Further, a portion of the depletion has been shown to be due to the presence of free C released by the dissociation of CH 4 . This depletion component can be reduced by reducing the helium residence time (increasing the helium flow rate) or by reducing the CH 4 concentration in the test gas. Equipment modifications to reduce depletion have been developed, tested, and in most cases implemented in the HTRMTL to date. These include increasing the Helium Loop No. 1 pumping capacity, conversion of metallic retorts and radiation shields to alumina, isolation of thermocouple probes from the test gas by alumina thermowells, and substitution of non-reactive Mo-TZM for reactive metallic structural components
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Khng, Kiat Hui
2017-11-01
A pre-test/post-test, intervention-versus-control experimental design was used to examine the effects, mechanisms and moderators of deep breathing on state anxiety and test performance in 122 Primary 5 students. Taking deep breaths before a timed math test significantly reduced self-reported feelings of anxiety and improved test performance. There was a statistical trend towards greater effectiveness in reducing state anxiety for boys compared to girls, and in enhancing test performance for students with higher autonomic reactivity in test-like situations. The latter moderation was significant when comparing high-versus-low autonomic reactivity groups. Mediation analyses suggest that deep breathing reduces state anxiety in test-like situations, creating a better state-of-mind by enhancing the regulation of adaptive-maladaptive thoughts during the test, allowing for better performance. The quick and simple technique can be easily learnt and effectively applied by most children to immediately alleviate some of the adverse effects of test anxiety on psychological well-being and academic performance.
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Combined approach to reduced duration integrated leakage rate testing
International Nuclear Information System (INIS)
Galanti, P.J.
1987-01-01
Even though primary reactor containment allowable leakage rates are expressed in weight percent per day of contained air, engineers have been attempting to define acceptable methods to test in < 24 h as long as these tests have been performed. The reasons to reduce testing duration are obvious, because time not generating electricity is time not generating revenue for the utilities. The latest proposed revision to 10CFR50 Appendix J, concerning integrated leakage rate testing (ILRTs), was supplemented with a draft regulatory guide proposing yet another method. This paper proposes a method that includes elements of currently accepted concepts for short duration testing with a standard statistical check for criteria acceptance. Following presentation of the method, several cases are presented showing the results of these combined criteria
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Trial Manufacture and Evaluation of a Hologram with an unnecessary development process at 1.55 μm
大島, 茂
2016-01-01
A holographic optical element (HOE) for optical fiber coupling has been investigated. The hologram with an unnecessary development process has been manufactured at wavelength of 1.55μm. Diimonium organic dye was used for photosensitive material. Because diimonium organic dye did not stick to a plate glass, acrylic resin was used for binder resin. The thin film of the organic dye was exposed by improved equipment for high power light irradiation at wavelength of 1.55μm. The thin film became th...
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Thermosyphon Flooding in Reduced Gravity Environments Test Results
Gibson, Marc A.; Jaworske, Donald A.; Sanzi, Jim; Ljubanovic, Damir
2013-01-01
The condenser flooding phenomenon associated with gravity aided two-phase thermosyphons was studied using parabolic flights to obtain the desired reduced gravity environment (RGE). The experiment was designed and built to test a total of twelve titanium water thermosyphons in multiple gravity environments with the goal of developing a model that would accurately explain the correlation between gravitational forces and the maximum axial heat transfer limit associated with condenser flooding. Results from laboratory testing and parabolic flights are included in this report as part I of a two part series. The data analysis and correlations are included in a follow on paper.
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Ravenzwaay, van B.
2013-01-01
'Many of the in vitro toxicological studies have not been sufficiently validated to determine their applicability domain, even less have gained regulatory acceptance. Major advantage of in vitro testing today is the early identification of significant hazards in compound development and reduced and
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In vitro vaccine potency testing: a proposal for reducing animal use for requalification testing.
Brown, K; Stokes, W
2012-01-01
This paper proposes a program under which the use of animals for requalification of in vitro potency tests could be eliminated. Standard References (USDA/CVB nomenclature) would be developed, characterized, stored and monitored by selected reference laboratories worldwide. These laboratories would employ scientists skilled in protein and glycoprotein chemistry and equipped with state-of-the-art instruments for required analyses. After Standard References are established, the reference laboratories would provide them to the animal health industry as "gold standards". Companies would then establish and validate a correlation between the Standard Reference and the company Master Reference (USDA/CVB nomenclature) using an internal in vitro assay. After this correlation is established, the company could use the Standard References for qualifying, monitoring and requalifying company Master References without the use of animals. Such a program would eliminate the need for animals for requalification of Master References and the need for each company to develop and validate a battery of Master Reference Monitoring assays. It would also provide advantages in terms of reduced costs and reduced time for requalification testing. As such it would provide a strong incentive for companies to develop and use in vitro assays for potency testing.
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Niu, Xiang-Ke; Li, Jun; Das, Susant Kumar; Xiong, Yan; Yang, Chao-Bing; Peng, Tao
2017-02-01
.001, respectively). The nomogram based on multiparametric magnetic resonance imaging (mp-MRI) for forecasting HGPCa is effective, which could reduce unnecessary prostate biopsies in patients with PSA 4-10 ng/ml and nomogram-based risk-score could provide a more robust parameter of assessing the aggressiveness of HGPCa in PSA gray zone.
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Ice load reducer for dams : laboratory tests
Energy Technology Data Exchange (ETDEWEB)
Lupien, R.; Cote, A.; Robert, A. [Institut de Recherche d' Hydro-Quebec, Varennes, PQ (Canada)
2009-07-01
Many studies have focused on measuring static ice loads on various hydraulic structures in Canada. This paper discussed a Hydro-Quebec research project whose main purpose was to harmonize the ice thrust value in load combinations for use in general hydraulic works or for specific cases. The objectives of the project were to obtain a better understanding of existing data and to characterize sites and their influence on ice thrust; study the structural mechanisms involved in the generation of ice thrust, their consequences on the structural behaviour of ice and the natural mitigating circumstances that may be offered by ice properties or site operating procedures; and examine the relevance of developing an ice load reducer for works that might not fit the harmonized design value. The paper presented the main research goals and ice load reducer goals, with particular focus on the four pipe samples that were planned, built and tested. The experimental program involved checking the pipe shape behaviour in terms of flexibility-stiffness; maximum deformations; maximum load reduction; permanent deformations; and, ability to shape recovering. The testing also involved examining the strength versus strain rate; creep versus strain rate; and creep capacity under biaxial state of tension and compression. It was concluded that the two phenomena involved in generation of ice thrust, notably thermal expansion and water level changes, had very low strain rates. 8 refs., 2 tabs., 16 figs.
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NASA Lewis Stirling SPRE testing and analysis with reduced number of cooler tubes
International Nuclear Information System (INIS)
Wong, W.A.; Cairelli, J.E.; Swec, D.M.; Doeberling, T.J.; Lakatos, T.F.; Madi, F.J.
1994-01-01
Free-piston Stirling power converters are a candidate for high capacity space power applications. The Space Power Research Engine (SPRE), a free-piston Stirling engine coupled with a linear alternator, is being tested at the NASA Lewis Research Center in support of the Civil Space Technology Initiative. The SPRE is used as a test bed for evaluating converter modifications which have the potential to improve converter performance and for validating computer code predictions. Reducing the number of cooler tubes on the SPRE has been identified as a modification with the potential to significantly improve power and efficiency. This paper describes experimental tests designed to investigate the effects of reducing the number of cooler tubes on converter power, efficiency and dynamics. Presented are test results from the converter operating with a reduced number of cooler tubes and comparisons between this data and both baseline test data and computer code predictions
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Directory of Open Access Journals (Sweden)
Anita Sabzghabaei
2017-10-01
Full Text Available Introduction: Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients. Objective: The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments. Methods: This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients’ admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer’s V test in IBM SPSS-21. Results: This study examined a total of 500 patients (250 before training and 250 after, who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients’ admission and the overall and post-training troponin test results (P=0.000, and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000. The number of positive troponin test results did not differ significantly between the patients
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Acoustic emission testing of piston check valves
International Nuclear Information System (INIS)
Stewart, D.L.
1994-01-01
Based on test experience at Comanche Peak Unit 1, an acoustic emission data evaluation matrix for piston check valves has been developed. The degradations represented in this matrix were selected based on Edwards piston check valve failure data reported in the Nuclear Plant Reliability Data System. Evidence to support this matrix was collected from site test data on a variety of valve types. Although still under refinement, the matrix provides three major attributes for closure verification, which have proven useful in developing test procedures for inservice testing and preventing unnecessary disassembly
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Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.
Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini
2015-01-01
Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care.
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International Nuclear Information System (INIS)
Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison
2015-01-01
Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)
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Energy Technology Data Exchange (ETDEWEB)
Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)
2015-08-15
Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)
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Dambacher, Wendy M; de Kort, Ellen H M; Blom, W Marty; Houben, Geert F; de Vries, Esther
2013-02-08
Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. All children with suspected CMA under our care (Oct'05-Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.
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A Proactive Approach to Penicillin Allergy Testing in Hospitalized Patients.
Chen, Justin R; Tarver, Scott A; Alvarez, Kristin S; Tran, Trang; Khan, David A
Penicillin allergy testing is underutilized in inpatients despite its potential to immediately impact antibiotic treatment. Although most tested patients are able to tolerate penicillin, limited availability and awareness of this tool leads to the use of costly and harmful substitutes. We established an inpatient service at a large academic hospital to identify and test patients with a history of penicillin allergy with the goals of removing inaccurate diagnoses, reducing the use of beta-lactam alternatives, and educating patients and clinicians about the procedure. Eligible inpatients were flagged daily through the electronic medical record and prioritized via a specialized algorithm. A trained clinical pharmacist performed penicillin skin tests and challenges preemptively or by provider request. Clinical characteristics and antibiotic use were analyzed in tested patients. A total of 1203 applicable charts were detected by our system leading to 252 direct evaluations over 18 months. Overall, 228 subjects (90.5%) had their penicillin allergy removed. Of these, 223 were cleared via testing and 5 by discovery of prior penicillin tolerance. Among patients testing negative, 85 (38%) subsequently received beta-lactams, preventing 504 inpatient days and 648 outpatient days on alternative agents. Penicillin allergy testing using a physician-pharmacist team model effectively removes reported allergies in hospitalized patients. The electronic medical record is a valuable asset for locating and stratifying individuals who benefit most from intervention. Proactive testing substantially reduces unnecessary inpatient and outpatient use of beta-lactam alternatives that may otherwise go unaddressed. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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Reducing patient identification errors related to glucose point-of-care testing
Directory of Open Access Journals (Sweden)
Gaurav Alreja
2011-01-01
Full Text Available Background: Patient identification (ID errors in point-of-care testing (POCT can cause test results to be transferred to the wrong patient′s chart or prevent results from being transmitted and reported. Despite the implementation of patient barcoding and ongoing operator training at our institution, patient ID errors still occur with glucose POCT. The aim of this study was to develop a solution to reduce identification errors with POCT. Materials and Methods: Glucose POCT was performed by approximately 2,400 clinical operators throughout our health system. Patients are identified by scanning in wristband barcodes or by manual data entry using portable glucose meters. Meters are docked to upload data to a database server which then transmits data to any medical record matching the financial number of the test result. With a new model, meters connect to an interface manager where the patient ID (a nine-digit account number is checked against patient registration data from admission, discharge, and transfer (ADT feeds and only matched results are transferred to the patient′s electronic medical record. With the new process, the patient ID is checked prior to testing, and testing is prevented until ID errors are resolved. Results: When averaged over a period of a month, ID errors were reduced to 3 errors/month (0.015% in comparison with 61.5 errors/month (0.319% before implementing the new meters. Conclusion: Patient ID errors may occur with glucose POCT despite patient barcoding. The verification of patient identification should ideally take place at the bedside before testing occurs so that the errors can be addressed in real time. The introduction of an ADT feed directly to glucose meters reduced patient ID errors in POCT.
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Failure of introduction of food allergens after negative oral food challenge tests in children
J.P.M. van der Valk; R. Gerth van Wijk (Roy); Y. Vergouwe; N.W. de Jong (Nicolette)
2015-01-01
textabstractOne of the purposes to perform an oral food challenge (FC) test is to avoid unnecessary elimination of food allergens. In case of a negative FC test result, the food can be introduced. It is, however, unknown if patients act according to the outcome of the test. This study evaluates the
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MWTF jumper connector integral seal block development and leak testing
International Nuclear Information System (INIS)
Ruff, E.S.; Jordan, S.R.
1995-01-01
In fiscal year 1993, tests of an o-ring/tetraseal retainer designed to replace a gasket-type seal used in PUREX-type process jumper connectors encouraged the design of an improved seal block. This new seal block combines several parts into one unitized component called an integral seal block. This report summarizes development and leak testing of the new integral seal block. The integral seal block uses a standard o-ring nested in a groove to accomplish leak tightness. This seal block eliminates the need to machine acme threads into the lower skirt casting and seal retainers, eliminates tolerance stack-up, reduces parts inventory, and eliminates an unnecessary leak path in the jumper connector assembly. This report also includes test data on various types of o-ring materials subjected to heat and pressure. Materials tested included Viton, Kalrez, and fluorosilicone, with some incidental data on teflon coated silicone o-rings. Test experience clearly demonstrates the need to test each seal material for temperature and pressure in its intended application. Some materials advertised as being open-quotes betterclose quotes at higher temperatures did not perform up to expectations. Inspection of the fluorosilicone and Kalrez seals after thermal testing indicates that they are much more susceptible to heat softening than Viton
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Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Du Pasquier, David; Embry, Michelle; Halder, Marlies; Lampi, Mark; Lee, Lucy; Norberg-King, Teresa J.; Rattner, Barnett A.; Schirmer, Kristin; Thomas, Paul
2016-01-01
The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades.
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Limiting the testing of urea: Urea along with every plasma creatinine test?
Zhang, Gao-Ming; Guo, Xu-Xiao; Zhang, Guo-Ming
2017-09-01
We found that it is not necessary to simultaneously detect both creatinine (CREA) and urea until the concentration of CREA is lower than the certain level. To reduce urea testing, we suggest measuring urea only when CREA or estimated glomerular filtration rate (eGFR) exceeds a predetermined limit. CREA and urea data were analyzed consisting of almost all of people age above 65 years old check-up (n=95441) in Shuyang countryside, and inpatients (n=101631), outpatients (n=18474) and Routine Health Check-up (n=20509) in Shuyang People's Hospital. The proportions of elevated urea were derived. The data used in this study was generated from people more than 13 years old in both outpatients and inpatients. When the limits for initiating urea testing were used at 85 μmol/L CREA and 120 mL/min/1.73 m 2 eGFR, the percentage of unnecessary urea test are 94.5% and 64.7% (elderly health check-up), 67.9% and 84.5% (outpatients), 88.5% and 73.2% (inpatients), 92.2% and 81.7% (routine health check-up). The missing rate of urea are 1%, 2.5%, 4.6% and 9.2%, 0.1%, 0.4%, 0.9% and 1.8%, 0.4%, 0.8%, 1.4%, and 2.5%, 0.05%, 0.1%, 1.1%, and 0.8% of ureas exceeding 9.28 mmol/L and 8.3 mmol/L in above each group, respectively. If the CREA≤85 μmol/L or eGFR≥90 mL/min/1.73 m 2 , there is 97.5% urea urea missed is 2.5%. We suggest that the initiating urea testing should be based on the upper limit of Reference Intervals serum CREA of females or a 120 mL/min/1.73 m 2 eGFR limit. Conservatively, the urea testing would be reduced by 65% at least. © 2017 Wiley Periodicals, Inc.
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The effects of pen partitions and thermal pig simulators on airflow in a livestock test room
DEFF Research Database (Denmark)
Bjerg, B.; Svidt, Kjeld; Zhang, G.
2000-01-01
measurements and CFD simulations showed that the introduction of pen partitions and thermal pig simulators reduced the air velocities in the occupied zone of the test room. Detailed geometric modelling of the animals might often be unnecessary for simulation of airflow in livestock rooms. This will especially......The aim of this work was to investigate the influence of pen partitions and heated simulated pigs on airflow in a slot ventilated test room and to evaluate computer fluid dynamics (CFD) as a tool to predict airflow in livestock rooms. To obtain two-dimensional flow in the occupied zone, four...... guiding plates were mounted beneath the ceiling in the test room. Experiments were carried out in three arrangements: (a) the room with guiding plates; (b) the room with guiding plates and eight heated pig simulators; and (c) the room with guiding plates, eight heated pig simulators and 0.8 m high...
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Toxicity testing of polymer materials for dialysis equipment: reconsidering in vivo testing.
Sauer, U G; Liebsch, M; Kolar, R
2000-01-01
In fulfilment of the aims of the European Union Biocidal Directive (Directive 98/8/EC), Technical Guidance Documents are currently being compiled. Part I of these Technical Guidance Documents covers data requirements for active substances and biocidal products. The Three Rs principle has been applied in certain parts of the toxicity and ecotoxicity testing scheme for pesticides, such as testing for acute oral toxicity, skin and eye irritation, skin sensitisation, and dermal absorption. Further recommendations on how to proceed with regard to the continuing replacement, reduction and refinement of animal experiments in this field of regulatory testing are included for consideration. In this context, besides stressing the necessity to validate and accept further alternatives, emphasis is placed on providing the possibility of waiving unnecessary tests and on the continuous evaluation of whether certain tests are needed at all. 2000 FRAME.
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International Nuclear Information System (INIS)
1994-01-01
The Radiation Protection Bureau has set out guidelines for the testing of diagnostic x-ray equipment and facilities. This guide provides information for the x-ray inspector, test engineer, technologist, medical physicist and any other person responsible for verifying the regulatory compliance or safety of diagnostic x-ray equipment and facilities. Diagnostic x-radiation is an essential part of present day medical practice. The largest contributor of irradiation to the general population comes from diagnostic x-radiation. Although individual irradiations are usually small, there is a concern of possible excess cancer risk when large populations are irradiated. Unnecessary irradiations to patients from radiological procedures can be significantly reduced with little or no decrease in the value of medical diagnostic information. This can be achieved by using well designed x-ray equipment which is installed, used and maintained by trained personnel, and by the adoption of standardized procedures. In general, when patient surface dose is reduced, there is a corresponding decrease in dose to x-ray equipment operators and other health care personnel. 2 tabs., 4 figs
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Energy Technology Data Exchange (ETDEWEB)
NONE
1994-12-31
The Radiation Protection Bureau has set out guidelines for the testing of diagnostic x-ray equipment and facilities. This guide provides information for the x-ray inspector, test engineer, technologist, medical physicist and any other person responsible for verifying the regulatory compliance or safety of diagnostic x-ray equipment and facilities. Diagnostic x-radiation is an essential part of present day medical practice. The largest contributor of irradiation to the general population comes from diagnostic x-radiation. Although individual irradiations are usually small, there is a concern of possible excess cancer risk when large populations are irradiated. Unnecessary irradiations to patients from radiological procedures can be significantly reduced with little or no decrease in the value of medical diagnostic information. This can be achieved by using well designed x-ray equipment which is installed, used and maintained by trained personnel, and by the adoption of standardized procedures. In general, when patient surface dose is reduced, there is a corresponding decrease in dose to x-ray equipment operators and other health care personnel. 2 tabs., 4 figs.
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Feedback enhances the positive effects and reduces the negative effects of multiple-choice testing.
Butler, Andrew C; Roediger, Henry L
2008-04-01
Multiple-choice tests are used frequently in higher education without much consideration of the impact this form of assessment has on learning. Multiple-choice testing enhances retention of the material tested (the testing effect); however, unlike other tests, multiple-choice can also be detrimental because it exposes students to misinformation in the form of lures. The selection of lures can lead students to acquire false knowledge (Roediger & Marsh, 2005). The present research investigated whether feedback could be used to boost the positive effects and reduce the negative effects of multiple-choice testing. Subjects studied passages and then received a multiple-choice test with immediate feedback, delayed feedback, or no feedback. In comparison with the no-feedback condition, both immediate and delayed feedback increased the proportion of correct responses and reduced the proportion of intrusions (i.e., lure responses from the initial multiple-choice test) on a delayed cued recall test. Educators should provide feedback when using multiple-choice tests.
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International Nuclear Information System (INIS)
Takebe, Hiraku
2000-01-01
Three workers were heavily exposed to radiations in the Tokai mura nuclear accident, and one of them died due to the acute effects of radiations. Doses for the heavily exposed persons were estimated to be 2.5, 10 and 18 Sv, according to the Science and Technology Agency. Workers who tried to stop the chain reaction by breaking the water pipe were estimated to have been exposed up to 120 mSv. Possible doses for other workers and residents in the neighborhoods were estimated to be less than 10 mSv, with a few workers with slightly higher film badge records. After the accident, many reports in mass-media warned that the exposed persons may develop cancers and leukemias in future and follow-up healthcare should be needed. Judging from our knowledge of the extensive epidemiological survey of the atomic bomb survivors in Hiroshima and Nagasaki, these reports are very misleading. There would be absolutely no or extremely small possibility of developing any health hazard among the workers and the residents except for the three unfortunate heavily exposed workers. If so-called follow-up health checks would involve x-ray diagnosis for cancers, the radiation doses by the diagnosis would exceed the exposure by the accident. Also, the test for the DNA damage applied to some workers and residents is not reliable at all, and could cause unnecessary fear among the persons who were mistakingly said to be of high-risk. (author)
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Satellite Vibration Testing: Angle optimisation method to Reduce Overtesting
Knight, Charly; Remedia, Marcello; Aglietti, Guglielmo S.; Richardson, Guy
2018-06-01
Spacecraft overtesting is a long running problem, and the main focus of most attempts to reduce it has been to adjust the base vibration input (i.e. notching). Instead this paper examines testing alternatives for secondary structures (equipment) coupled to the main structure (satellite) when they are tested separately. Even if the vibration source is applied along one of the orthogonal axes at the base of the coupled system (satellite plus equipment), the dynamics of the system and potentially the interface configuration mean the vibration at the interface may not occur all along one axis much less the corresponding orthogonal axis of the base excitation. This paper proposes an alternative testing methodology in which the testing of a piece of equipment occurs at an offset angle. This Angle Optimisation method may have multiple tests but each with an altered input direction allowing for the best match between all specified equipment system responses with coupled system tests. An optimisation process that compares the calculated equipment RMS values for a range of inputs with the maximum coupled system RMS values, and is used to find the optimal testing configuration for the given parameters. A case study was performed to find the best testing angles to match the acceleration responses of the centre of mass and sum of interface forces for all three axes, as well as the von Mises stress for an element by a fastening point. The angle optimisation method resulted in RMS values and PSD responses that were much closer to the coupled system when compared with traditional testing. The optimum testing configuration resulted in an overall average error significantly smaller than the traditional method. Crucially, this case study shows that the optimum test campaign could be a single equipment level test opposed to the traditional three orthogonal direction tests.
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van Bokhoven, Marloes A.; Koch, Hèlen; van der Weijden, Trudy; Grol, Richard P. T. M.; Bindels, Patrick J. E.; Dinant, Geert-Jan
2006-01-01
BACKGROUND: General practitioners (GPs) frequently order blood tests when they see patients presenting with unexplained complaints. Due to the low prevalence of serious pathology in general practice, the risk of false-positive test results is relatively high. This may result in unnecessary further
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Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations
Energy Technology Data Exchange (ETDEWEB)
Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)
2017-03-15
Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)
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The role of molecular diagnostic testing in the management of thyroid nodules.
Moore, Maureen D; Panjwani, Suraj; Gray, Katherine D; Finnerty, Brendan M; Zarnegar, Rasa; Fahey, Thomas J
2017-06-01
Fine needle aspiration (FNA) with cytologic examination remains the standard of care for investigation of thyroid nodules. However, as many as 30% of FNA samples are cytologically indeterminate for malignancy, which confounds clinical management. To reduce the burden of repeat diagnostic testing and unnecessary surgery, there has been extensive investigation into molecular markers that can be detected on FNA specimens to more accurately stratify a patient's risk of malignancy. Areas covered: In this review, the authors discuss recent evidence and progress in molecular markers used in the diagnosis of thyroid cancer highlighting somatic gene alterations, molecular technologies and microRNA analysis. Expert commentary: The goal of molecular markers is to improve diagnostic accuracy and aid clinicians in the preoperative management of thyroid lesions. Modalities such as direct mutation analysis, mRNA gene expression profiling, next-generation sequencing, and miRNA expression profiling have been explored to improve the diagnostic accuracy of thyroid nodule FNA. Although no perfect test has been discovered, molecular diagnostic testing has revolutionized the management of thyroid nodules.
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[Advantages and disadvantages of direct-to-consumer genetic tests].
Christiansen, Camilla Worm; Gerdes, Anne-Marie Axø
2017-03-13
Direct-to-consumer genetic tests are sold over the internet to consumers all over the world - including Denmark. No regulation of these tests has been introduced neither in Denmark nor in Europe, even though they have been on the market since 2007. Such tests have several advantages, but indeed also a long list of potential disadvantages, which are most often ignored, and among these is insufficient training of general practitioners in performing the necessary counselling but also the risk of increased expenses to unnecessary follow-up consultations.
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Reduced enrichment for research and test reactors: Proceedings
Energy Technology Data Exchange (ETDEWEB)
1993-08-01
November 9--10, 1978, marked the first of what has become an annual event--the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and it established the basis for all later meetings. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort. This report provides presentations and discussions of this original meeting. Individual papers have been cataloged separately.
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Reduced enrichment for research and test reactors: Proceedings
International Nuclear Information System (INIS)
1993-08-01
November 9--10, 1978, marked the first of what has become an annual event--the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and it established the basis for all later meetings. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort. This report provides presentations and discussions of this original meeting. Individual papers have been cataloged separately
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Opportunities and strategies to further reduce animal use for Leptospira vaccine potency testing.
Walker, A; Srinivas, G B
2013-09-01
Hamsters are routinely infected with virulent Leptospira for two purposes in the regulation of biologics: the performance of Codified potency tests and maintenance of challenge culture for the Codified potency tests. Options for reducing animal use in these processes were explored in a plenary lecture at the "International Workshop on Alternative Methods for Leptospira Vaccine Potency Testing: State of the Science and the Way Forward" held at the Center for Veterinary Biologics in September 2012. The use of validated in vitro potency assays such as those developed by the U.S. Department of Agriculture for Leptospira (L.) canicola, Leptospira grippotyphosa, Leptospira pomona, and Leptospira icterohaemorrhagiae rather than the Codified hamster vaccination-challenge assay was encouraged. Alternatives such as reduced animal numbers in the hamster vaccination-challenge testing were considered for problematic situations. Specifically, the merits of sharing challenge controls, reducing group sizes, and eliminating animals for concurrent challenge dose titration were assessed. Options for maintaining virulent, stable cultures without serial passage through hamsters or with decreased hamster use were also discussed. The maintenance of virulent Leptospira without the use of live animals is especially difficult since a reliable means to maintain virulence after multiple in vitro passages has not yet been identified. Published by Elsevier Ltd.
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Diagnostic testing for celiac disease among patients with abdominal symptoms a systematic review
van der Windt, D.A.W.M.; Jellema, A.P.; Mulder, C.J.J.; Kneepkens, C.M.F.; van der Horst, H.E.
2010-01-01
Context: The symptoms and consequences of celiac disease usually resolve with a lifelong gluten-free diet. However, clinical presentation is variable and most patients presenting with abdominal symptoms in primary care will not have celiac disease and unnecessary diagnostic testing should be
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Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review
van der Windt, Daniëlle A. W. M.; Jellema, Petra; Mulder, Chris J.; Kneepkens, C. M. Frank; van der Horst, Henriëtte E.
2010-01-01
The symptoms and consequences of celiac disease usually resolve with a lifelong gluten-free diet. However, clinical presentation is variable and most patients presenting with abdominal symptoms in primary care will not have celiac disease and unnecessary diagnostic testing should be avoided. To
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Comparison of Anxiety Management Training and Desensitization in Reducing Test and Other Anxieties.
Deffenbacher, Jerry L.; Shelton, John L.
1978-01-01
Effects of systematic desensitization and anxiety management training in reducing test anxiety and generalizing to other anxieties were compared. Both desensitization and anxiety management training produced significant reduction of text anxiety, but by follow-up, anxiety management training produced significantly more test-anxiety reduction on…
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van Boxtel, M P; ten Tusscher, M P; Metsemakers, J F; Willems, B; Jolles, J
2001-10-01
It is unknown to what extent the performance on the Stroop color-word test is affected by reduced visual function in older individuals. We tested the impact of common deficiencies in visual function (reduced distant and close acuity, reduced contrast sensitivity, and color weakness) on Stroop performance among 821 normal individuals aged 53 and older. After adjustment for age, sex, and educational level, low contrast sensitivity was associated with more time needed on card I (word naming), red/green color weakness with slower card 2 performance (color naming), and reduced distant acuity with slower performance on card 3 (interference). Half of the age-related variance in speed performance was shared with visual function. The actual impact of reduced visual function may be underestimated in this study when some of this age-related variance in Stroop performance is mediated by visual function decrements. It is suggested that reduced visual function has differential effects on Stroop performance which need to be accounted for when the Stroop test is used both in research and in clinical settings. Stroop performance measured from older individuals with unknown visual status should be interpreted with caution.
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A computational environment for creating and testing reduced chemical kinetic mechanisms
Energy Technology Data Exchange (ETDEWEB)
Montgomery, C.J.; Swensen, D.A.; Harding, T.V.; Cremer, M.A.; Bockelie, M.J. [Reaction Engineering International, Salt Lake City, UT (USA)
2002-02-01
This paper describes software called computer assisted reduced mechanism problem solving environment (CARM-PSE) that gives the engineer the ability to rapidly set up, run and examine large numbers of problems comparing detailed and reduced (approximate) chemistry. CARM-PSE integrates the automatic chemical mechanism reduction code CARM and the codes that simulate perfectly stirred reactors and plug flow reactors into a user-friendly computational environment. CARM-PSE gives the combustion engineer the ability to easily test chemical approximations over many hundreds of combinations of inputs in a multidimensional parameter space. The demonstration problems compare detailed and reduced chemical kinetic calculations for methane-air combustion, including nitrogen oxide formation, in a stirred reactor and selective non-catalytic reduction of NOx, in coal combustion flue gas.
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Characterization of test specimens produced in reduced size for X-ray microtomography (µ-CT tests
Directory of Open Access Journals (Sweden)
E. E. BERNARDES
Full Text Available Abstract The need to use reduced sample sizes, in order to attain improved spatial resolution in (µ-CT tests applied in Portland cement composites, makes researchers perform the fractionation of materials to obtain samples with dimensions compatible with the capacity of the scanning equipment, which might cause alterations in the microstructure under analysis. Therefore, a test specimen (TS with dimensions compatible with the scanning capacity of a microtomography system that operates with an X-ray tube and voltage ranging from 20 to 100 kV was proposed. Axial compression strength tests were made and their total porosity was assessed by an apparent density and solid fraction density ratio, which were obtained by means of mercury and helium pycnometry and µ-CT technique, respectively. The adoption of that TS has shown to be viable for providing a sample with a higher level of representation.
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A Novel Approach to Improving Utilization of Laboratory Testing.
Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D
2018-02-01
- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.
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Siriussawakul, Arunotai; Nimmannit, Akarin; Rattana-arpa, Sirirat; Chatrattanakulchai, Siritda; Saengtawan, Puttachard; Wangdee, Aungsumat
2013-01-01
Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.
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Instrumented impact testing machine with reduced specimen oscillation effects
International Nuclear Information System (INIS)
Rintamaa, R.; Rahka, K.; Wallin, K.
1984-07-01
Owing to small and inexpensive specimens the Charpy impact test is widely used in quality control and alloy development. Limitations in power reactor survellance capsules it is also widely used for safety analysis purposes. Instrumenting the tup and computerizing data acquisition, makes dynamic fracture mechanics data measurement possible and convenient. However, the dynamic effects (inertia forces, specimen oscillations) in the impact test cause inaccuracies in the recorded load-time diagram and hence diminish the reliability of the calculated dynamic fracture mechanics parameters. To decrease inaccuracies a new pendulum type of instrumented impact test apparatus has been developed and constructed in the Metals Laboratory of the Technical Research Centre of Finland. This tester is based on a new principle involving inverted test geometry. The purpose of the geometry inversion is to reduce inertia load and specimen oscillation effects. Further, the new impact tester has some other novel features: e.g. the available initia impact energy is about double compared to the conventional standard (300 J) impact tester allowing the use of larger (10 x 20 x 110 mm) bend specimens than normal Charpy specimens. Also, the rotation asix in the three point bending is nearly stationary making COD-measurements possible. An experimental test series is described in which the inertia effects and specimen oscillations are compared in the conventional and new impact tester utilizing Charpy V-notch specimens. Comparison of the two test geometries is also made with the aid of an analytical model using finite element method (FEM) analysis. (author)
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International Nuclear Information System (INIS)
Kim, D.S.; Seong, P.H.
1994-01-01
This paper describes the optimal testing input sets required for the fault diagnosis of the nuclear power plant digital electronic circuits. With the complicated systems such as very large scale integration (VLSI), nuclear power plant (NPP), and aircraft, testing is the major factor of the maintenance of the system. Particularly, diagnosis time grows quickly with the complexity of the component. In this research, for reduce diagnosis time the authors derived the optimal testing sets that are the minimal testing sets required for detecting the failure and for locating of the failed component. For reduced diagnosis time, the technique presented by Hayes fits best for the approach to testing sets generation among many conventional methods. However, this method has the following disadvantages: (a) it considers only the simple network (b) it concerns only whether the system is in failed state or not and does not provide the way to locate the failed component. Therefore the authors have derived the optimal testing input sets that resolve these problems by Hayes while preserving its advantages. When they applied the optimal testing sets to the automatic fault diagnosis system (AFDS) which incorporates the advanced fault diagnosis method of artificial intelligence technique, they found that the fault diagnosis using the optimal testing sets makes testing the digital electronic circuits much faster than that using exhaustive testing input sets; when they applied them to test the Universal (UV) Card which is a nuclear power plant digital input/output solid state protection system card, they reduced the testing time up to about 100 times
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Lillicrap, Adam; Belanger, Scott; Burden, Natalie; Pasquier, David Du; Embry, Michelle R; Halder, Marlies; Lampi, Mark A; Lee, Lucy; Norberg-King, Teresa; Rattner, Barnett A; Schirmer, Kristin; Thomas, Paul
2016-11-01
The need for alternative approaches to the use of vertebrate animals for hazard assessment of chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate organisms is minimized wherever possible. For some regulatory purposes, the use of vertebrate organisms for environmental risk assessments has been banned; in other situations, the number of organisms tested has been dramatically reduced or the severity of the procedure refined. However, there is still a long way to go to achieve a complete replacement of vertebrate organisms to generate environmental hazard data. The development of animal alternatives is based not just on ethical considerations but also on reducing the cost of performing vertebrate ecotoxicity tests and in some cases on providing better information aimed at improving environmental risk assessments. The present Focus article provides an overview of the considerable advances that have been made toward alternative approaches for ecotoxicity assessments over the last few decades. Environ Toxicol Chem 2016;35:2637-2646. © 2016 SETAC. © 2016 SETAC.
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Radiological bile acid absorption test {sup 75}SeHCAT in patients with diarrhoea of unknown cause
Energy Technology Data Exchange (ETDEWEB)
Rudberg, U. [St. Goeran`s Hospital, Stockholm (Sweden). Dept. of Diagnostic Radiology; Nylander, B. [St. Goeran`s Hospital, Stockholm (Sweden). Dept. of Internal Medicine
1996-09-01
Purpose: The purpose with this study was to investigate the usefulness of the {sup 75}SeHCAT test in patients suffering from `functional` diarrhoea and to disclose earlier radiological investigations performed in the course of disease. Material and Methods: Twenty patients with chronic diarrhoea of unknown cause were investigated with the {sup 75}SeHCAT test. The cholestyramine test and an estimation of oro-caecal transit time (OCTT) were also performed in 13 and 10 patients respectively. Results: Ten patients had low 7-day retention ({<=}15%). Nine of these were tested with cholestyramine and 8 showed complete relief from the diarrhoea. The cholestyramine test had no effect on the 4 patients with normal bile acid retention. No correlation was found between the retention of {sup 75}SeHCAT and OCCT. A total of 80 inconclusive gastrointestinal barium examinations were performed during the course of disease. Conclusion: Pathological bile acid retention, studied with the radiological {sup 75}SeHCAT test, is common in patients with diarrhoea of unknown cause. The test should be performed earlier in the course of disease in order to prevent unnecessary radiological investigations and to reduce patient suffering and distress. (orig.).
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International Nuclear Information System (INIS)
Sodhi, Kushaljit S.; Krishna, Satheesh; Saxena, Akshay K.; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y.
2015-01-01
Highlights: • Practice of ALARA (As Low As Reasonably Achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be saved from harmful radiation exposure if ‘Justification’ and ‘Optimization’ principles of ALARA are applied before obtaining CT imaging in a developing country. • A consecutive 1302 CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children’s hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, ‘Justification’ of CT was evaluated and then ‘Optimization’ was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies that was avoided by applying ‘Justification’ and ‘Optimization’ principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. • Based on evaluation of the CT request forms for ‘Justification’ and ‘Optimization’ principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were saved from unnecessary or additional radiation exposure The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient departments (p < 0.05). • To conclude, a substantial number of pediatric patients, particularly coming from inpatients departments, can be saved from unnecessary or additional radiation exposure from CT imaging when ‘Justification’ and ‘Optimization’ principle of ALARA are applied
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2017-07-01
This study develops a Tailgate Test Kit to be used in the field to test flocculants for reducing turbidity in construction stormwater discharge. Turbidity of stormwater runoff at construction sites varies depending on which site soils are exposed to ...
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Reducing transfusion requirements in liver transplantation.
Donohue, Ciara I; Mallett, Susan V
2015-12-24
Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusion-free transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT.
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The RERTR [Reduced Enrichment Research and Test Reactor] program:
International Nuclear Information System (INIS)
Travelli, A.
1987-01-01
The progress of the Reduced Enrichment Research and Test Reactor (RERTR) program is described. After a brief summary of the results which the RERTR program, in collaboration with its many international partners, had achieved by the end of 1986, the activities, results and new developments which ocurred in 1987 are reviewed. Irradiation of the second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels was completed and postirradiation examinations were performed on many of its miniplates. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 was completed at the end of March with excellent results and with 29 elements estimated to have reached at least 40 % average burnup. Good progress was made in the area of LEU usage for the production of fission 99 Mo, and in the coordination of safety evaluations related to LEU conversions of U.S. university reactors. Planned activities include testing and demonstrating advanced fuels intended to allow use of reduced enrichment uranium in very-high-performance reactors. Two candidate fuels are U 3 Si-Al with 19.75 % enrichment and U 3 Si 2 -Al with 45 % enrichment. Demonstration of these fuels will include irradiation of full-size elements and, possibly, a full-core demonstration. Achievement of the final program goals is still projected for 1990. This progress could not have been possible without the close international cooperation which has existed from the beginning, and which is essential to the ultimate success of the RERTR program. (Author)
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Scintigraphic ventriculography and stress testing
International Nuclear Information System (INIS)
Goris, M.L.; Hung, J.; Debusk, R.F.
1982-01-01
Scintigraphic stress ventriculography yields information which is complex and defies description by the difference in ejection fraction between rest and maximum exercise only. The complexity results in part from the ''derived'' nature of the ejection fraction measurement, which is physiologically secondary to stroke volume and end-diastolic volume. Furthermore, the nature of the stress test in which the pulse (stress) is not independent from the response forces an analysis which considers ''when'' as much as ''what'' happens. Automation in data processing, however, has made oversimplification unnecessary and allows a more exhaustive but correct analysis
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Directory of Open Access Journals (Sweden)
Valeria Quartarone
2012-01-01
Full Text Available Many invasive procedures, including surgery (ear cropping, tail docking, and debarking in the dog, are performed on dogs for purely cosmetic reasons or convenience. These procedures, also known as “cosmetic surgery”, fall into a variety of categories from the questionably unethical to the undoubtedly criminal, because they are mostly carried out solely to alter a dog’s physical appearance. Although in several European countries these procedures are banned, except when performed by a veterinarian for medical reasons, veterinarians are often requested to perform them for various reasons. Though controversial, canine cosmetic surgery continues to be performed, reaching epidemic proportions. The authors summarize legislation, individual positions and veterinary attitudes regarding cosmetic surgery in Italy and the Czech Republic. Additionally, they explain the ways in which the law is being used in the two countries to prevent these unnecessary procedures, and how current and future anti-cruelty laws can stop unethical use of cosmetic surgery.
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Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang
2015-05-01
To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.
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Directory of Open Access Journals (Sweden)
Arunotai Siriussawakul
2013-01-01
Full Text Available Background. Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. Methods. This retrospective study was conducted on adult patients over a one-year period. The institute’s guidelines recommend tests according to the patients’ age groups: a complete blood count (CBC for those patients aged 18–45; CBC, chest radiograph (CXR and electrocardiography (ECG for those aged 46–60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN, and creatinine (Cr for patients aged 61–65. Results. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5–13.9. BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. Conclusions. The need to utilize the institution’s preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.
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A preoperative cotininury test for abdominoplasty reduces peri-operative complications.
Delaunay, F; Coquerel-Beghin, D; Magalon, G; Cohen, S R; Casanova, D; Niddam, J; Milliez, P-Y; Peillon, C; Delpierre, V; Auquit-Auckbur, I
2018-05-16
Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
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Hueth, Kyle D; Jackson, Brian R; Schmidt, Robert L
2018-05-31
To evaluate the prevalence of potentially unnecessary repeat testing (PURT) and the associated economic burden for an inpatient population at a large academic medical facility. We evaluated all inpatient test orders during 2016 for PURT by comparing the intertest times to published recommendations. Potential cost savings were estimated using the Centers for Medicare & Medicaid Services maximum allowable reimbursement rate. We evaluated result positivity as a determinant of PURT through logistic regression. Of the evaluated 4,242 repeated target tests, 1,849 (44%) were identified as PURT, representing an estimated cost-savings opportunity of $37,376. Collectively, the association of result positivity and PURT was statistically significant (relative risk, 1.2; 95% confidence interval, 1.1-1.3; P < .001). PURT contributes to unnecessary health care costs. We found that a small percentage of providers account for the majority of PURT, and PURT is positively associated with result positivity.
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Effects of Reducing the Cognitive Load of Mathematics Test Items on Student Performance
Directory of Open Access Journals (Sweden)
Susan C. Gillmor
2015-01-01
Full Text Available This study explores a new item-writing framework for improving the validity of math assessment items. The authors transfer insights from Cognitive Load Theory (CLT, traditionally used in instructional design, to educational measurement. Fifteen, multiple-choice math assessment items were modified using research-based strategies for reducing extraneous cognitive load. An experimental design with 222 middle-school students tested the effects of the reduced cognitive load items on student performance and anxiety. Significant findings confirm the main research hypothesis that reducing the cognitive load of math assessment items improves student performance. Three load-reducing item modifications are identified as particularly effective for reducing item difficulty: signalling important information, aesthetic item organization, and removing extraneous content. Load reduction was not shown to impact student anxiety. Implications for classroom assessment and future research are discussed.
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The Careful Puppet Master: Reducing risk and fortifying acceptance testing with Jenkins CI
Smith, Jason A.; Richman, Gabriel; DeStefano, John; Pryor, James; Rao, Tejas; Strecker-Kellogg, William; Wong, Tony
2015-12-01
Centralized configuration management, including the use of automation tools such as Puppet, can greatly increase provisioning speed and efficiency when configuring new systems or making changes to existing systems, reduce duplication of work, and improve automated processes. However, centralized management also brings with it a level of inherent risk: a single change in just one file can quickly be pushed out to thousands of computers and, if that change is not properly and thoroughly tested and contains an error, could result in catastrophic damage to many services, potentially bringing an entire computer facility offline. Change management procedures can—and should—be formalized in order to prevent such accidents. However, like the configuration management process itself, if such procedures are not automated, they can be difficult to enforce strictly. Therefore, to reduce the risk of merging potentially harmful changes into our production Puppet environment, we have created an automated testing system, which includes the Jenkins CI tool, to manage our Puppet testing process. This system includes the proposed changes and runs Puppet on a pool of dozens of RedHat Enterprise Virtualization (RHEV) virtual machines (VMs) that replicate most of our important production services for the purpose of testing. This paper describes our automated test system and how it hooks into our production approval process for automatic acceptance testing. All pending changes that have been pushed to production must pass this validation process before they can be approved and merged into production.
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Directory of Open Access Journals (Sweden)
Ignjatović Igor I.
2015-01-01
Full Text Available Introduction. Autoimmune cholangitis or immunoglobulin G4-associated cholangitis (IAC has been recently regarded as a new clinical and histopathological entity and is a part of a complex autoimmune disorder - IgG4-related systemic disease (ISD. ISD is an autoimmune disease with multi-organic involvement, characterized with IgG4-positive plasmocytic infiltration of various tissues and organs with a consequent sclerosis, which responds well to steroid therapy. Most commonly affected organs are the pancreas (autoimmune pancreatitis, [AIP] and the common bile duct (IAC. IAC and cholangiocarcinoma (CCA share many clinical, laboratory and imaging findings. Case Outline. We present a case of a 60-year-old male with a biliary stricture of a common bile duct, which was clinically considered as a bile duct carcinoma and treated surgically. Definite histopathological findings and immunohistochemistry revealed profound chronic inflammation, showing lymphoplasmacytic IgG-positive infiltration of a resected part of a common bile duct, highly suggestive for the diagnosis of IAC. In addition, postoperative IgG4 serum levels were also increased. Conclusion. It is of primary clinical importance to make a difference between IAC and CCA, in order to avoid unnecessary surgical intervention. Therefore, IAC should be considered in differential diagnosis in similar cases.
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Larson, E M; O'Donnell, M; Chamblee, S; Horsburgh, C R; Marsh, B J; Moreland, J D; Johnson, L S; von Reyn, C Fordham
2011-11-01
A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infection (LTBI). To assess misclassification of LTBI, as assessed by skin testing with Mycobacterium avium sensitin (MaS), and to determine how this misclassification affects the analysis of risk factors for LTBI. In a population-based survey, participants underwent skin testing with M. tuberculosis purified protein derivative (PPD) and MaS. A PPD-dominant skin test was a reaction that was ≥ 3 mm larger than the MaS reaction; a MaS-dominant skin test was a reaction that was ≥ 3 mm larger than the PPD reaction. Of 447 randomly selected persons, 135 (30%) had a positive PPD test. Of these, 21 (16%) were MaS- dominant, and were therefore attributable to NTM and misclassified as LTBI. PPD reactions of 5-14 mm were more likely to be misclassified than those ≥ 15 mm (OR = 5.0, 95%CI 1.9-13.2). Adjusting for misclassification had only a small impact on the analysis of risk factors for LTBI. A substantial number of individuals who are diagnosed with LTBI are actually sensitized to NTM. Using dual skin testing would reduce misdiagnosis and prevent unnecessary treatment.
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Rajiah, Kingston; Saravanan, Coumaravelou
2014-11-15
To analyze the effect of psychological intervention on reducing performance anxiety and the consequences of the intervention on first-year pharmacy students. In this experimental study, 236 first-year undergraduate pharmacy students from a private university in Malaysia were approached between weeks 5 and 7 of their first semester to participate in the study. The completed responses for the Westside Test Anxiety Scale (WTAS), the Kessler Perceived Distress Scale (PDS), and the Academic Motivation Scale (AMS) were received from 225 students. Out of 225 students, 42 exhibited moderate to high test anxiety according to the WTAS (score ranging from 30 to 39) and were randomly placed into either an experiment group (n=21) or a waiting list control group (n=21). The prevalence of test anxiety among pharmacy students in this study was lower compared to other university students in previous studies. The present study's anxiety management of psychoeducation and systematic education for test anxiety reduced lack of motivation and psychological distress and improved grade point average (GPA). Psychological intervention helped significantly reduce scores of test anxiety, psychological distress, and lack of motivation, and it helped improve students' GPA.
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Identification of reduced-order model for an aeroelastic system from flutter test data
Directory of Open Access Journals (Sweden)
Wei Tang
2017-02-01
Full Text Available Recently, flutter active control using linear parameter varying (LPV framework has attracted a lot of attention. LPV control synthesis usually generates controllers that are at least of the same order as the aeroelastic models. Therefore, the reduced-order model is required by synthesis for avoidance of large computation cost and high-order controller. This paper proposes a new procedure for generation of accurate reduced-order linear time-invariant (LTI models by using system identification from flutter testing data. The proposed approach is in two steps. The well-known poly-reference least squares complex frequency (p-LSCF algorithm is firstly employed for modal parameter identification from frequency response measurement. After parameter identification, the dominant physical modes are determined by clear stabilization diagrams and clustering technique. In the second step, with prior knowledge of physical poles, the improved frequency-domain maximum likelihood (ML estimator is presented for building accurate reduced-order model. Before ML estimation, an improved subspace identification considering the poles constraint is also proposed for initializing the iterative procedure. Finally, the performance of the proposed procedure is validated by real flight flutter test data.
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Interventions to Educate Family Physicians to Change Test Ordering
Directory of Open Access Journals (Sweden)
Roger Edmund Thomas MD, PhD, CCFP, MRCGP
2016-03-01
Full Text Available The purpose is to systematically review randomised controlled trials (RCTs to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations. We identified 29 RCTs (4,111 physicians, 175,563 patients. Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control, 14 diabetes (average 8% > control, 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%, and two to increase test groups. Intervention strategies: one study used education (no change: two feedback (one 5% increase, one 27% desired decrease; eight education + feedback (average increase in desired direction >control 4.9%, ten system change (average increase 14.9%, one system change + feedback (increases 5-44%, three education + system change (average increase 6%, three education + system change + feedback (average 7.7% increase, one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20% probably obtained real change.
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International Nuclear Information System (INIS)
Allen, M.W.; Hendi, P.; Schwimmer, J.; Gambhir, S.S.; Bassett, L.
2000-01-01
The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients. Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well as over a range of values for all of the variables of each strategy. Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strategy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A. These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies
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Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users
Directory of Open Access Journals (Sweden)
Jameel Sughair
2018-02-01
Full Text Available Introduction: Case management is an effective, short-term means to reduce emergency department (ED visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS, accrued costs, and utilization of diagnostic tests. Methods: The study consisted of a retrospective chart review of ED and inpatient visits in our hospital’s ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management. Results: The study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant. Conclusion: Case management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.
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Reduced enrichment for research and test reactors: Proceedings
Energy Technology Data Exchange (ETDEWEB)
1988-05-01
The international effort to develop new research reactor fuel materials and designs based on the use of low-enriched uranium, instead of highly-enriched uranium, has made much progress during the eight years since its inception. To foster direct communication and exchange of ideas among the specialist in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the ninth of a series which began in 1978. All previous meetings of this series are listed on the facing page. The focus of this meeting was on the LEU fuel demonstration which was in progress at the Oak Ridge Research (ORR) reactor, not far from where the meeting was held. The visit to the ORR, where a silicide LEU fuel with 4.8 g A/cm/sup 3/ was by then in routine use, illustrated how far work has progressed.
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Reduced enrichment for research and test reactors: Proceedings
International Nuclear Information System (INIS)
1988-05-01
The international effort to develop new research reactor fuel materials and designs based on the use of low-enriched uranium, instead of highly-enriched uranium, has made much progress during the eight years since its inception. To foster direct communication and exchange of ideas among the specialist in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the ninth of a series which began in 1978. All previous meetings of this series are listed on the facing page. The focus of this meeting was on the LEU fuel demonstration which was in progress at the Oak Ridge Research (ORR) reactor, not far from where the meeting was held. The visit to the ORR, where a silicide LEU fuel with 4.8 g A/cm 3 was by then in routine use, illustrated how far work has progressed
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Poghosyan, Hermine R; Jamalyan, Smbat V
2012-10-01
Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.
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Performance and durability tests of smart icephobic coatings to reduce ice adhesion
Energy Technology Data Exchange (ETDEWEB)
Janjua, Zaid A.; Turnbull, Barbara [Faculty of Engineering, University of Nottingham (United Kingdom); Choy, Kwang-Leong; Pandis, Christos [Institute for Materials Discovery, University College London (UCL) (United Kingdom); Liu, Junpeng; Hou, Xianghui; Choi, Kwing-So [Faculty of Engineering, University of Nottingham (United Kingdom)
2017-06-15
Highlights: • Repeated ice adhesion and removal occurs on nanocoatings. • Icephobicity of nanocoatings reduces with each test cycle. • Adhesion strength linked to contact angle hysteresis in Gaussian fit. • Icephobicity not linked to hydrophobicity. - Abstract: The accretion of ice can cause damage in applications ranging from power lines and shipping decks, to wind turbines and rail infrastructure. In particular on aircraft, it can change aerodynamic characteristics, greatly affecting the flight safety. Commercial aircraft are therefore required to be equipped with de-icing devices, such as heating mats over the wings. The application of icephobic coatings near the leading edge of a wing can in theory reduce the high power requirements of heating mats, which melt ice that forms there. Such coatings are effective in preventing the accretion of runback ice, formed from airborne supercooled droplets, or the water that the heating mats generate as it is sheared back over the wing's upper surface. However, the durability and the practicality of applying them over a large wing surface have been prohibitive factors in deploying this technology so far. Here, we evaluated the ice adhesion strength of four non-conductive coatings and seven thermally conductive coatings by shearing ice samples from coated plates by spinning them in a centrifuge device. The durability of the coating performance was also assessed by repeating the tests, each time regrowing ice samples on the previously-used coatings. Contact angle parameters of each coating were tested for each test to determine influence on ice adhesion strength. The results indicate that contact angle hysteresis is a crucial parameter in determining icephobicity of a coating and hydrophobicity is not necessarily linked to icephobicity.
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Directory of Open Access Journals (Sweden)
Jeremiah S. Hinson
2017-02-01
Full Text Available Introduction: Our goal was to reduce ordering of coagulation studies in the emergency department (ED that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR. Methods: We used a pre and post quasi-experimental study design to evaluate the impact of an EMRbased intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. Results: Pre-intervention, 73.8% (76/103 of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76 were non-value added. Post-intervention, 38.5% (40/104 of patients with chest pain had coagulation studies ordered, of which 60% (24/40 were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0% in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0% in non-value added order placement. Conclusion: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. [West J Emerg Med. 2017;18(2267-269.
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Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara
2016-01-01
The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.
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National Aeronautics Research, Development, Test and Evaluation (RDT&E) Infrastructure Plan
2011-01-01
addressed in the National Aeronautics R&D Plan, identi- fying unnecessary redundancy solely on the basis of infrastructure required to support H H13 ...near, mid, and far terms, and impact not only scramjet propulsion systems, but potential turbine-based combined cycle systems as well. Turbine Engine...Icing Test Facilities A greater understanding of the impact that icing conditions have on turbine engine opera- tions is needed to develop enhanced
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Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?
Directory of Open Access Journals (Sweden)
C. Descovich
2013-05-01
, defining the “best – locally applicable – standard of care”, are suitable tools to facilitate communication for reducing inappropriate test-ordering. CONCLUSIONS Excessive ordering increases the use of technology and adds unnecessary costs to the delivery of health care. Hospitals with growing health care costs can improve their resource utilization through peer management of testing behaviours by using evidence based medicine for clinical audit. A basic, homogeneous and shared panel of critical tests may be adopted even in complex health organizations, including several hospitals too.
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Automatic test pattern generation for stuck-at and delay faults in combinational circuits
International Nuclear Information System (INIS)
Kim, Dae Sik
1998-02-01
The present studies are developed to propose the automatic test pattern generation (ATG) algorithms for combinational circuits. These ATG algorithms are realized in two ATG programs: One is the ATG program for stuck-at fault and the other one for delay faults. In order to accelerate the ATG process, these two ATG programs have a common feature (the search method based on the concept of the degree of freedom), whereas only ATG program for the delay fault utilizes the 19-valued logic, a type of composite valued logic. This difference between two ATG programs results from the difference of the target fault. Accelerating the ATG process is indispensable for improving the ATG algorithms. This acceleration is mainly achieved by reducing the number of the unnecessary backtrackings, making the earlier detection of the conflicts, and shortening the computation time between the implication. Because of this purpose, the developed ATG programs include the new search method based on the concept of the degree of freedom (DF). The DF concept, computed directly and easily from the system descriptions such as types of gates and their interconnections, is the criterion to decide which, among several alternate lines' logic values required along each path, promises to be the most effective in order to accelerate and improve the ATG process. This DF concept is utilized to develop and improve both of ATG programs for stuck-at and delay faults in combinational circuits. In addition to improving the ATG process, reducing number of test pattern is indispensable for testing the delay faults because the size of the delay faults grows rapidly as increasing the size of the circuit. In order to improve the compactness of the test set, 19-valued logic are derived. Unlike other TG logic systems, 19-valued logic is utilized to generate the robustly hazard-free test pattern. This is achieved by using the basic 5-valued logic, proposed in this work, where the transition with no hazard is
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LENUS (Irish Health Repository)
Cadogan, S L
2016-07-19
Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP\\'s views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care.
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Kose, Engin; Sirin Kose, Seda; Akca, Deniz; Yildiz, Kerem; Elmas, Cengizhan; Baris, Mustafa; Anil, Murat
2016-08-01
We aimed to investigate the effect of rapid antigen detection test (RADT) in the diagnosis of streptococcal pharyngitis, its impact on antibiotic prescription decision of pediatricians and influence on reduction of antibiotic treatment costs in children with pharyngitis. The study group consisted of 223 patients who were diagnosed with pharyngitis by pediatricians. The sensitivity and specificity of RADT were 92.1% (95% Cl: 78.6-98.3%) and 97.3% (95% Cl: 93.8-99.1%), respectively. In the first assessment, before performing RADT, pediatricians decided to prescribe antibiotics for 178 (79.8%) patients with pharyngitis. After learning RADT results, pediatricians finally decided to prescribe antibiotics for 83 (37.2%) patients with pharyngitis, and antibiotic prescription decreased by 42.6%. Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis and all subjects groups decreased by 80.8%, 48%, and 76.4%, respectively. Performing RADT in children with pharyngitis has an important impact on treatment decision of clinicians, reduction of unnecessary antibiotic prescriptions and antibiotic costs. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Energy Technology Data Exchange (ETDEWEB)
Lustbader, J. A.; Venson, T.; Adelman, S.; Dehart, C.; Yeakel, S.; Castillo, M. S.
2012-10-01
Each intercity long-haul truck in the U.S. idles approximately 1,800 hrs per year, primarily for sleeper cab hotel loads. Including workday idling, over 2 billion gallons of fuel are used annually for truck idling. NREL's CoolCab project works closely with industry to design efficient thermal management systems for long-haul trucks that keep the cab comfortable with minimized engine idling and fuel use. The impact of thermal load reduction technologies on idle reduction systems were characterized by conducting thermal soak tests, overall heat transfer tests, and 10-hour rest period A/C tests. Technologies evaluated include advanced insulation packages, a solar reflective film applied to the vehicle's opaque exterior surfaces, a truck featuring both film and insulation, and a battery-powered A/C system. Opportunities were identified to reduce heating and cooling loads for long-haul truck idling by 36% and 34%, respectively, which yielded a 23% reduction in battery pack capacity of the idle-reduction system. Data were also collected for development and validation of a CoolCalc HVAC truck cab model. CoolCalc is an easy-to-use, simplified, physics-based HVAC load estimation tool that requires no meshing, has flexible geometry, excludes unnecessary detail, and is less time-intensive than more detailed computer-aided engineering modeling approaches.
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Beliaev, Andrei M; Barber, P Alan; Marshall, Roger J; Civil, Ian
2014-06-01
Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool. This is a registry-based study of blunt trauma patients admitted to Auckland City Hospital from 1998 to 2012. The diagnosis of BCVI was confirmed or excluded with CTA, magnetic resonance angiography and, if these imaging were non-conclusive, four-vessel digital subtraction angiography. Thirty (61%) BCVI and 19 (39%) non-BCVI patients met eligibility criteria. The Denver protocol applied to our cohort of patients had a sensitivity of 97% (95% confidence interval (CI): 83-100%) and a specificity of 42% (95% CI: 20-67%). With a prevalence of BCVI in blunt trauma patients of 0.2% and 2.7%, post-test odds of a screen-positive test were 0.03 (95% CI: 0.002-0.005) and 0.046 (95% CI: 0.314-0.068), respectively. Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards. © 2013 Royal Australasian College of Surgeons.
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Lean manufacturing implementation in reducing waste for electronic assembly line
Directory of Open Access Journals (Sweden)
Zakaria Nurul Husna
2017-01-01
Full Text Available Lean manufacturing is the most convenient way to eliminate unnecessary waste and can provide what customers demand. This paper presents possibilities and sustainability of application of lean manufacturing method by using a virtual simulation of the workers performance in a line production of small and medium industry. Actual case study and Witness simulation were used in this study to find the waste that exists in the production and identified the performance of workers in the production line. Lean manufacturing concept has identified and rectified problems related to low productivity in the assembly line. The case study is involved a line production for electronic part assembly. The result of this preliminary study should illustrate the relationship of worker’s performance by lean manufacturing method as well as the productivity improvements which help to reduce cost for manufacturer. Lean manufacturing method has been used during the study to reduce the cost when waste is eliminated by reducing the workstation without reducing the performance of the production. The performance of the production is increased when allocating the labor in a needed working area. Lastly, the study also proves that the new layout has improved the process to be used for future production process.
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Directory of Open Access Journals (Sweden)
André Tito Pereira Bueno
Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: The purpose of screening tests for cancer is to detect it at an early stage in order to increase the chances of treatment. However, their unrestrained use may lead to unnecessary examinations, overdiagnosis and higher costs. It is thus necessary to evaluate their clinical effects in terms of benefits and harm. DESIGN AND SETTING: Review of Cochrane systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on the clinical effectiveness of cancer screening procedures were included. Study titles and abstracts were independently assessed by two authors. Conflicts were resolved by another two authors. Findings were summarized and discussed. RESULTS: Seventeen reviews were selected: fifteen on screening for specific cancers (bladder, breast, colorectal, hepatic, lung, nasopharyngeal, esophageal, oral, prostate, testicular and uterine and two others on cancer in general. The quality of evidence of the findings varied among the reviews. Only two reviews resulted in high-quality evidence: screening using low-dose computed tomography scans for high-risk individuals seems to reduce lung cancer mortality; and screening using flexible sigmoidoscopy and fecal occult blood tests seems to reduce colorectal cancer mortality. CONCLUSION: The evidence found through Cochrane reviews did not support most of the commonly used screening tests for cancer. It is recommended that patients should be informed of the possibilities of false positives and false negatives before they undergo the tests. Further studies to fully assess the effectiveness of cancer screening tests and adverse outcomes are required.
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Evaluation of Transition Untestable Faults Using a Multi-Cycle Capture Test Generation Method
Yoshimura, Masayoshi; Ogawa, Hiroshi; Hosokawa, Toshinori; Yamazaki, Koji
2010-01-01
Overtesting induces unnecessary yield loss. Untestable faults have no effect on normal functions of circuits. However, in scan testing, untestable faults may be detected through scan chains. Detected untestable faults cause overtesting. Untestable faults consist of uncontrollable faults, unobservable faults, and uncontrollable and unobservable faults. Uncontrollable faults may be detected under invalid states through scan chains by shift-in operations. Unobservable faults cannot be observed ...
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Wachelka, D; Katz, R C
1999-09-01
Test anxiety seems like a benign problem to some people, but it can be potentially serious when it leads to high levels of distress and academic failure in otherwise capable students. Because test anxiety is common in older students with learning disabilities (LD), it is surprising that little research has been done on ways to reduce the distress these students experience in test situations. In this study, we used a randomized pretest-posttest control group design to examine the effectiveness of a cognitive-behavioral treatment for reducing test anxiety and improving academic self-esteem in a cohort (N = 27) of high school and college students with learning disabilities (LD). All of the students participated voluntarily. They were enrolled in classes for students with learning problems. Before the study began, they complained of test anxiety and showed an elevated score on the Test Anxiety Inventory (TAI). Eleven students (85%) completed the 8-week long treatment, which consisted of progressive muscle relaxation, guided imagery, self-instruction training, as well as training in study and test-taking skills. Results showed significant improvement in the treated group which was not evident in an untreated control group (N = 16). Compared to the control group, the treated group showed significant reductions in test anxiety on the TAI, as well as improvement in study skills and academic self-esteem as measured by the Survey of Study Habits and Attitudes, and the school scale of the Coopersmith Self-Esteem Inventory. These results extend the generality of similar studies on reducing test anxiety and improving academic self-esteem in younger students. They also suggest that relief from test anxiety can be expected fairly quickly when cognitive-behavioral methods are used. Additional implications and methodological limitations of the study are discussed.
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New EPA Guidance for Testing Pesticides Will Reduce Animal Testing
EPA is issuing guidance for requesting waivers of acute dermal toxicity testing requirements for pesticide formulations, which will lead to fewer animal tests for acute dermal toxicity for pesticides.
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Directory of Open Access Journals (Sweden)
Mathieu Boulin
Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.
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International Nuclear Information System (INIS)
Rafferty, M. W.; Jacob, C. S.
1995-01-01
Performance testing of medical diagnostic X-ray equipment can reveal equipment faults which, while not always clinically detectable, may contribute to reduced image quality and unnecessary radiation exposure of both patients and staff. Routine testing of such equipment is highly desirable to identify such faults and allows them to be rectified. The Radiological council of Western Australia is moving towards requiring compulsory compliance testing of all (new and existing) medical diagnostic X-ray equipment that all new mobile radiographic and new mammographic X-ray equipment be issued with a compliance test certificate as a prerequisite for registration. Workbooks which provide details of the tests required and recommended test methods have been prepared for medical radiographic (mobile and fixed), fluoroscopic and mammographic X-ray equipment. It is intended that future workbooks include details of the tests and methods for dental and computed tomography X-ray units. The workbooks are not limited to the compliance testing of items as specified in the Regulations, but include tests for other items such as film processing, darkrooms and image quality (for fluoroscopic equipment). Many of the workbook tests could be used within a regular quality assurance program for diagnostic X-ray equipment. Persons who conduct such compliance tests will need to be licensed and have all test certificates endorsed by a qualified expert. Suitable training and assessment of compliance testers will be required. Notification of such tests (including non-compliant items and corrective actions taken) will be required by the Radiological Council as a condition of equipment registration. 9 refs
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Directory of Open Access Journals (Sweden)
Atar Herziger
2017-06-01
Full Text Available Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism in an empirical research design. The project will test (a whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b whether self-transcendence (i.e., biospheric and self-enhancement (i.e., egoistic and hedonic values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating, while priming the relevant values and goals (self-transcendence or self-enhancement. These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions.
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Herziger, Atar; Benzerga, Amel; Berkessel, Jana; Dinartika, Niken L.; Franklin, Matija; Steinnes, Kamilla K.; Sundström, Felicia
2017-01-01
Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism) in an empirical research design. The project will test (a) whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b) whether self-transcendence (i.e., biospheric) and self-enhancement (i.e., egoistic and hedonic) values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating), while priming the relevant values and goals (self-transcendence or self-enhancement). These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions. PMID:28649220
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Herziger, Atar; Benzerga, Amel; Berkessel, Jana; Dinartika, Niken L; Franklin, Matija; Steinnes, Kamilla K; Sundström, Felicia
2017-01-01
Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing social media trend (Minimalism) in an empirical research design. The project will test (a) whether the Minimalism trend could benefit consumers interested in reducing their consumption, and (b) whether self-transcendence (i.e., biospheric) and self-enhancement (i.e., egoistic and hedonic) values and goals have a similar impact in promoting voluntary simplicity. A one-week intervention program will test the efficacy of watching user-generated voluntary simplicity videos in reducing non-essential consumption. Each of the two intervention conditions will present participants with similar tutorial videos on consumption reduction (e.g., decluttering, donating), while priming the relevant values and goals (self-transcendence or self-enhancement). These interventions will be compared to a control condition, involving no user-generated content. Participants will undergo baseline and post-intervention evaluations of: voluntary simplicity attitudes and behaviors, buying and shopping behaviors, values and goals in reducing consumption, and life satisfaction. Experience sampling will monitor affective state during the intervention. We provide a detailed stepwise procedure, materials, and equipment necessary for executing this intervention. The outlined research design is expected to contribute to the limited literature on voluntary simplicity, online behavioral change interventions, and the use of social marketing principles in consumer interventions.
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Tuberculin skin testing in patients with HIV infection: limited benefit of reduced cutoff values
Cobelens, Frank G.; Egwaga, Saidi M.; van Ginkel, Tessa; Muwinge, Hemed; Matee, Mecky I.; Borgdorff, Martien W.
2006-01-01
BACKGROUND: When determining eligibility for isoniazid preventive therapy of human immunodeficiency virus (HIV)-infected patients, the cutoff value of the tuberculin skin test (TST) is often reduced from an induration of 10 mm in diameter to one of 5 mm in diameter to compensate for loss of
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Energy Technology Data Exchange (ETDEWEB)
Fotter, R.; Hoellwarth, M.
1981-07-01
The water syphon test is a simple and easily performed method for demonstrating gastro-oesophageal reflux with a high degree of reliability. It is carried out following a conventional barium swallow. Compared with clinical findings and oesophageal manometry, the water syphon test is very reliable for demonstrating gastro-oesophageal reflux during childhood. Prolonged irradiation in order to see spontaneous reflux becomes unnecessary. This results in a significant reduction in radiation dose. Barium swallow and the water syphon test are the most useful initial examinations in children with symptoms which suggest reflux.
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The need for alternative approaches to the use of vertebrate animals for hazard assessing chemicals and pollutants has become of increasing importance. It is now the first consideration when initiating a vertebrate ecotoxicity test, to ensure that unnecessary use of vertebrate or...
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Performance-based containment leakage testing
International Nuclear Information System (INIS)
Cybulskis, P.
1995-01-01
The U.S. Nuclear Regulatory Commission (NRC) is reviewing regulatory requirements in an effort to revise those that are marginal to safety but impose significant burdens on licensees. Identification of requirements marginal to safety and development and evaluation of alternatives utilize the NRC safety goals and insights from probabilistic risk assessments (PRAs). Since earlier studies found design-basis containment leakage to be a minor contributor to reactor accident risk, containment leakage testing has been selected as a candidate for change in regulations. This paper summarizes the technical analyses supporting the NRC proposal to amend Appendix J of 10 CFR Part 50 as its first effort to decrease unnecessary regulatory burdens on licensees
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Seismic tests on a reduced scale mock-up of a reprocessing plant cooling pond
International Nuclear Information System (INIS)
Queval, J.C.; Gantenbein, F.; Lebelle, M.
1995-01-01
In conjunction with COGEMA and SGN, CEA has launched an important research program to validate the reprocessing plant cooling pond calculation mainly for the effect of the racks on the fluid-pond interaction. The paper presents the tests performed on a reduced scale mock-up (scale 1/5). The tests are composed by: -random excitations at very low excitation level to measure the natural frequencies, especially the first sloshing mode frequency; -sinusoidal tests to measure the damping; -seismic tests performed with 3 different time reduction scales (1, 1/5, 1/√5) and 3 different synthetic accelerograms. Two types of simplified model with added masses and finite element model were developed. Comparisons of measured and calculated pressure fields against the panels will be presented. The measured frequencies, obtained during tests, are in good agreement with Housner's results. (authors). 2 refs., 4 figs., 5 tabs
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Comparing diagnostic tests on benefit-risk.
Pennello, Gene; Pantoja-Galicia, Norberto; Evans, Scott
2016-01-01
Comparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.
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78 FR 36369 - Heavy-Duty Engine and Vehicle, and Nonroad Technical Amendments
2013-06-17
... model year compliance, better align testing procedures to market realities, and reduce unnecessary...: www.regulations.gov : Follow the on-line instructions for submitting comments. Email: a-and-r-docket..., U.S. Department of Transportation, West Building, Ground Floor, Rm. W12-140, 1200 New Jersey Avenue...
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Energy Technology Data Exchange (ETDEWEB)
Spick, Claudio; Pinker-Domenig, Katja; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), General Hospital Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)
2014-06-15
To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53 ± 0.38 x 10{sup -3} mm{sup 2}/s in benign lesions and 1.06 ± 0.27 x 10{sup -3} mm{sup 2}/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58 x 10{sup -3} mm{sup 2}/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. (orig.)
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Directory of Open Access Journals (Sweden)
Qi-Hong Sun
2015-01-01
Conclusions: Our data suggest that isolated use of the gonadorelin stimulation test is almost sufficient to discriminate between HH and CDP in males, but unnecessary in females. The most useful predictor is serum basal or peak LH to differentiate these two disorders in males, but serum basal LH or FSH in females.
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Status of the RERTR [Reduced Enrichment Research and Test Reactor] program in Argentina
International Nuclear Information System (INIS)
Giorsetti, D.R.
1987-01-01
The Argentine Atomic Energy Commission started in 1978 the Reduced Enrichment Research and Test Reactors in the field of reactor engineering; engineering, development and manufacturing of fuel elements and research reactors operators. This program was initiated with the conviction that it would contribute to the international efforts to reduce risks of nuclear weapons proliferation owing to an uncontrolled use of highly enriched uranium. It was intended to convert RA-3 reactor to make possible its operation with low enriched fuel (LEU), instead of high enriched fuel (HEU) and to develop manufacturing techniques for said LEU. Afterwards, this program was adapted to assist other countries in reactors conversion, development of the corresponding fuel elements and supply of fuel elements to other countries. (Author)
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Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana
2017-01-01
Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at pcommunication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.
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Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign.
Khunlertkit, Adjhaporn; Dorissaint, Leonard; Chen, Allen; Paine, Lori; Pronovost, Peter J
2017-10-25
Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months. The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years. Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.
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Korte, S.M.; de Kloet, E.R.; Buwalda, B; Bouman, S.D.; Bohus, B
1996-01-01
Immobility time of rats in the forced swim test was reduced after bilateral infusion of an 18-mer antisense phosphorothioate oligodeoxynucleotide targeted to the glucocorticoid receptor mRNA into the dentate gyrus of the hippocampus. Vehicle-, sense- and scrambled sequence-treated animals spent
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Proceedings of the 1988 International Meeting on Reduced Enrichment for Research and Test Reactors
Energy Technology Data Exchange (ETDEWEB)
1993-07-01
The international effort to develop and implement new research reactor fuels utilizing low-enriched uranium, instead of highly- enriched uranium, continues to make solid progress. This effort is the cornerstone of a widely shared policy aimed at reducing, and possibly eliminating, international traffic in highly-enriched uranium and the nuclear weapon proliferation concerns associated with this traffic. To foster direct communication and exchange of ideas among the specialists in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the eleventh of a series which began 1978. Individual papers presented at the meeting have been cataloged separately.
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Proceedings of the 1988 International Meeting on Reduced Enrichment for Research and Test Reactors
International Nuclear Information System (INIS)
1993-07-01
The international effort to develop and implement new research reactor fuels utilizing low-enriched uranium, instead of highly- enriched uranium, continues to make solid progress. This effort is the cornerstone of a widely shared policy aimed at reducing, and possibly eliminating, international traffic in highly-enriched uranium and the nuclear weapon proliferation concerns associated with this traffic. To foster direct communication and exchange of ideas among the specialists in this area, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the eleventh of a series which began 1978. Individual papers presented at the meeting have been cataloged separately
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Cortisol response to the Trier Social Stress Test in obese and reduced obese individuals.
Therrien, Fanny; Drapeau, Vicky; Lalonde, Josée; Lupien, Sonia J; Beaulieu, Serge; Doré, Jean; Tremblay, Angelo; Richard, Denis
2010-05-01
Impact of body weight loss, body fat distribution and the nutritional status on the cortisol response to the Trier Social Stress Test (TSST) was investigated in this study. Fifty-one men (17 non-obese, 20 abdominally obese and 14 reduced obese) and 28 women (12 non-obese, 10 peripherally obese and 6 reduced obese) were subjected to the TSST in fed and fasted states. The TSST response was determined using salivary cortisol measurements. The nutritional status (being fed or fasted) had no effect on the cortisol levels during and following the TSST. Reduced obese men exhibited lower cortisol levels than non-obese men. Cortisol levels in obese men were not different from those of non-obese and reduced obese subjects. In women, there was no significant difference between groups. These finding suggest that weight status in men influences cortisol reactivity to a psychological stress and the different responses seen among genders could be linked to the different fat distributions that characterize men and women. Copyright 2010 Elsevier B.V. All rights reserved.
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Need for beta-blockade in hypertension reduced with long-term minoxidil.
Brunner, H R; Jaeger, P; Ferguson, R K; Jequier, E; Turini, G; Gavras, H
1978-01-01
Sequential changes in plasma renin activity and urinary aldosterone and noradrenaline were assessed in eight patients with severe hypertension after minoxidil had been added to their treatment. Doses of 2.5--27.5 (mean 12.5) mg/day reduced the mean blood pressure from 166/113 +/-6/2 mm Hg to 124/88+/-4/2 mm Hg in one week. Plasma renin activity and urinary aldosterone and noradrenaline increased twofold to threefold initially but returned to baseline values within two to three weeks and remained unchanged during a mean follow-up of 5.1 months. Beta-blocking drugs were then withdrawn slowly in six patients without adverse effects, though blood pressure and heart rate increased in three patients, who required minimal doses of beta-blockers. Plasma renin activity and urinary aldosterone and noradrenaline did not change significantly after beta-blockade had been stopped. We conclude that the need for beta-blockade is greatly reduced with long-term minoxidil treatment and that it may be unnecessary in some patients. PMID:28811
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Reduced Enrichment for Research and Test Reactors. Proceedings of the XIV international meeting
Energy Technology Data Exchange (ETDEWEB)
Suripto, Asmedi; Hastowo, Hudi; Hersubeno, J B [eds.
1995-07-01
Apart from the progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program the national programs of Indonesia, Japan and China were presented. The major events, findings, and activities of 1991 are reviewed with a brief summary of the results which the RERTR Program had achieved by the end of 1990 in collaboration with its many international partners. The RERTR program, has concentrated its efforts on technology transfer and implementation activities consistent with the guidance received from the Department of Energy at the end of 1990. A number of presentations were devoted to development of new fuel uranium silicide fuel elements, fuel irradiation testing and reactor core conversions from highly enriched (HEU) to slightly enriched uranium (LEU). Calculations and measurements of converted reactor core parameters were shown related to safety test and analysis. Fuel cycle issue were discussed as well. One should note that a significant number of papers were devoted to Indonesian GA SIWABESSY reactor core conversion and related topics.
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Reduced Enrichment for Research and Test Reactors. Proceedings of the XIV international meeting
International Nuclear Information System (INIS)
Suripto, Asmedi; Hastowo, Hudi; Hersubeno, J.B.
1995-01-01
Apart from the progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program the national programs of Indonesia, Japan and China were presented. The major events, findings, and activities of 1991 are reviewed with a brief summary of the results which the RERTR Program had achieved by the end of 1990 in collaboration with its many international partners. The RERTR program, has concentrated its efforts on technology transfer and implementation activities consistent with the guidance received from the Department of Energy at the end of 1990. A number of presentations were devoted to development of new fuel uranium silicide fuel elements, fuel irradiation testing and reactor core conversions from highly enriched (HEU) to slightly enriched uranium (LEU). Calculations and measurements of converted reactor core parameters were shown related to safety test and analysis. Fuel cycle issue were discussed as well. One should note that a significant number of papers were devoted to Indonesian GA SIWABESSY reactor core conversion and related topics
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LaPaglia, Jessica A; Chan, Jason C K
2013-01-01
A number of recent studies have found that recalling details of an event following its occurrence can increase people's suggestibility to later presented misinformation. However, several other studies have reported the opposite result, whereby earlier retrieval can reduce subsequent eyewitness suggestibility. In the present study, we investigated whether differences in the way misinformation is presented can modulate the effects of testing on suggestibility. Participants watched a video of a robbery and some were questioned about the event immediately afterwards. Later, participants were exposed to misinformation in a narrative (Experiment 1) or in questions (Experiment 2). Consistent with previous studies, we found that testing increased suggestibility when misinformation was presented via a narrative. Remarkably, when misinformation was presented in questions, testing decreased suggestibility. Copyright © 2013 John Wiley & Sons, Ltd.
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Cornish, Richard D.; Dilley, Josiah S.
1973-01-01
Systematic desensitization, implosive therapy, and study counseling have all been effective in reducing test anxiety. In addition, systematic desensitization has been compared to study counseling for effectiveness. This study compares all three methods and suggests that systematic desentization is more effective than the others, and that implosive…
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Evaluation of the performance of the reduced local lymph node assay for skin sensitization testing.
Ezendam, Janine; Muller, Andre; Hakkert, Betty C; van Loveren, Henk
2013-06-01
The local lymph node assay (LLNA) is the preferred method for classification of sensitizers within REACH. To reduce the number of mice for the identification of sensitizers the reduced LLNA was proposed, which uses only the high dose group of the LLNA. To evaluate the performance of this method for classification, LLNA data from REACH registrations were used and classification based on all dose groups was compared to classification based on the high dose group. We confirmed previous examinations of the reduced LLNA showing that this method is less sensitive compared to the LLNA. The reduced LLNA misclassified 3.3% of the sensitizers identified in the LLNA and misclassification occurred in all potency classes and that there was no clear association with irritant properties. It is therefore not possible to predict beforehand which substances might be misclassified. Another limitation of the reduced LLNA is that skin sensitizing potency cannot be assessed. For these reasons, it is not recommended to use the reduced LLNA as a stand-alone assay for skin sensitization testing within REACH. In the future, the reduced LLNA might be of added value in a weight of evidence approach to confirm negative results obtained with non-animal approaches. Copyright © 2013 Elsevier Inc. All rights reserved.
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Experimental results of the SMART ECC injection performance with reduced scale of test facility
Energy Technology Data Exchange (ETDEWEB)
Cho, Young Il; Cho, Seok; Ko, Yung Joo; Shin, Yong Cheol; Kwon, Tae Soon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)
2011-05-15
SMART pressurized water reactor type is different from the existing integral NSSS commercial pressurized water reactor system which is equipped with the main features. In addition, RCS piping is removed and the feature of the SBLOCA is a major design break accident. SWAT (SMART ECC Water Asymmetric Two-phase choking test facility) test facility is to simulate the 2 inch SBLOCA of the SMART using with reduced scale. The Test was performed to produce experimental data for the validation of the TASS/SMR-S thermal hydraulic analysis code, and to investigate the related thermal hydraulic phenomena in the down-comer region during the 2 inch SBLOCA of the safety inject line. The particular phenomena for the observation are ECC bypass and multi-dimensional flow characteristics to verify the effectiveness and performance of the safety injection system. In this paper, the corresponding steady state test conditions, including initial and boundary conditions along with major measuring parameters, and related experimental results were described
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Evaluation of a rapid immunodiagnostic test kit for rabies virus.
Kang, BoKyu; Oh, JinSik; Lee, ChulSeung; Park, Bong-Kyun; Park, YoungNam; Hong, KyungSoo; Lee, KyungGi; Cho, ByungKi; Song, DaeSub
2007-10-01
A rapid immunodiagnostic test kit for rabies virus detection was evaluated using 51 clinical samples and 4 isolates of rabies virus. The quick detection of rabies virus under field conditions may be helpful in determining if post-exposure prophylaxis is needed, thereby avoiding unnecessary treatments, as well as undue economic burden. There are several widely used diagnostic methods for rabies, including fluorescent antibody tests, reverse transcription polymerase chain reaction, and electron microscopy; however, these methods include time-consuming, intricate, and costly procedures. The rapid immunodiagnostic test was able to detect rabies virus in clinical samples, including brain tissue and saliva, in addition to 10(3.2) 50% lethal dose (LD(50))/mL cell-adapted rabies virus. The assay was not cross-reactive with non-rabies virus microbes. When the performance of the rapid immunodiagnostic test was compared to a fluorescent antibody test, the rapid immunodiagnostic test had a sensitivity of 91.7% and specificity of 100% (95.8% CI).
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International Nuclear Information System (INIS)
Li, Y.C.; Chen, K.T.; Su, Y.L.; Ting, K.; Chien, F.T.; Li, G.D.; Huang, S.H.
2012-01-01
Safety related valves such as Motor Operated Valves (MOV), Air Operated Valves (AOV) or Check Valves (CV) play an important role in nuclear power plant. Functioning of these valves mainly aim at emergency reactivity control, post-accident residue heat removal, post-accident radioactivity removal and containment isolation when a design basis accident occurred. In order to maintain these valves under operable conditions, an Inservice Testing Program (IST) is defined for routine testing tasks based on the ASME Boiler and Pressure Vessel Code section XI code requirements. Risk based Inservice Testing Programs have been studied and developed extensively in the nuclear energy industry since the 1990s. Risk Based evaluations of IST can bring positive advantages to the licensee such as identifying the vulnerability of the system, reducing unnecessary testing burden, concentrating testing resources on the critical pass oriented valves and saving plant’s personnel dose exposure. This risk evaluation is incorporated with quantitative and qualitative analyses to the Motor Operated Valves under current Inservice Testing Program for PWR nuclear power plant in Taiwan. With the outcome of the risk classifications for the safety related MOVs through numerical or deterministic analyses, a risk based testing frequency relief is suggested to demonstrate the benefits received from the risk based Inservice Testing Program. The goal made of this study, it could be as a reference and cornerstone for the licensee to perform overall scope Risk-Informed Inservice Testing Program (RI-IST) evaluation by referring relevant methodologies established in this study.
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Energy Technology Data Exchange (ETDEWEB)
Kljucanin, T. (Institut za Rudarska Istrazivanja, Tuzla (Yugoslavia))
1989-01-01
Analyzes individual phases of coal excavation in surface mines from the viewpoint of energy consumption. Equipment operation with unnecessary lifting of loosened overburden or coal on mine benches during bulk loading into dump trucks, onto belt conveyors or during transportation is pointed out. Energy consumption calculations showed that unnecessary bulk lifting by equipment configurations results in annual energy losses, both fuel or electricity. A mathematical formula for calculating energy losses is provided. A calculation example with surface mining operations is given, demonstrating that 55 MWh per excavator may be saved over a 25 year period if lifting height of overburden were reduced by 22 m. Overburden removal equipment employed consists of the PH-1900 shovel excavator, 60 to 155 t capacity dump trucks and inclined belt conveyor system. 1 ref.
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The RERTR [Reduced Enrichment Research and Test Reactor] Program: Progress and plans
International Nuclear Information System (INIS)
Travelli, A.
1987-01-01
The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1986, the activities, results, and new developments which occurred in 1987 are reviewed. Irradiation of the second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels, was completed and postirradiation examinations were performed on many of its miniplates. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 was completed at the end of March with excellent results and with 29 elements estimated to have reached at least 40% average burnup. Good progress was made in the area of LEU usage for the production of fission 99 Mo, and in the coordination of safety evaluations related to LEU conversions of US university reactors. Planned activities include testing and demonstrating advanced fuels intended to allow use of reduced enrichment uranium in very-high-performance reactors. Two candidate fuels are U 3 Si-Al with 19.75% enrichment and U 3 Si 2 -Al with 45% enrichment. Demonstration of these fuels will include irradiation of full-size elements and, possibly, a full-core demonstration. Achievement of the final program goals is still projected for 1990. This progress could not have been possible without the close international cooperation which has existed from the beginning, and which is essential to the ultimate success of the RERTR Program
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Korn, Christoph W; Vunder, Johanna; Miró, Júlia; Fuentemilla, Lluís; Hurlemann, Rene; Bach, Dominik R
2017-10-01
Rodent approach-avoidance conflict tests are common preclinical models of human anxiety disorder. Their translational validity mainly rests on the observation that anxiolytic drugs reduce rodent anxiety-like behavior. Here, we capitalized on a recently developed approach-avoidance conflict computer game to investigate the impact of benzodiazepines and of amygdala lesions on putative human anxiety-like behavior. In successive epochs of this game, participants collect monetary tokens on a spatial grid while under threat of virtual predation. In a preregistered, randomized, double-blind, placebo-controlled trial, we tested the effect of a single dose (1 mg) of lorazepam (n = 59). We then compared 2 patients with bilateral amygdala lesions due to Urbach-Wiethe syndrome with age- and gender-matched control participants (n = 17). Based on a previous report, the primary outcome measure was the effect of intra-epoch time (i.e., an adaptation to increasing potential loss) on presence in the safe quadrant of the spatial grid. We hypothesized reduced loss adaptation in this measure under lorazepam and in patients with amygdala lesions. Lorazepam and amygdala lesions reduced loss adaptation in the primary outcome measure. We found similar results in several secondary outcome measures. The relative reduction of anxiety-like behavior in patients with amygdala lesions was qualitatively and quantitatively indistinguishable from an impact of anterior hippocampus lesions found in a previous report. Our results establish the translational validity of human approach-avoidance conflict tests in terms of anxiolytic drug action. We identified the amygdala, in addition to the hippocampus, as a critical structure in human anxiety-like behavior. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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Community Intervention Model to Reduce Inappropriate Antibiotic Use
Alder, Stephen; Wuthrich, Amy; Haddadin, Bassam; Donnelly, Sharon; Hannah, Elizabeth Lyon; Stoddard, Greg; Benuzillo, Jose; Bateman, Kim; Samore, Matthew
2010-01-01
Background: The Inter-Mountain Project on Antibiotic Resistance and Therapy (IMPART) is an intervention that addresses emerging antimicrobial resistance and the reduction of unnecessary antimicrobial use. Purpose: This study assesses the design and implementation of the community intervention component of IMPART. Methods: The study was conducted…
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Dose optimization in computed tomography: ICRP 87
International Nuclear Information System (INIS)
2007-01-01
The doses given in the use of computed tomography scans are studied, aiming to calibrate the limits of irradiation in patients who need these tests. Furthermore, a good value of computed tomography should be guaranteed by physicians and radiologists for people not being irradiated unfairly, reducing doses and unnecessary tests. A critical evaluation by an ethics committee is suggested for cases where the test is performed for medical research without a cause [es
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Han, Sheng; Liang, Huigang; Su, Weiping; Xue, Yajiong; Shi, Luwen
2013-01-01
The objective of this article is to investigate whether the Chinese government's pricing policies have reduced pharmaceutical expenses. The purchasing records for systemic antibacterial drugs of 12 hospitals in Beijing from 1996 to 2005 were analyzed by separating the expenditure growth into three components: the price change, the volume change, and the structure change. Our results reveal that the structure change is the dominant determinant of drug expenditure growth. Despite lowered prices, the antibacterial drug expenditure was raised because more expensive drugs in the same therapeutic category were prescribed. It is insufficient to rely only on pricing policies to reduce drug expenses, given that physicians could circumvent the policy by prescribing more expensive drugs. In addition, physician behaviors need to be regulated to eliminate unnecessary overprescribing.
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Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.
Almorsy, Lamia; Khalifa, Mohamed
2016-01-01
Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.
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Garrison, Louis P; Babigumira, Joseph B; Masaquel, Anthony; Wang, Bruce C M; Lalla, Deepa; Brammer, Melissa
2015-06-01
Patients with breast cancer whose tumors test positive for human epidermal growth factor receptor 2 (HER2) are treated with HER2-targeted therapies such as trastuzumab, but limitations with HER2 testing may lead to false-positive (FP) or false-negative (FN) results. To develop a US-level model to estimate the effect of tumor misclassification on health care costs and patient quality-adjusted life-years (QALYs). Decision analysis was used to estimate the number of patients with early-stage breast cancer (EBC) whose HER2 status was misclassified in 2012. FP results were assumed to generate unnecessary trastuzumab costs and unnecessary cases of trastuzumab-related cardiotoxicity. FN results were assumed to save money on trastuzumab, but with a loss of QALYs and greater risk of disease recurrence and its associated costs. QALYs were valued at $100,000 under a net monetary benefit approach. Among 226,870 women diagnosed with EBC in 2012, 3.12% (n = 7,070) and 2.18% (n = 4,955) were estimated to have had FP and FN test results, respectively. Approximately 8400 QALYs (discounted, lifetime) were lost among women not receiving trastuzumab because of FN results. The estimated incremental per-patient lifetime burden of FP or FN results was $58,900 and $116,000, respectively. The implied incremental losses to society were $417 million and $575 million, respectively. HER2 tests result in misclassification and nonoptimal treatment of approximately 12,025 US patients with EBC annually. The total economic societal loss of nearly $1 billion suggests that improvements in HER2 testing accuracy are needed and that further clinical and economic studies are warranted. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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Economic impact of clinical variability in preoperative testing for major outpatient surgery.
Gil-Borrelli, Christian Carlo; Agustí, Salomé; Pla, Rosa; Díaz-Redondo, Alicia; Zaballos, Matilde
2016-05-01
With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated. Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
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Planned Hypothesis Tests Are Not Necessarily Exempt From Multiplicity Adjustment
Directory of Open Access Journals (Sweden)
Andrew V. Frane
2015-10-01
Full Text Available Scientific research often involves testing more than one hypothesis at a time, which can inflate the probability that a Type I error (false discovery will occur. To prevent this Type I error inflation, adjustments can be made to the testing procedure that compensate for the number of tests. Yet many researchers believe that such adjustments are inherently unnecessary if the tests were “planned” (i.e., if the hypotheses were specified before the study began. This longstanding misconception continues to be perpetuated in textbooks and continues to be cited in journal articles to justify disregard for Type I error inflation. I critically evaluate this myth and examine its rationales and variations. To emphasize the myth’s prevalence and relevance in current research practice, I provide examples from popular textbooks and from recent literature. I also make recommendations for improving research practice and pedagogy regarding this problem and regarding multiple testing in general.
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International Nuclear Information System (INIS)
Morris, R.N.; Baldwin, C.A.; Wilson, D.F.
1998-07-01
The Fissile Materials Disposition Program (FMDP) is investigating the use of weapons grade plutonium in mixed oxide (MOX) fuel for light-water reactors (LWR). Commercial MOX fuel has been successfully used in overseas reactors for many years; however, weapons derived fuel may differ from the previous commercial fuels because of small amounts of gallium impurities. A concern presently exists that the gallium may migrate out of the fuel, react with and weaken the clad, and thereby promote loss of fuel pin integrity. Phases 1 and 2 of the gallium task are presently underway to investigate the types of reactions that occur between gallium and clad materials. This is a Level-2 document as defined in the Fissile Materials Disposition Program Light-Water Reactor Mixed-Oxide Fuel Irradiation Test Project Plan. This Plan summarizes the projected Phase 3 Gallium-Cladding compatibility heating test and the follow-on post test examination (PTE). This work will be performed using centrally-heated surrogate pellets, to avoid unnecessary complexities and costs associated with working with plutonium and an irradiation environment. Two sets of rodlets containing pellets prepared by two different methods will be heated. Both sets will have an initial bulk gallium content of approximately 10 ppm. The major emphasis of the PTE task will be to examine the material interactions, particularly indications of gallium transport from the pellets to the clad
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Mezadri, T J; Batista, G M; Portes, A C; Marino-Neto, J; Lino-de-Oliveira, C
2011-02-15
The forced swim test (FST) is a pre-clinical test to short and long term treatment with antidepressant drugs (ADT), which requires between-subject designs. Herein a modified protocol of the FST using within-subject design (repeated rat-FST) was evaluated. Male Wistar rats were submitted to 15 min of swimming (Day 1: pretest) followed by three subsequent 5 min-swimming tests one week apart (Day 2: test, Day 7: retest 1, Day 14: retest 2). To determine the temporal and factorial characteristics of the variables scored in the repeated rat-FST, the protocol was carried out in untreated animals (E1). To validate the method, daily injections of Fluoxetine (FLX, 2.5mg/kg, i.p.) or saline were given over a 2-week period (E2). Tests and retests have been videotaped for further register of the latency, frequency and duration of behaviors. Over retesting the latency to immobility decreased whereas duration of immobility tended to increase. Factorial analysis revealed that the test, the retest 1 as well as the retest 2 have variables suitable to detection of antidepressant-like effects of ADT. Compared to saline, FLX chronically administrated reduced duration of immobility whereas increased duration of swimming in retest 2. The data suggest that repeated rat-FST detected the gradual increase in the efficacy of low doses of FLX over time. Therefore, repeated rat-FST seemed suitable to detect short and long term effects of selective serotonin reuptake inhibitors, or other ADT, thus reducing the number of animals used in the screenings of this type of compounds. © 2010 Elsevier B.V. All rights reserved.
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Sapp, Marty
A two-group randomized multivariate analysis of covariance (MANCOVA) was used to investigate the effects of cognitive-behavioral hypnosis in reducing test anxiety and improving academic performance in comparison to a Hawthorne control group. Subjects were enrolled in a rigorous introductory psychology course which covered an entire text in one…
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Risk-based inservice testing program modifications at Palo Verde nuclear generating station
International Nuclear Information System (INIS)
Knauf, S.; Lindenlaub, B.; Linthicum, R.
1996-01-01
Arizona Public Service Company (APS) is investigating changes to the Palo Verde Inservice Testing (IST) Program that are intended to result in the reduction of the required test frequency for various valves in the American Society of Mechanical Engineers (ASME) Section XI IST program. The analytical techniques employed to select candidate valves and to demonstrate that these frequency reductions are acceptable are risk based. The results of the Palo Verde probabilistic risk assessment (PRA), updated in June 1994, and the risk significant determination performed as part of the implementation efforts for 10 CFR 50.65 (the maintenance rule) were used to select candidate valves for extended test intervals. Additional component level evaluations were conducted by an 'expert panel.' The decision to pursue these changes was facilitated by the ASME Risk-Based Inservice Testing Research Task Force for which Palo Verde is participating as a pilot plant. The NRC's increasing acceptance of cost beneficial licensing actions and risk-based submittals also provided incentive to seek these changes. Arizona Public Service is pursuing the risk-based IST program modification in order to reduce the unnecessary regulatory burden of the IST program through qualitative and quantitative analysis consistent with maintaining a high level of plant safety. The objectives of this project at Palo Verde are as follows: (1) Apply risk-based technologies to IST components to determine their risk significance (i.e., high or low). (2) Apply a combination of deterministic and risk-based methods to determine appropriate testing requirements for IST components including improvement of testing methods and frequency intervals for high-risk significant components. (3) Apply risk-based technologies to high-risk significant components identified by the open-quotes expert panelclose quotes and outside of the IST program to determine whether additional testing requirements are appropriate
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Risk-based inservice testing program modifications at Palo Verde nuclear generating station
Energy Technology Data Exchange (ETDEWEB)
Knauf, S.; Lindenlaub, B.; Linthicum, R.
1996-12-01
Arizona Public Service Company (APS) is investigating changes to the Palo Verde Inservice Testing (IST) Program that are intended to result in the reduction of the required test frequency for various valves in the American Society of Mechanical Engineers (ASME) Section XI IST program. The analytical techniques employed to select candidate valves and to demonstrate that these frequency reductions are acceptable are risk based. The results of the Palo Verde probabilistic risk assessment (PRA), updated in June 1994, and the risk significant determination performed as part of the implementation efforts for 10 CFR 50.65 (the maintenance rule) were used to select candidate valves for extended test intervals. Additional component level evaluations were conducted by an `expert panel.` The decision to pursue these changes was facilitated by the ASME Risk-Based Inservice Testing Research Task Force for which Palo Verde is participating as a pilot plant. The NRC`s increasing acceptance of cost beneficial licensing actions and risk-based submittals also provided incentive to seek these changes. Arizona Public Service is pursuing the risk-based IST program modification in order to reduce the unnecessary regulatory burden of the IST program through qualitative and quantitative analysis consistent with maintaining a high level of plant safety. The objectives of this project at Palo Verde are as follows: (1) Apply risk-based technologies to IST components to determine their risk significance (i.e., high or low). (2) Apply a combination of deterministic and risk-based methods to determine appropriate testing requirements for IST components including improvement of testing methods and frequency intervals for high-risk significant components. (3) Apply risk-based technologies to high-risk significant components identified by the {open_quotes}expert panel{close_quotes} and outside of the IST program to determine whether additional testing requirements are appropriate.
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Imaging techniques for ultrasonic testing
International Nuclear Information System (INIS)
2013-01-01
These seminar proceedings contain 16 lectures on the following topics: 1. From imaging to quantification - ultrasound methods in medical diagnostics; 2. SAFT, TOFD, Phased Array - classical applications and recent developments in ultrasonic imaging; 3. Innovative ultrasonic imaging methods in research and application; 4. Industrial ultrasonic testing of fibre-reinforced structures of complex geometry; 5. Visualisation of crack tips in the inspection of wheel set shafts with longitudinal boreholes as a means of avoiding unnecessary wheel set changes; 6. Areal analysis of the propagation of Lamb waves on curved, anisotropic structures; 7. High-resolution representation in immersion technique testing; 8. Variants in generating images from phased array measurement data - practical examples involving copper, carbon-fibre reinforced plastic and other materials; 9. GIUM - an unconventional method of microstructure imaging using ultrasonic stimulation and laser vibrometry scanning; 10. Innovative air-ultrasonic testing concepts for improved imaging; 11. Use of imaging methods for improving the quality of test results from nondestructive testing; 12. Modelling and visualisation of EMUS stimulation for transducer optimisation; 13. Use of SAFT in the manufacture of energy conversion machines; 14. Ultrasonic imaging tests for improved defect characterisation during weld seam inspection on longitudinally welded large-diameter pipes; 15. SAFT reconstruction for testing austenitic weld seams and dissimilar metal weld seams for transverse cracks; 16. Imaging-based optimisation method for quantitative ultrasonic testing of anisotropic inhomogeneous austenitic welded joints with determination and utilisation of their elastic properties. One contribution has been abstracted separately. [de
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Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management.
Moskal, Dezarie; Maisto, Stephen A; Possemato, Kyle; Lynch, Kevin G; Oslin, David W
2018-03-26
Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients' treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol
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Halimi-Asl, Aliasghar; Hosseini, Amir Hossein; Nabavizadeh, Pooneh
2014-08-01
Recently, new predictors of vesicoureteral reflux (VUR) in children with a first febrile UTI such as Procalcitonin (PCT) were introduced as selective approaches for cystography. This study wants to show the capability of PCT in predicting presence of VUR at the first febrile UTI in children. Patients between 1 month and 15 years of age with febrile UTI were included in this prospective study. PCT values were measured through a semi-quantitative method in four grades comprising values less than 0.5, 0.5-2.0, 2.0-10.0 and above 10.0 ng/ml. The independence of PCT levels in predicting VUR were assessed after adjustment for all potential confounders using a logistic-regression model. A total of 68 patients, 54 (79.4%) girls and 14 (20.6%) boys were evaluated. PCT level demonstrated a significant difference between patients with positive VUR and those with negative VUR (P=0.012). To calculate the independent factors that may predict the presence of VUR, all included variables were adjusted for age and sex. Results of logistic regression showed that a PCT level between 2.0 and 10.0 ng/mL could independently predict presence of VUR (Odds ratio=6.11, CI 95%= 1.22-30.77, P=0.03). Our finding in this study showed that readily available semi-quantitative measures for PCT are feasible for detecting patients with VUR. We suggest that in semi-quantitative measurements of PCT, levels between 2.0 and 10.0 ng/ml could be an independent predictor of positive VUR.
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Clinical evaluation of serum bile acids as a new liver function test
Energy Technology Data Exchange (ETDEWEB)
Biffl, H; Pristautz, H; Parsche, P; Passath, A; Leb, G [Graz Univ. (Austria). Medizinische Klinik
1980-01-01
In a randomized patient material, with various histologically verified hepatobiliary diseases, the serum levels of Cholyl glycine (CG) and Sulfolithocholyl glycine (SLCG) were compared with each other. SLCG levels are a more sensitive parameter and permit a more significant differentiation between fatty and normal livers and between cases with and without portal hypertension in liver cirrhosis. There were poor correlations between the hitherto routinely performed laboratory tests and the SLCG levels, but good correlations between SLCG and defined parenchymal liver diseases. The publication ends with the presentation of a newly developed SLCG-stimulation test, which provides a staging of parenchymal liver diseases without unnecessary requirements of time and material and with minimal stress to the patients.
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Safety Assessment for transient event occurred during the ASTS test of Hanbit Unit 2
International Nuclear Information System (INIS)
Yang, Changkeun; Kim, Yohan; Ha, Sangjun
2014-01-01
Safety Injection has been actuated during the ASTS (Automatic Seismic Trip System) test of Hanbit Unit 2 on Feb. 28, 2014. It could be bad effect on system integrity. KHNP has been performed safety assessment of system for effect of Safety Injection (SI) actuation occurred during the ASTS test of hanbit Unit 2. Stable state of nuclear power plant system has been confirmed according to Safety Injection and reactor trip event occurred during the ASTS test of hanbit Unit 2. In the result of system safety assessment, major variables of nuclear power plant are located in optimal range and not exceed safety limit. It remains nuclear fuel and the integrity of the power plant is in a safe condition were conformed. After ASTS action, thermal elimination has been processed throughout the turbine until turbine signal occurrence because ASTS is connected to M-G set in the present hanbit Unit 2. Therefore, Safety Injection signal has been actuated by rapid reduction of Steam Generator pressure. In this paper, it is concluded that consideration of equipment and setpoint is needed for that Safety Injection has been not occurred under the unnecessary situation. Stable state of nuclear power plant system has been confirmed for Safety Injection and reactor trip event occurred during the ASTS test of hanbit Unit 2. In the result of system safety assessment, major variables of nuclear power plant are located in optimal range and not exceed safety limit. It remains nuclear fuel and the integrity of the plant is in a safe condition were conformed. It is concluded that consideration of equipment and setpoint is needed for that Safety Injection has been not occurred under the unnecessary situation
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Parikh, Amay; Rizzo, John A; Canetta, Pietro; Forster, Catherine; Sise, Meghan; Maarouf, Omar; Singer, Eugenia; Elger, Antje; Elitok, Saban; Schmidt-Ott, Kai; Barasch, Jonathon; Nickolas, Thomas L
2017-01-01
Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone. A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated. For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp) in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients). Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs. Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.
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Directory of Open Access Journals (Sweden)
Amay Parikh
Full Text Available Urine neutrophil gelatinase-associated lipocalin (uNGAL is a sensitive and specific diagnostic test for acute kidney injury (AKI in the Emergency Department (ED, but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone.A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr. A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated.For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients. Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs.Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.
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International Nuclear Information System (INIS)
Koren, G.; Pastuszak, A.
1990-01-01
As part of a new approach to counselling pregnant women concerned about antenatal exposure to drugs, chemicals, or radiation, we measured their tendency to terminate their pregnancy by using a visual analogue scale (VAS). Analysis of 78 cases where women had less than 50% tendency to continue pregnancy before they were advised by us reveals that 61 decided to continue their pregnancy after the consultation (57 normal, healthy infants, four miscarriages) and 17 terminated. Women who continued their pregnancy significantly changed their tendency after we discussed relevant information with them (from 34.3 +/- 2.5% to 84.5 +/- 3.3%, P less than 0.00001), whereas most of those who eventually terminated pregnancy did not change their tendency to continue pregnancy beyond the 50% mark (from 24.8 +/- 5.4% to 45.1 +/- 9.8%) (P greater than 0.1). Only two of the women who terminated their pregnancy were exposed to teratogenic drugs; however, in most other cases, other obvious reasons, unrelated to the exposure in question, were identified by the women as leading reasons for termination. An appropriate intervention in early pregnancy can prevent unnecessary pregnancy terminations by correcting misinformation and thereby decreasing the unrealistically high perception of risk by women exposed to nonteratogens
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Inhibition of TRPM8 channels reduces pain in the cold pressor test in humans.
Winchester, Wendy J; Gore, Katrina; Glatt, Sophie; Petit, Wendy; Gardiner, Jennifer C; Conlon, Kelly; Postlethwaite, Michael; Saintot, Pierre-Philippe; Roberts, Sonia; Gosset, James R; Matsuura, Tomomi; Andrews, Mark D; Glossop, Paul A; Palmer, Michael J; Clear, Nicola; Collins, Susie; Beaumont, Kevin; Reynolds, David S
2014-11-01
The transient receptor potential (subfamily M, member 8; TRPM8) is a nonselective cation channel localized in primary sensory neurons, and is a candidate for cold thermosensing, mediation of cold pain, and bladder overactivity. Studies with TRPM8 knockout mice and selective TRPM8 channel blockers demonstrate a lack of cold sensitivity and reduced cold pain in various rodent models. Furthermore, TRPM8 blockers significantly lower body temperature. We have identified a moderately potent (IC50 = 103 nM), selective TRPM8 antagonist, PF-05105679 [(R)-3-[(1-(4-fluorophenyl)ethyl)(quinolin-3-ylcarbonyl)amino]methylbenzoic acid]. It demonstrated activity in vivo in the guinea pig bladder ice water and menthol challenge tests with an IC50 of 200 nM and reduced core body temperature in the rat (at concentrations >1219 nM). PF-05105679 was suitable for acute administration to humans and was evaluated for effects on core body temperature and experimentally induced cold pain, using the cold pressor test. Unbound plasma concentrations greater than the IC50 were achieved with 600- and 900-mg doses. The compound displayed a significant inhibition of pain in the cold pressor test, with efficacy equivalent to oxycodone (20 mg) at 1.5 hours postdose. No effect on core body temperature was observed. An unexpected adverse event (hot feeling) was reported, predominantly periorally, in 23 and 36% of volunteers (600- and 900-mg dose, respectively), which in two volunteers was nontolerable. In conclusion, this study supports a role for TRPM8 in acute cold pain signaling at doses that do not cause hypothermia. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics.
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Directory of Open Access Journals (Sweden)
Carlos Eduardo Leite Arieta
2004-02-01
Full Text Available O objetivo deste experimento clínico foi determinar a freqüência dos exames considerados dispensáveis numa rotina pré-operatória de facectomias e avaliar os gastos com eles. Se o paciente foi sorteado para testes-seletivos, solicitou-se que nenhum teste fosse executado, a menos que o paciente apresentasse um novo problema médico, ou piora de uma doença preexistente, a qual requeresse os testes independentemente da realização da cirurgia. Para pacientes sorteados para testes-rotineiros, foram solicitados: eletrocardiograma, dosagem de hemoglobina e glicemia de jejum. Foram calculados os gastos com exames considerados desnecessários. A amostra de 1.025 pacientes incluiu 513 sorteados para testes seletivos e 512 para testes rotineiros. A freqüência de eventos adversos intra-operatórios foi semelhante nos dois grupos (p = 0,923. O grupo de testes seletivos realizou de 60,7% menos exames que o de testes rotineiros. Os resultados sugerem que a requisição seletiva de exames pré-operatórios em facectomias, além de não prejudicar o paciente do ponto de vista de complicações clínicas intra-operatórias, possibilita expressiva economia de recursos quando comparada à atual rotina.The objective of this clinical trial was to determine the frequency of medical tests considered unnecessary in routine preoperative evaluation for cataract surgery. Unnecessary costs with these tests were also evaluated. For patients assigned to the selective testing group, it was requested that no preoperative testing be performed unless the patient presented a new or worsening medical problem warranting medical evaluation with testing. For patients assigned to the routine testing group, three tests were requested: a 12-lead electrocardiogram, complete blood count, and serum glucose level. The costs of tests considered unnecessary were calculated. The sample of 1,025 patients consisted of 512 assigned to the routine testing group and 513 to the selective
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Energy Technology Data Exchange (ETDEWEB)
Mediaas, Heidi; Grande, Knut; Hustad, Britt-Marie; Hoevik, Kim Reidar; Kummernes, Hege; Nergaard, Bjoern; Vindstad, Jens Emil
2006-03-15
Producing and refining high-TAN crude oils introduces a number of challenges, among which calcium naphthenate deposition in process facilities is the most serious production issue. Until recently, the only option for studying chemicals and process parameters in order to prevent naphthenate deposition has been field tests. Statoil has now developed a small scale pilot plant where these experiments can be performed in the laboratory at Statoil's Research and Technology Center in Trondheim, Norway. The results from the pilot plant are in full agreement with the extensive naphthenate experience obtained from almost 9 years operation of the Heidrun oilfield. The design and operational procedures for this test facility are based on the recent discovery by Statoil and ConocoPhillips of the ARN acid. The ARN acid is a prerequisite for calcium naphthenate deposition. The new continuous flow pilot plant, the Naphthenate Rig, is used to develop new environmental friendly naphthenate inhibitors and to optimize process operating conditions. Since it operates on real crudes the need for field tests in qualifying new naphthenate inhibitors is reduced. To the best of our knowledge, the rig is the first of its kind in the world. (Author)
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LENUS (Irish Health Repository)
O'Connor, D B
2012-02-01
BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.
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Reducing Test Anxiety among 12th Grade Students: Iraqi Kurdistan Region/Soran City as an Example
Faqe, Chiayee Khorshid; Moheddin, Kurdistan Rafiq; Kakamad, Karwan Kakabra
2016-01-01
This study aims at reducing test anxiety among twelfth grade students at Soran city high schools. Throughout the study both quantitative and qualitative methods used to collect data. The participants were 450 twelfth grade students in five schools at Soran City-Kurdistan region of Iraq. Non-random purposive sampling because the students needed…
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Will fewer tests improve healthcare or profits?
Directory of Open Access Journals (Sweden)
Robbins RA
2012-04-01
Full Text Available No abstract available. Article truncated at 150 words. Earlier this month, the American Board of Internal Medicine (ABIM Foundation, in partnership with Consumer Reports, announced an educational initiative called Choosing Wisely (1. Nine medical organizations were asked to name five things physicians and patients should question. The initiative lists specific, evidence-based recommendations physicians and patients should discuss to make wise decisions on their individual situation. The list of tests and procedures Choosing Wisely advises against include common procedures and treatments such as EKGs done routinely during a physical examination, routine MRI’s for back pain, antibiotics for mild sinusitis, and routine EKG and chest X-rays preoperatively. Some experts estimate that up to one-third of the $2 trillion of annual health care costs in the United States each year is spent on unnecessary hospitalizations and tests, unproven treatments, ineffective new drugs and medical devices, and futile care at the end of life (2. We at the Southwest Journal of Pulmonary …
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Optimum value engineering and integrated design methods for reducing the cost of R-2000 houses
Energy Technology Data Exchange (ETDEWEB)
Proskiw, G. [Proskiw Engineering Ltd., Winnipeg, MB (Canada); Parekh, A. [Natural Resources Canada, Ottawa, ON (Canada)
2009-07-01
Opportunities exist to reduce the incremental cost of R-2000 construction by using optimum value engineering (OVE) and integrated design (ID) techniques. OVE is a construction philosophy in which components and systems are designed to meet their intended purposes without excessive or unnecessary use of resources. This paper summarized a study that was designed to identify opportunities for reducing the costs of R-2000 houses while improving their performance. These included detailed energy and cost analysis of various OVE/ID options which were then applied to a sample of 18 representative new home designs from British Columbia, Manitoba, and New Brunswick. The paper described the OVE/ID measures studied, cost analysis, measure utilization and energy analysis. It also included a detailed discussion of individual OVE/ID measures. Examples of some of these measures were the elimination of floor system cross-bridging; support of non-load bearing partition walls; engineered wood beams; drywall clips at corners; and non-load bearing partition walls. It was concluded that significant opportunities exist to reduce the incremental cost of R-2000 houses through careful application of OVE and ID practices. 5 refs., 4 tabs., 1 fig.
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The U.S. reduced enrichment research and test reactor (RERTR) program
International Nuclear Information System (INIS)
Travelli, A.
1993-01-01
Research and test reactors are widely deployed to study the irradiation behavior of materials of interest in nuclear engineering, to produce radioisotopes for medicine, industry, and agriculture, and as a basic research and teaching tool. In order to maximize neutron flux per unit power and/or to minimize capital costs and fuel cycle costs, most of these reactors were de- signed to utilize uranium with very high enrichment (in the 70% to 95% range). Research reactor fuels with such high uranium enrichment cause a potential risk of nuclear weapons proliferation. Over 140 research and test reactors of significant power (between 10 kW and 250 MW) are in operation with very highly enriched uranium in more than 35 countries, with total power in excess of 1,700 MW. The overall annual fuel requirement of these reactors corresponds to approximately 1,200 kg of 235 U. This highly strategic material is normally exported from the United States, converted to metal form, shipped to a fuel fabricator, and then shipped to the reactor site in finished fuel element form. At the reactor site the fuel is first stored, then irradiated, stored again, and eventually shipped back to the United States for reprocessing. The whole cycle takes approximately four years to complete, bringing the total required fuel inventory to approximately 5,000 kg of 235 U. The resulting international trade in highly-enriched uranium may involve several countries in the process of refueling a single reactor and creates a considerable concern that the highly-enriched uranium may be diverted for non-peaceful purposes while in fabrication, transport, or storage, particularly when it is in the unirradiated form. The proliferation resistance of nuclear fuels used in research and test reactors can be considerably improved by reducing their uranium enrichment to a value less than 20%, but significantly greater than natural to avoid excessive plutonium production
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Atar Herziger; Amel Benzerga; Jana Berkessel; Niken L. Dinartika; Matija Franklin; Kamilla K. Steinnes; Felicia Sundström
2017-01-01
Excessive consumption is on the rise, as is apparent in growing financial debt and global greenhouse gas emissions. Voluntary simplicity, a lifestyle choice of reduced consumption and sustainable consumer behavior, provides a potential solution for excessive consumers. However, voluntary simplicity is unpopular, difficult to adopt, and under researched. The outlined research project will test a method of promoting voluntary simplicity via user-generated content, thus mimicking an existing soc...
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Capovilla, G; Salvador, R; Spadotto, L; Voltarel, G; Pesenti, E; Perazzolo, A; Nicoletti, L; Merigliano, S; Costantini, M
2017-10-01
Wireless pH monitoring of the esophagus has been widely used to detect GERD for more than a decade. It is generally well tolerated and accepted by patients, but it is still unclear whether prolonging a recording beyond the usual 48 hours can improve the test's diagnostic value. The aim of this study is to examine the diagnostic yield of 96-hour pH monitoring vis-à-vis 24- and 48-hour tests, and to ascertain whether any gain in diagnostic terms was of genuine clinical utility. Patients with suspected GERD underwent 4-day PPI-off wireless pH monitoring of the distal esophagus. The capsule was inserted under endoscopic control, 6 cm above the squamocolumnar junction. Average acid exposure time was calculated after 24, 48, and 96 hours of recording. Ninety-nine patients completed the 96 hour test, and formed the study sample. The wireless test method was used in 42 patients (42.4%) unable to tolerate the traditional pH-monitoring catheter, and in 57 (57.6%) with a previous negative pH study despite symptoms suggestive of GERD. On complete analysis, 47 patients (47.5%) had a pathological test result: 19 patients within the first 24 hours (19.2%, 24 hour group); another 16 after 48 hours (+16.2%, 48 hour group), and a further 12 (+12.1%, 96 hour group) only after 96 hours of monitoring. All 47 patients with an abnormal acid exposure were offered and accepted surgery (10 patients) or medical therapy (37 patients). Clinical follow-up was obtained in all patients with a positive Bravo test result after a median 67 months (IQR: 38-98) using a validated symptom questionnaire. A good outcome after fundoplication or medical therapy was achieved in 73.7% of patients in the 24 hour group, in 62.5% of those in the 48 hour group, and in only 25% of those in the 96 hour group, P = 0.02. Long-term wireless pH monitoring enables an increase in the diagnostic yield over traditional 24- and 48-hour pH studies, but prolonging the test may constitute an unwanted bias and prompt the
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Assessment of preoperative exams request in a teaching hospital
Directory of Open Access Journals (Sweden)
Eduardo Toshiyuki Moro
2014-04-01
Background: preoperative exams aim to identify disorders that may compromise the patient´s perioperative care. However, unnecessary tests rarely change the outcome, and are expensive to institution. The aim of this study was to evaluate the preoperative tests ordered in Santa Lucinda hospital, Sorocaba - SP. Methods: after approval by the Ethics Committee of PUC-SP University, we assessed pre-anesthetic evaluation of patients undergoing elective surgery from march to August, 2011. We recorded: age, sex, ASA physical status, the presence of coexisting diseases, medication use, type of surgery and preoperative tests. They were classified as sufficient, sufficient with unnecessary tests, insufficient, or insufficient with unnecessary tests. Results: two hundred and nineteen records were evaluated, of which 52% were considered sufficient, but with unnecessary tests. For 24% of patients, the tests were insufficient, with some ordered unnecessarily. To 8% of patients, the tests were insufficient, and only 16% didn´t have insufficient and unnecessary tests. The most frequently ordered tests were hematocrit and hemoglobin. The exams most unnecessarily ordered were coagulation tests and dosage of serum urea. Among the necessary examinations, but unsolicited, there were ECG (27%, electrolytes (13% and creatinine (11%. Seventy-nine tests showed some kind of problem, but they didn´t change in behavior. Conclusions: preoperative tests unnecessarily ordered are frequent, which do not guarantee that some patients present to surgery without fundamental exams according to their risk group.
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Improving access to new diagnostics through harmonised regulation: priorities for action
Directory of Open Access Journals (Sweden)
Ruth McNerney
2014-04-01
Full Text Available A new generation of diagnostic tests is being developed for use at the point of care that could save lives and reduce the spread of infectious diseases through early detection and treatment. It is important that patients in developing countries have access to these products at affordable prices and without delay. Regulation of medical products is intended to ensure safety and quality whilst balancing the need for timely access to beneficial new products. Current regulatory oversight of diagnostic tests in developing countries is highly variable and weak regulation allows poor-quality tests to enter the market. However, inefficient orover zealous regulation results in unnecessary delays, increases costs and acts as a barrier to innovation and market entry. Setting international standards and streamlining the regulatory process could reduce these barriers. Four priority activities have been identified where convergence of standards and protocols or joint review of data would be advantageous: (1 adoption of a common registration file for pre-market approval; (2 convergence of quality standards for manufacturing site inspections; (3 use of common evaluation protocols, aswell as joint review of data, to reduce unnecessary duplication of lengthy and costly clinical performance studies; and (4 use of networks of laboratories for post-market surveillance in order to monitor ongoing quality of diagnostic devices. The adoption and implementation of such measures in developing countries could accelerate access to new diagnostic tests that are safe and affordable.
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Improving access to new diagnostics through harmonised regulation: priorities for action.
McNerney, Ruth; Sollis, Kimberly; Peeling, Rosanna W
2014-01-01
A new generation of diagnostic tests is being developed for use at the point of care that could save lives and reduce the spread of infectious diseases through early detection and treatment. It is important that patients in developing countries have access to these products at affordable prices and without delay. Regulation of medical products is intended to ensure safety and quality whilst balancing the need for timely access to beneficial new products. Current regulatory oversight of diagnostic tests in developing countries is highly variable and weak regulation allows poor-quality tests to enter the market. However, inefficient or overzealous regulation results in unnecessary delays, increases costs and acts as a barrier to innovation and market entry. Setting international standards and streamlining the regulatory process could reduce these barriers. Four priority activities have been identified where convergence of standards and protocols or joint review of data would be advantageous: (1) adoption of a common registration file for pre-market approval; (2) convergence of quality standards for manufacturing site inspections; (3) use of common evaluation protocols, as well as joint review of data, to reduce unnecessary duplication of lengthy and costly clinical performance studies; and (4) use of networks of laboratories for post-market surveillance in order to monitor ongoing quality of diagnostic devices. The adoption and implementation of such measures in developing countries could accelerate access to new diagnostic tests that are safe and affordable.
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Testing of Baker Flo-XS Pipeline Drag-Reducing Additive. Compilation of Tests and Results
National Research Council Canada - National Science Library
Guiliano, John
2000-01-01
... 0.8 ppm for errors in injection). Through a CRADA with Buckeye Pipeline Inc, thermal stability testing of the additive was completed. Additionally, low temperature testing, additive/additive compatibility testing and specification testing of additized fuel was also completed. Material compatibility testing was also taken into consideration.
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Progress of the RERTR [Reduced Enrichment Research and Test Reactor] Program in 1989
International Nuclear Information System (INIS)
Travelli, A.
1989-01-01
The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1988, the major events, findings, and activities of 1989 are reviewed. The scope of the RERTR Program activities was curtailed, in 1989, by an unexpected legislative restriction which limited the ability of the Arms Control and Disarmament Agency to adequately fund the program. Nevertheless, the thrust of the major planned program activities was maintained, and meaningful results were obtained in several areas of great significance for future work. 15 refs., 12 figs
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International Nuclear Information System (INIS)
Pustejovska, P.; Silvie, B.
2013-01-01
The paper analyses details for renewal of the research in blast furnace process within Research Centre ENET at VSB - Technical University of Ostrava. A newly established laboratory for reducibility testing is an impuls to overcome the former limits and renew a research in its coherence after years. The paper deals with the possibilities of optimization of blast furnace operation. In the introduction, it sums up different approaches how to model blast furnace operation. It discusses the variety of optimal operation for different kinds of iron making technologies. It evaluates reduction course and reducing gas consumption in the stack of reduction aggregate. In the experimental, it creates kinetics model of blast furnace operating using Matlab mathematical library. It determines kinetic and heat limits of carbon consumption for different process conditions. (author)
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Intelligent Test Mechanism Design of Worn Big Gear
Directory of Open Access Journals (Sweden)
Hong-Yu LIU
2014-10-01
Full Text Available With the continuous development of national economy, big gear was widely applied in metallurgy and mine domains. So, big gear plays an important role in above domains. In practical production, big gear abrasion and breach take place often. It affects normal production and causes unnecessary economic loss. A kind of intelligent test method was put forward on worn big gear mainly aimed at the big gear restriction conditions of high production cost, long production cycle and high- intensity artificial repair welding work. The measure equations transformations were made on involute straight gear. Original polar coordinate equations were transformed into rectangular coordinate equations. Big gear abrasion measure principle was introduced. Detection principle diagram was given. Detection route realization method was introduced. OADM12 laser sensor was selected. Detection on big gear abrasion area was realized by detection mechanism. Tested data of unworn gear and worn gear were led in designed calculation program written by Visual Basic language. Big gear abrasion quantity can be obtained. It provides a feasible method for intelligent test and intelligent repair welding on worn big gear.
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Nortunen, Simo; Leskelä, Hannu-Ville; Haapasalo, Heidi; Flinkkilä, Tapio; Ohtonen, Pasi; Pakarinen, Harri
2017-03-15
This study aimed to identify factors from standard radiographs that contributed to the stability of the ankle mortise in patients with isolated supination-external rotation fractures of the lateral malleolus (OTA/AO 44-B). Non-stress radiographs of the mortise and lateral views, without medial clear space widening or incongruity, were prospectively collected for 286 consecutive patients (mean age, 45 years [range, 16 to 85 years]), including 144 female patients (mean age, 50 years [range, 17 to 85 years]) and 142 male patients (mean age, 40 years [range, 16 to 84 years]) from 2 trauma centers. The radiographs were analyzed for fracture morphology by 2 orthopaedic surgeons, who were blinded to each other's measurements and to the results of external rotation stress radiographs (the reference for stability). Factors significantly associated with ankle mortise stability were tested in multiple logistic regression. Receiver operating characteristic analyses were performed for continuous variables to determine optimal thresholds. A sensitivity of >90% was used as the criterion for an optimal threshold. According to external rotation stress radiographs, 217 patients (75.9%) had a stable injury, defined as that with a medial clear space of ankle mortise were female sex (odds ratio [OR], 2.5 [95% confidence interval (CI), 1.4 to 4.6]), a posterior diastasis of fracture fragments (OR, 7.3 [95% CI, 2.1 to 26.3]). When the posterior diastasis was fracture fragments were present, the probability of a stable ankle mortise was 0.98 for 48 female patients (16.8%) and 0.94 for 37 male patients (12.9%). Patients with noncomminuted lateral malleolar fractures (85 patients [29.7%]) could be diagnosed with a stable ankle mortise without further stress testing, when the fracture line widths were <2 mm on lateral radiographs. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Eklund, Martin; Nordström, Tobias; Aly, Markus; Adolfsson, Jan; Wiklund, Peter; Brandberg, Yvonne; Thompson, James; Wiklund, Fredrik; Lindberg, Johan; Presti, Joseph C; StLezin, Mark; Clements, Mark; Egevad, Lars; Grönberg, Henrik
2016-11-23
Prostate cancer screening is associated with low specificity, unnecessary biopsies, and overdiagnosis. We have previously shown that the Stockholm-3 model (S3M) can reduce biopsies compared with using prostate-specific antigen (PSA) ≥3ng/ml as an indication for biopsy. Urologists in today's current prostate cancer testing (CPT) have access to numerous variables in addition to PSA (eg, age, ethnicity, family history, free PSA, PSA velocity, digital rectal examination, and prostate volume) to support biopsy decisions. We estimated the number of prostate cancers diagnosed and prostate biopsies performed if S3M replaced CPT in Stockholm, Sweden, by comparing biopsy results in 56 282 men who underwent PSA testing according to CPT in Stockholm in 2011 with the 47 688 men enrolled in the STHLM3 validation cohort 2012-2015. With the same sensitivity as CPT to diagnose Gleason score ≥7 prostate cancer, S3M was estimated to reduce the number of men biopsied by 53% (95% confidence interval [CI]: 41-65%), avoid 76% (95% CI: 67-81%) of negative biopsies, and reduce Gleason score 6 cancers by 23% (95% CI: 6-40%). S3M has the potential to improve prostate cancer diagnostics by better selecting men with high risk of GS ≥7 prostate cancer. We modeled the effect the Stockholm-3 model would have on prostate cancer diagnostics if it replaced current clinical practice. We found that Stockholm-3 model may substantially reduce the number of biopsies, while maintaining the same sensitivity to diagnose clinically significant prostate cancer. Copyright © 2016. Published by Elsevier B.V.
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Duh, Helen Inseng; Grubliauskiene, Aiste; Dewitte, Siegfried
2016-01-01
It has been suggested that the consumption of unhealthy Westernized diet in a context of poverty and resultant food insecurity may have contributed to South-Africa's status of the third fattest country in the World. Considering that a number of South-Africans are reported to have experienced, or are still experiencing food insecurity, procedures which have been shown to reduce the consumption of unhealthy food in higher income countries may be ineffective in South-Africa. We thus tested the robustness of the so called pre-exposure procedure in South-Africa. We also tested the moderating role of childhood poverty in the pre-exposure procedure. With the pre-exposure procedure, a respondent is exposed to a tempting unhealthy food (e.g. candy) in a context that is designed such that eating the food interferes with a task goal. The typical result is that this procedure spills over and reduces consumption of similar tempting food later on. An experimental study conducted in a South-African laboratory showed that the pre-exposure effect is robust even with a sample, where food insecurity prevails. Childhood poverty did not moderate the effect. This study proves that behavioral procedures aimed at reducing the consumption of unhealthy food would be valuable in less rich non-Western countries. Further testing of the robustness of the pre-exposure effect is however recommended in other poorer food insecure countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Shen, Lujun; Yang, Lei; Zhang, Jing; Zhang, Meng
2018-01-01
To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students. The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants' writing manuscripts. Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05). Students' writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days' manuscripts and the last 10 days' ones. Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.
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Directory of Open Access Journals (Sweden)
Lujun Shen
Full Text Available To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students.The Test Anxiety Scale (TAS was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants' writing manuscripts.Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05. Students' writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days' manuscripts and the last 10 days' ones.Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.
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Zhang, Jing; Zhang, Meng
2018-01-01
Purpose To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students. Methods The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants’ writing manuscripts. Results Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P 0.05). Students’ writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days’ manuscripts and the last 10 days’ ones. Conclusions Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study. PMID:29401473
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Directory of Open Access Journals (Sweden)
Arash Vaziri
2009-09-01
Conclusion Prescribing errors remain a major source of unnecessary morbidity and mortality and current systems do not appear to have significantly reduced this problem; nor has the extensive literature about how to reduce unnecessary alerts been taken into account. We need a new and more rational basis for the selection and presentation of alerts that would help, not hinder, the clinician's performance.
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Directory of Open Access Journals (Sweden)
Peiman Eini
2012-04-01
Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.
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Adaptive and robust active vibration control methodology and tests
Landau, Ioan Doré; Castellanos-Silva, Abraham; Constantinescu, Aurelian
2017-01-01
This book approaches the design of active vibration control systems from the perspective of today’s ideas of computer control. It formulates the various design problems encountered in the active management of vibration as control problems and searches for the most appropriate tools to solve them. The experimental validation of the solutions proposed on relevant tests benches is also addressed. To promote the widespread acceptance of these techniques, the presentation eliminates unnecessary theoretical developments (which can be found elsewhere) and focuses on algorithms and their use. The solutions proposed cannot be fully understood and creatively exploited without a clear understanding of the basic concepts and methods, so these are considered in depth. The focus is on enhancing motivations, algorithm presentation and experimental evaluation. MATLAB®routines, Simulink® diagrams and bench-test data are available for download and encourage easy assimilation of the experimental and exemplary material. Thre...
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Immunostimulation asa method limiting unnecessary antibiotic therapy
Directory of Open Access Journals (Sweden)
Agnieszka Szczukocka-Zych
2015-12-01
Full Text Available Recurring respiratory tract infections are typical of childhood. This results from the fact that children are exposed to pathogens, usually in groups of people, and from the immaturity of the immune system. Most upper and lower respiratory tract infections are caused by viruses. Nevertheless, antibiotics, which target bacteria, are often prescribed. Antibiotic overuse leads to increased microbial resistance to these drugs, resulting in their inefficacy. Improper treatment of respiratory infections with antibiotics ultimately leads to treatment failure. An increase in antibiotic resistance of many bacterial strains is becoming a serious global problem and makes treatment much more difficult. It is a responsibility of each physician to use antibiotics properly and implement adequate prevention of recurring respiratory tract infections. For many years, it has been attempted to find effective agents that improve immunity in children. The pharmaceutical market offers various preparations advertised as immunostimulants, such as bacterial lysates, vitamins, dietary supplements, probiotics or herbal, animal and homeopathic products. The role of immunomodulatory substances is to promote the immune system to fight pathogens, reduce the frequency of infections and decrease the demand for antibiotics. Unfortunately, most immunomodulators do not have sufficiently reliable clinical trials that would confirm their efficacy.
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Directory of Open Access Journals (Sweden)
Glenn P. Morlock
2017-01-01
Full Text Available The primary platform used for pyrazinamide (PZA susceptibility testing of Mycobacterium tuberculosis is the MGIT culture system (Becton Dickinson. Since false-resistant results have been associated with the use of this system, we conducted a multicenter evaluation to determine the effect of using a reduced cell density inoculum on the rate of false resistance. Two reduced inoculum densities were compared with that prescribed by the manufacturer (designated as “BD” method. The reduced inoculum methods (designated as “A” and “C” were identical to the manufacturer’s protocol in all aspects with the exception of the cell density of the inoculum. Twenty genetically and phenotypically characterized M. tuberculosis isolates were tested in duplicate by ten independent laboratories using the three inoculum methods. False-resistant results declined from 21.1% using the standard “BD” method to 5.7% using the intermediate (“A” inoculum and further declined to 2.8% using the most dilute (“C” inoculum method. The percentages of the resistant results that were false-resistant declined from 55.2% for the “BD” test to 28.8% and 16.0% for the “A” and “C” tests, respectively. These results represent compelling evidence that the occurrence of false-resistant MGIT PZA susceptibility test results can be mitigated through the use of reduced inoculum densities.
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John-Baptiste, A; Sowerby, L J; Chin, C J; Martin, J; Rotenberg, B W
2016-01-01
When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.
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Dalrymple, Annette; Ordoñez, Patricia; Thorne, David; Walker, David; Camacho, Oscar M; Büttner, Ansgar; Dillon, Debbie; Meredith, Clive
2016-06-01
Many laboratories are working to develop in vitro models that will replace in vivo tests, but occasionally there remains a regulatory expectation of some in vivo testing. Historically, cigarettes have been tested in vivo for 90 days. Recently, methods to reduce and refine animal use have been explored. This study investigated the potential of reducing animal cigarette smoke (CS) exposure to 3 or 6 weeks, and the feasibility of separate lung lobes for histopathology or the Comet assay. Rats were exposed to sham air or CS (1 or 2 h) for 3 or 6 weeks. Respiratory tissues were processed for histopathological evaluation, and Alveolar type II cells (AEC II) isolated for the Comet assay. Blood was collected for Pig-a and micronucleus quantification. Histopathological analyses demonstrated exposure effects, which were generally dependent on CS dose (1 or 2 h, 5 days/week). Comet analysis identified that DNA damage increased in AEC II following 3 or 6 weeks CS exposure, and the level at 6 weeks was higher than 3 weeks. Pig-a mutation or micronucleus levels were not increased. In conclusion, this study showed that 3 weeks of CS exposure was sufficient to observe respiratory tract pathology and DNA damage in isolated AEC II. Differences between the 3 and 6 week data imply that DNA damage in the lung is cumulative. Reducing exposure time, plus analyzing separate lung lobes for DNA damage or histopathology, supports a strategy to reduce and refine animal use in tobacco product testing and is aligned to the 3Rs (replacement, reduction and refinement).
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Lean engineering for planning systems redesign - staff participation by simulation
van der Zee, D.J.; Pool, A.; Wijngaard, J.; Mason, S.J.; Hill, R.R.; Moench, L.; Rose, O.
2008-01-01
Lean manufacturing aims at flexible and efficient manufacturing systems by reducing waste in all forms, such as, production of defective parts, excess inventory, unnecessary processing steps, and unnecessary movements of people or materials. Recent research stresses the need to include planning
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Directory of Open Access Journals (Sweden)
E. A. Bondar
2010-06-01
Full Text Available It is shown that at present an acceptable way of reducing the concentration of harmful substances in the surface layer of the atmosphere at rheostat tests of locomotives is their dispersion in a large volume of air. Channels, installed above an exhaust pipe of diesel locomotive with a break at the gas flow, work as ejectors. We have solved jointly the equation of aerodynamic characteristics of the ejector device and the equation of diffusion of gases; as a result the calculated dependence for determining the necessary height of ejector device has been obtained.
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Using a Bedside Video-assisted Test Tube Test to Assess Stoma Viability: A Report of 4 Cases.
Ahmad, Sarwat; Turner, Keli; Shah, Paulesh; Diaz, Jose
2016-07-01
Mucosal discoloration of an intestinal stoma may indicate self-limited venous congestion or necrosis necessitating operative revision. A common bedside technique to assess stoma viability is the "test tube test". A clear tube is inserted into the stoma and a hand-held light is used to assess the color of the stoma. A technique (video-assisted test tube test [VATTT]) developed by the authors utilizes a standard video bronchoscope inserted into a clear plastic blood collection tube to visually inspect and assess the mucosa. This technique was evaluated in 4 patients (age range 49-72 years, all critically ill) with a discolored stoma after emergency surgery. In each case, physical exam revealed ischemic mucosa at the surface either immediately after surgery or after worsening hypotension weeks later. Serial test tube test assessments were ambiguous when trying to assess deeper mucosa. The VATTT assessment showed viable pink mucosa beneath the surface and until the fascia was revealed in 3 patients. One (1) patient had mucosal ischemia down to the fascia, which prompted operative revision of the stoma. The new stoma was assessed with a VATTT and was viable for the entire length of the stoma. VATTT provided an enhanced, magnified, and clearer way to visually assess stoma viability in the postoperative period that can be performed at the bedside with no adverse events. It may prevent unnecessary relaparotomy or enable earlier diagnosis of deep ostomy necrosis. Validity and reliability studies are warranted.
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International Nuclear Information System (INIS)
Lean, Hooi Hooi; Smyth, Russell
2010-01-01
This paper employs annual data from 1971 to 2006 to examine the causal relationship between aggregate output, electricity consumption, exports, labor and capital in a multivariate model for Malaysia. We find that there is bidirectional Granger causality running between aggregate output and electricity consumption. The policy implication of this result is that Malaysia should adopt the dual strategy of increasing investment in electricity infrastructure and stepping up electricity conservation policies to reduce unnecessary wastage of electricity, in order to avoid the negative effect of reducing electricity consumption on aggregate output. We also find support for the export-led hypothesis which states Granger causality runs from exports to aggregate output. This result is consistent with Malaysia pursuing a successful export-orientated strategy. (author)
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International Nuclear Information System (INIS)
Day, S D; Wong, F G; Gordon, S R; Wong, L L; Rebak, R B
2006-01-01
Alloy 22 (N06022) is the material selected for the fabrication of the outer shell of the nuclear waste containers for the Yucca Mountain high-level nuclear waste repository site. A key technical issue in the waste package program has been the integrity of the container weld joints. The currently selected welding process for fabricating and sealing the containers is the traditional gas tungsten arc welding (GTAW) or TIG method. An appealing faster alternative technique is reduced pressure electron beam (RPEB) welding. It was of interest to compare the corrosion properties of specimens prepared using both types of welding techniques. Standard electrochemical tests were carried on GTAW and RPEB welds as well as on base metal (non-welded) to determine their relative corrosion behavior in simulated concentrated water (SCW) at 90 C (alkaline), 1 M HCl at 60 C (acidic) and 1 M NaCl at 90 C (neutral) solutions. Results show that for all practical purposes, the three tested materials had the same electrochemical behavior in the three tested electrolytes
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International Nuclear Information System (INIS)
S. Daniel Day; Frank M.G. Wong; Steven R. Gordon; Lana L. Wong; Raul B. Rebak
2006-01-01
Alloy 22 (N06022) is the material selected for the fabrication of the outer shell of the nuclear waste containers for the Yucca Mountain high-level nuclear waste repository site. A key technical issue in the waste package program has been the integrity of the container weld joints. The currently selected welding process for fabricating and sealing the containers is the traditional gas tungsten arc welding (GTAW) or TIC method. An appealing faster alternative technique is reduced pressure electron beam (RPEB) welding. It was of interest to compare the corrosion properties of specimens prepared using both types of welding techniques. Standard electrochemical tests were carried on GTAW and RPEB welds as well as on base metal (non-welded) to determine their relative corrosion behavior in simulated concentrated water (SCW) at 90 C (alkaline), 1 M HCI at 60 C (acidic) and 1 M NaCl at 90 C (neutral) solutions. Results show that for all practical purposes, the three tested materials had the same electrochemical behavior in the three tested electrolytes
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2010-02-24
... hardware and software features should manufacturers build into CT and fluoroscopic devices in order to... ALARA concept (maintaining dose As Low As Reasonably Achievable) and utilize or provide for...
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Festini, Sara B.; Reuter-Lorenz, Patricia A.
2017-01-01
Directed forgetting tasks instruct people to forget targeted memoranda. In the context of working memory, people attempt to forget representations that are currently held in mind. Here, we evaluated candidate mechanisms of directed forgetting within working memory, by (a) testing the influence of articulatory suppression, a rehearsal-reducing and…
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Directory of Open Access Journals (Sweden)
Bethany Shinkins
Full Text Available To evaluate the diagnostic accuracy of a single CEA (carcinoembryonic antigen blood test in detecting colorectal cancer recurrence.Patients who have undergone curative resection for primary colorectal cancer are typically followed up with scheduled CEA testing for 5 years. Decisions to investigate further (usually by CT imaging are based on single test results, reflecting international guidelines.A secondary analysis was undertaken of data from the FACS trial (two arms included CEA testing. The composite reference standard applied included CT-CAP imaging, clinical assessment and colonoscopy. Accuracy in detecting recurrence was evaluated in terms of sensitivity, specificity, likelihood ratios, predictive values, time-dependent area under the ROC curves, and operational performance when used prospectively in clinical practice are reported.Of 582 patients, 104 (17.9% developed recurrence during the 5 year follow-up period. Applying the recommended threshold of 5μg/L achieves at best 50.0% sensitivity (95% CI: 40.1-59.9%; in prospective use in clinical practice it would lead to 56 missed recurrences (53.8%; 95% CI: 44.2-64.4% and 89 false alarms (56.7% of 157 patients referred for investigation. Applying a lower threshold of 2.5μg/L would reduce the number of missed recurrences to 36.5% (95% CI: 26.5-46.5% but would increase the false alarms to 84.2% (924/1097 referred. Some patients are more prone to false alarms than others-at the 5μg/L threshold, the 89 episodes of unnecessary investigation were clustered in 29 individuals.Our results demonstrated very low sensitivity for CEA, bringing to question whether it could ever be used as an independent triage test. It is not feasible to improve the diagnostic performance of a single test result by reducing the recommended action threshold because of the workload and false alarms generated. Current national and international guidelines merit re-evaluation and options to improve performance, such as
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Design of Hydraulic Bushing and Vehicle Testing for Reducing the Judder Vibration
Directory of Open Access Journals (Sweden)
Kim Youngman
2018-01-01
Full Text Available Generally, judder vibration is a low-frequency vibration phenomenon caused by a braking force imbalance that occurs when a vehicle is lightly decelerated within a range of 0.1 to 0.2g at a speed of 120 to 60 km/h. This comes from the change in the brake disk thickness (DTV, which is mainly caused by the side run-out (SRO and thermal deformation. The adoption of hydro-bushing in the low arm G bushings of the vehicle front suspension has been done in order to provide great damping in a particular frequency range (<20Hz in order to prevent this judder vibration from being transmitted to the body. The hydro bushing was formulated using a lumped parameter model. The fluid passage between the two chambers was modelled as a nonlinear element such as an orifice, and its important parameters (resistance, compliance were measured using a simplified experimental setup. The main design parameters are the ratio of the cross-sectional area of the chamber to the fluid passage, the length of the fluid passage, etc., and their optimal design is such that the loss angle is greater than 45 ° in the target frequency range of 10 to 20 Hz. The hydro bushing designed for reducing the judder vibration was prepared for the actual vehicle application test and applied to the actual vehicle test. In this study, the proposed hydro bushing was applied to the G bushing of the low arm of the front suspension system of the vehicle. The loss angle of the manufactured hydro bushing was measured using acceleration signals before and after passing through the bushing. The actual vehicle test was performed on the noise dynamometer for the performance analysis of the judder vibration reduction.
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Sodhi, Kushaljit S; Krishna, Satheesh; Saxena, Akshay K; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y
2015-09-01
Practice of ALARA (as low as reasonably achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be protected from harmful radiation exposure if 'Justification' and 'Optimization' principles of ALARA are applied before obtaining CT imaging in a developing country. This can save children from potential radiation risks including development of brain cancer and leukemia. Consecutive CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children's hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, 'Justification' of CT was evaluated and then 'Optimization' was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies avoided by applying 'Justification' and 'Optimization' principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. A total of 1302 consecutive CT request forms were received during the study period. Some of the request forms (n=86; 6.61%) had requests for more than one (multiple) anatomical regions, hence, a total of 1392 different anatomical CT requests were received. Based on evaluation of the CT request forms for 'Justification' and 'Optimization' principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were protected from unnecessary or additional radiation exposure.The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient
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International Nuclear Information System (INIS)
1983-08-01
Separate abstracts were prepared for each of the papers presented in the following areas: (1) Reduced Enrichment Fuels for Research and Test Reactors (RERTR) Program Status; (2) Fuel Development; (3) Fuel Demonstrations; (4) General Topics; and (5) Specific Reactor Applications
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Risky Business: Reducing Moral Hazard in Airlift Operations
2015-01-01
compared to USAF standards.43 McCarty was con- cerned about airlift transporting unnecessary items like champagne and ice that would normally move by...ice and champagne to Dien Bien Phu.44 Further con- firmation exists in the fact that upon his promotion to brigadier general, de Castries’ new rank...and congratulatory bottle of champagne were airdropped to him but fell instead into Viet Minh hands.45 Certainly not all airlifts into Dien Bien Phu
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Directory of Open Access Journals (Sweden)
Susan Robinson
2015-06-01
Full Text Available Over the past couple of decades, Australian police organisations have sought to increase the numbers of women in sworn policing roles by strictly adhering to equal treatment of men and women in the recruitment process. Unfortunately this blind adherence to equal treatment in the recruitment processes may inadvertently disadvantage and limit women. In particular, the emphasis on masculine attributes in recruitment, as opposed to the ‘soft’ attributes of communication and conflict resolution skills, and the setting of the minimum pass standards according to average male performance, disproportionately disadvantages women and serves to unnecessarily limit the number of women in policing. This paper reviews studies undertaken by physiotherapists and a range of occupational experts to discuss the relevance of physical fitness and agility tests and the pass standards that are applied to these in policing. It is suggested that masculinised recruitment tests that pose an unnecessary barrier to women cannot be justified unless directly linked to the job that is to be undertaken. Utilising a policy development and review model, an analysis of the problem posed by physical testing that is unadjusted for gender, is applied. As a result, it is recommended that police organisations objectively review recruitment processes and requirements to identify and eliminate unnecessary barriers to women’s entry to policing. It is also recommended that where fitness and agility tests are deemed essential to the job, the pass level is adjusted for gender.
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DEFF Research Database (Denmark)
Hjortø, Line; Ettema, Jehan Frans; Kargo, Morten
2015-01-01
Until now, genomic information has mainly been used to improve the accuracy of genomic breeding values for breeding animals at a population level. However, we hypothesize that the use of information from genotyped females also opens up the possibility of reducing genetic lag in a dairy herd......, especially if genomic tests are used in combination with sexed semen or a high management level for reproductive performance, because both factors provide the opportunity for generating a reproductive surplus in the herd. In this study, sexed semen is used in combination with beef semen to produce high......-value crossbred beef calves. Thus, on average there is no surplus of and selection among replacement heifers whether to go into the herd or to be sold. In this situation, the selection opportunities arise when deciding which cows to inseminate with sexed semen, conventional semen, or beef semen. We tested...
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Directory of Open Access Journals (Sweden)
Yulia Shichkina
2017-01-01
Full Text Available This article presents the results of research on the acceleration of data processing in the construction routing in dynamic DTN, realized through the devices established in moving objects and connected by means of Wi-Fi. The routes are constructed based on the prehistory of the movement of objects, which is stored in the database in the csv format. This database has a large volume and contains unnecessary and incorrect information. The article shows the possibility of speeding up the process of constructing routes using data precleaning. Reducing data volume is proposed by constructing an enlarged grid on the object movement map. This article also demonstrates the use of fuzzy logic and graph theory for constructing routes.
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Acceptance sampling for attributes via hypothesis testing and the hypergeometric distribution
Samohyl, Robert Wayne
2017-10-01
This paper questions some aspects of attribute acceptance sampling in light of the original concepts of hypothesis testing from Neyman and Pearson (NP). Attribute acceptance sampling in industry, as developed by Dodge and Romig (DR), generally follows the international standards of ISO 2859, and similarly the Brazilian standards NBR 5425 to NBR 5427 and the United States Standards ANSI/ASQC Z1.4. The paper evaluates and extends the area of acceptance sampling in two directions. First, by suggesting the use of the hypergeometric distribution to calculate the parameters of sampling plans avoiding the unnecessary use of approximations such as the binomial or Poisson distributions. We show that, under usual conditions, discrepancies can be large. The conclusion is that the hypergeometric distribution, ubiquitously available in commonly used software, is more appropriate than other distributions for acceptance sampling. Second, and more importantly, we elaborate the theory of acceptance sampling in terms of hypothesis testing rigorously following the original concepts of NP. By offering a common theoretical structure, hypothesis testing from NP can produce a better understanding of applications even beyond the usual areas of industry and commerce such as public health and political polling. With the new procedures, both sample size and sample error can be reduced. What is unclear in traditional acceptance sampling is the necessity of linking the acceptable quality limit (AQL) exclusively to the producer and the lot quality percent defective (LTPD) exclusively to the consumer. In reality, the consumer should also be preoccupied with a value of AQL, as should the producer with LTPD. Furthermore, we can also question why type I error is always uniquely associated with the producer as producer risk, and likewise, the same question arises with consumer risk which is necessarily associated with type II error. The resolution of these questions is new to the literature. The
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More than just T₄: diagnostic testing for hyperthyroidism in cats.
Peterson, Mark E
2013-09-01
In older cats presenting with clinical features of hyperthyroidism, confirmation of a diagnosis of thyroid disease is usually straightforward. However, the potential for false-negative and false-positive results exists with all thyroid function tests (especially in the context of routine screening of asymptomatic cats) and leads to clinical dilemmas. For example, a high serum T₄ value may be found in a cat that lacks clinical signs of hyperthyroidism, or hyperthyroidism may be suspected in a cat with normal total T₄ concentrations. To avoid unnecessary treatment and potentially adverse effects in a euthyroid cat, thyroid function tests must always be interpreted in the light of the cat's history, clinical signs, physical examination findings and other laboratory findings. In this article the author reviews the use of commonly recommended thyroid function tests, focusing on clinical scenarios that present diagnostic difficulties. In doing so, he draws on the veterinary and comparative literature, his own clinical experience, and data, unpublished to date, obtained from a series of 100 hyperthyroid cats consecutively diagnosed at his clinic.
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Operation without benefit in the services sector
International Nuclear Information System (INIS)
Brunner, C. U.; Nipkow, J.; Brechbuehl, B.; Glauser, H.; Steinemann, U.
2009-01-01
This final report for the Swiss Federal Office of Energy (SFOE) discusses the unnecessary operation of electrical equipment. This preliminary study examined in a top-down manner the electrical grid loads at night in Switzerland and attempts to identify unnecessary loads. The results of a bottom-up analysis of seven buildings in the service sector was made. One large complex was also used to identify the sources of night-time loads. Together, these two approaches allowed a first appreciation and a rough quantification of the load caused by the unnecessary operation of equipment in the Swiss electricity grid. The services sector has an estimated share of some 2.4 TWh/a caused by unnecessary operation. In a follow-up project the reduction of unnecessary loads is to be studied in more detail. This second analysis will also have to include loads caused by unnecessary operation during the daytime. The goal of the project is eventually to reduce any unnecessary electric loads and, as a result, the entire electricity demands of Switzerland
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Energy Technology Data Exchange (ETDEWEB)
Brunner, C. U.; Nipkow, J. [S.A.F.E., Zuerich (Switzerland); Brechbuehl, B. [Universitaet Zuerich, Zuerich (Switzerland); Glauser, H. [ea si, Windisch (Switzerland); Steinemann, U. [Ingenieurbuero US, Wollerau (Switzerland)
2009-01-15
This final report for the Swiss Federal Office of Energy (SFOE) discusses the unnecessary operation of electrical equipment. This preliminary study examined in a top-down manner the electrical grid loads at night in Switzerland and attempts to identify unnecessary loads. The results of a bottom-up analysis of seven buildings in the service sector was made. One large complex was also used to identify the sources of night-time loads. Together, these two approaches allowed a first appreciation and a rough quantification of the load caused by the unnecessary operation of equipment in the Swiss electricity grid. The services sector has an estimated share of some 2.4 TWh/a caused by unnecessary operation. In a follow-up project the reduction of unnecessary loads is to be studied in more detail. This second analysis will also have to include loads caused by unnecessary operation during the daytime. The goal of the project is eventually to reduce any unnecessary electric loads and, as a result, the entire electricity demands of Switzerland
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Kuljis, Jasna; Money, Arthur G; Perry, Mark; Barnett, Julie; Young, Terry
2017-09-01
Oral anticoagulation therapy requires regular blood testing to ensure therapeutic levels are maintained and excessive bleeding/clotting is avoided. Technology-assisted self-testing and management is seen as one of the key areas in which quality of care can be improved whilst reducing costs. Nevertheless, levels of patient engagement in self-testing and management remain low. To date, little research emphasis has been placed on understanding the patients' perspectives for low engagement. The typical approach adopted by healthcare providers is to provide patient education programmes, with the expectation that individual patients will change their behaviour and adopt new self-care strategies. However, if levels of patient engagement are to be increased, healthcare providers must also develop a better understanding of how their clinical service provision is perceived by patients and make adaptations. To explore patient views, needs and expectations of an anticoagulation service and the self-testing and management services provided. Interviews were conducted with 17 patients who currently engage in international normalised ratio (INR) self-testing and management. Thematic coding and analysis were carried out on the interview transcripts. Four high-level themes emerged from interviews: (i) role of clinic, (ii) motivations for self-testing, (iii) managing INR and (iv) trust. The clinic was seen as adding value in terms of specifying testing frequency, dosage profiles and calibrating equipment. Prompt communication from clinic to patient was also valued, although more personalised/real-time communication would help avoid feelings of isolation. Patients felt more in control as self-tester/managers and often took decisions about treatment adjustments themselves. However, some also manipulated their own test results to avoid 'unnecessary' interventions. More personalised/real-time communication, pragmatic and collaborative patient-clinician partnerships and recognition of
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Byun, Seung Won; Lee, Ahwon; Kim, Suyeon; Choi, Yeong Jin; Lee, Youn Soo; Park, Jong Sup
2013-01-01
Background: Atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) are ambiguous diagnostic entities for the prediction of high-grade cervical lesion. Objective and reproducible tests for predicting high-grade cervical lesions are needed to reduce unnecessary colposcopic referrals or follow-ups. Objective: We aimed to identify an adequate set of adjunctive ...
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TestMeEast: a campaign to increase HIV testing in hospitals and to reduce late diagnosis.
Bath, R; O'Connell, R; Lascar, M; Ferrand, R; Strachan, S; Matin, N; Bassnet, I; Orkin, C
2016-01-01
Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week ). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly [Ellis, S., & Curtis, H. (2012). HIV diagnoses and missed opportunities. Results of the British HIV association (BHIVA) National Audit 2010. Clinical Medicine, 12(5), 430-434]. We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.
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Peter, Simon; Leine, Remco I.
2017-11-01
Phase resonance testing is one method for the experimental extraction of nonlinear normal modes. This paper proposes a novel method for nonlinear phase resonance testing. Firstly, the issue of appropriate excitation is approached on the basis of excitation power considerations. Therefore, power quantities known from nonlinear systems theory in electrical engineering are transferred to nonlinear structural dynamics applications. A new power-based nonlinear mode indicator function is derived, which is generally applicable, reliable and easy to implement in experiments. Secondly, the tuning of the excitation phase is automated by the use of a Phase-Locked-Loop controller. This method provides a very user-friendly and fast way for obtaining the backbone curve. Furthermore, the method allows to exploit specific advantages of phase control such as the robustness for lightly damped systems and the stabilization of unstable branches of the frequency response. The reduced tuning time for the excitation makes the commonly used free-decay measurements for the extraction of backbone curves unnecessary. Instead, steady-state measurements for every point of the curve are obtained. In conjunction with the new mode indicator function, the correlation of every measured point with the associated nonlinear normal mode of the underlying conservative system can be evaluated. Moreover, it is shown that the analysis of the excitation power helps to locate sources of inaccuracies in the force appropriation process. The method is illustrated by a numerical example and its functionality in experiments is demonstrated on a benchmark beam structure.
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International Nuclear Information System (INIS)
Mullen, O.W.; Eubank, B.F.
1985-08-01
Fusileer was the name assigned to the series of underground nuclear experiments conducted at the Nevada Test Site from October 1, 1983 through September 30, 1984. This report is limited to announced nuclear tests. Remote radiation measurements were taken during and after each nuclear experiment by a telemetry system. Monitors with portable radiation detection instruments surveyed reentry routes into ground zeros before other planned entries were made. Continuous surveillance was provided while personnel were in radiation areas and appropriate precautions were taken to protect persons from unnecessary exposure to radiation and toxic gases. Protective clothing and equipment were issued as needed. Complete radiological safety and industrial hygiene coverage was provided during drilling and mineback operations. Telemetered and portable radiation detector measurements are listed. Detection instrumentation used is described and specific operational procedures are defined
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DEFF Research Database (Denmark)
Mastenbroek, Mirjam H.; Pedersen, Susanne S.; van der Tweel, Ingeborg
2016-01-01
-reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients...... programming strategy, unnecessary ICD therapy was prevented in 10% of ENHANCED-ICD patients during a median follow-up period of 1.3 years. With respect to patient-reported outcomes, levels of distress were highest and perceived health status lowest at the time of implantation, which both gradually improved...... during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life....
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Tractor accelerated test on test rig
Directory of Open Access Journals (Sweden)
M. Mattetti
2013-09-01
Full Text Available The experimental tests performed to validate a tractor prototype before its production, need a substantial financial and time commitment. The tests could be reduced using accelerated tests able to reproduce on the structural part of the tractor, the same damage produced on the tractor during real life in a reduced time. These tests were usually performed reproducing a particular harsh condition a defined number of times, as for example using a bumpy road on track to carry out the test in any weather condition. Using these procedures the loads applied on the tractor structure are different with respect to those obtained during the real use, with the risk to apply loads hard to find in reality. Recently it has been demonstrated how, using the methodologies designed for cars, it is possible to also expedite the structural tests for tractors. In particular, automotive proving grounds were recently successfully used with tractors to perform accelerated structural tests able to reproduce the real use of the machine with an acceleration factor higher than that obtained with the traditional methods. However, the acceleration factor obtained with a tractor on proving grounds is in any case reduced due to the reduced speed of the tractors with respect to cars. In this context, the goal of the paper is to show the development of a methodology to perform an accelerated structural test on a medium power tractor using a 4 post test rig. In particular, several proving ground testing conditions have been performed to measure the loads on the tractor. The loads obtained were then edited to remove the not damaging portion of signals, and finally the loads obtained were reproduced in a 4 post test rig. The methodology proposed could be a valid alternative to the use of a proving ground to reproduce accelerated structural tests on tractors.
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The RERTR [Reduced Enrichment Research and Test Reactor] program: A progress report
International Nuclear Information System (INIS)
Travelli, A.
1986-11-01
The progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program is described. After a brief summary of the results which the RERTR Program, in collaboration with its many international partners, had achieved by the end of 1985, the activities, results, and new developments which occurred in 1986 are reviewed. The second miniplate series, concentrating on U 3 Si 2 -Al and U 3 Si-Al fuels, was expanded and its irradiation continued. Postirradiation examinations of several of these miniplates and of six previously irradiated U 3 Si 2 -Al full-size elements were completed with excellent results. The whole-core ORR demonstration with U 3 Si 2 -Al fuel at 4.8 g U/cm 3 is well under way and due for completion before the end of 1987. DOE removed an important barrier to conversions by announcing that the new LEU fuels will be accepted for reprocessing. New DOE prices for enrichment and reprocessing services were calculated to have minimal effect on HEU reactors, and to reduce by about 8 to 10% the total fuel cycle costs of LEU reactors. New program activities include preliminary feasibility studies of LEU use in DOE reactors, evaluation of the feasibility to use LEU targets for the production of fission-product 99 Mo, and responsibility for coordinating safety evaluations related to LEU conversions of US university reactors, as required by NRC. Achievement of the final program goals is projected for 1990. This progress could not have been achieved without close international cooperation, whose continuation and intensification are essential to the achievement of the ultimate goals of the RERTR Program
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A new spirometry-based algorithm to predict occupational pulmonary restrictive impairment.
De Matteis, S; Iridoy-Zulet, A A; Aaron, S; Swann, A; Cullinan, P
2016-01-01
Spirometry is often included in workplace-based respiratory surveillance programmes but its performance in the identification of restrictive lung disease is poor, especially when the prevalence of this condition is low in the tested population. To improve the specificity (Sp) and positive predictive value (PPV) of current spirometry-based algorithms in the diagnosis of restrictive pulmonary impairment in the workplace and to reduce the proportion of false positives findings and, as a result, unnecessary referrals for lung volume measurements. We re-analysed two studies of hospital patients, respectively used to derive and validate a recommended spirometry-based algorithm [forced vital capacity (FVC) 55%] for the recognition of restrictive pulmonary impairment. We used true lung restrictive cases as a reference standard in 2×2 contingency tables to estimate sensitivity (Sn), Sp and PPV and negative predictive values for each diagnostic cut-off. We simulated a working population aged spirometry-based algorithm may be adopted to accurately exclude pulmonary restriction and to possibly reduce unnecessary lung volume testing in an occupational health setting. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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LENUS (Irish Health Repository)
Ahmad, Nasir Zaheer
2012-01-31
BACKGROUND AND OBJECTIVES: Liver function tests (LFTs) include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and bilirubin. The role of routine testing before and after laparoscopic cholecystectomy was evaluated in this study. PATIENTS AND METHODS: A total of 355 patients were retrospectively analyzed by examining the LFTs the day before, the day after, and 3 weeks after the surgery. The Wilcoxon signed-rank test and Student t test were performed to determine statistical significance. RESULTS: Alterations in the serum AST, ALT, and GGT were seen on the first postoperative day. Minor changes were seen in bilirubin and ALP. An overall disturbance in the LFTs was seen in more than two-thirds of the cases. Repeat LFTs performed after 3 weeks on follow-up were found to be within normal limits. CONCLUSION: Mild-to-moderate elevation in preoperative LFTs may not be associated with any deleterious effect, and, in the absence of clinical indications, routine preoperative or postoperative liver function testing is unnecessary.
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Testing for lead in toys at day care centers.
Sanders, Martha; Stolz, Julie; Chacon-Baker, Ashley
2013-01-01
Exposure to lead-based paint or material has been found to impact children's cognitive and behavioral development at blood lead levels far below current standards. The purpose of the project was to screen for lead in toy items in daycare centers in order to raise awareness of inside environmental lead exposures and minimize lead-based exposures for children. Occupational therapy students in a service learning class tested for lead in ten daycare or public centers using the XRF Thermo Scientific Niton XL3t, a method accepted by the Consumer Product Safety Commission (CPSC). A total of 460 items were tested over a two-month period for an average of 66 toys per setting. Fifty six (56) items tested > 100 ppm, which represented 12% of the entire sample. Items with high lead levels included selected toys constructed with lead-based paint, lead metals, plastics using lead as a color enhancer, and decorative objects. While the actual number of lead-based products is small, the cumulative exposure or habitual use may pose an unnecessary risk to children. Indoor exposures occurred for all day care centers regardless of socio-economic levels. Recommendations to minimize exposures are provided.
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Cryomdoule Test Stand Reduced-Magnetic Support Design at Fermilab
Energy Technology Data Exchange (ETDEWEB)
McGee, Mike [Fermilab; Chandrasekaran, Saravan Kumar [Fermilab; Crawford, Anthony [Fermilab; Harms, Elvin [Fermilab; Leibfritz, Jerry [Fermilab; Wu, Genfa [Fermilab
2016-06-01
In a partnership with SLAC National Accelerator Laboratory (SLAC) and Jefferson Lab, Fermilab will assemble and test 17 of the 35 total 1.3 GHz cryomodules for the Linac Coherent Light Source II (LCLS-II) Project. These devices will be tested at Fermilab's Cryomodule Test Facility (CMTF) within the Cryomodule Test Stand (CMTS-1) cave. The problem of magnetic pollution became one of major issues during design stage of the LCLS-II cryomodule as the average quality factor of the accelerating cavities is specified to be 2.7 x 10¹⁰. One of the possible ways to mitigate the effect of stray magnetic fields and to keep it below the goal of 5 mGauss involves the application of low permeable materials. Initial permeability and magnetic measurement studies regarding the use of 316L stainless steel material indicated that cold work (machining) and heat affected zones from welding would be acceptable.
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Halligan, E; Edgeworth, J; Bisnauthsing, K; Bible, J; Cliff, P; Aarons, E; Klein, J; Patel, A; Goldenberg, S
2014-08-01
Laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. Tests are often requested sequentially and undertaken in different laboratories. This causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. A molecular multiplex test (Luminex(®) Gastrointestinal Pathogen Panel (GPP)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use of isolation facilities and user acceptability. A total of 262 (12%) patients had a pathogen detected by conventional methods compared with 483 (22.1%) by GPP. Most additional cases were detected in patients developing symptoms in the first 4 days of admission. Additional cases were detected because of presumed improved diagnostic sensitivity but also because clinicians had not requested the correct pathogen. Turnaround time (41.8 h) was faster than bacterial culture (66.5 h) and parasite investigation (66.5 h) but slower than conventional testing for Clostridium difficile (17.3 h) and viruses (27 h). The test could allow simplified requesting by clinicians and a consolidated laboratory workflow, reducing the overall number of specimens received by the laboratory. A total of 154 isolation days were saved at an estimated cost of £30 800. Consumables and labour were estimated at £150 641 compared with £63 431 for conventional testing. Multiplex molecular testing using a panel of targets allowed enhanced detection and a consolidated laboratory workflow. This is likely to be of greater benefit to cases that present within the first 4 days of hospital admission. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.
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Greuter, Marjolein Je; Schouten, Charlotte S; Castelijns, Jonas A; de Graaf, Pim; Comans, Emile Fi; Hoekstra, Otto S; de Bree, Remco; Coupé, Veerle Mh
2017-04-11
Considerable variation exists in diagnostic tests used for local response evaluation after chemoradiation in patients with advanced oropharyngeal cancer. The yield of invasive examination under general anesthesia (EUA) with biopsies in all patients is low and it may induce substantial morbidity. We explored four response evaluation strategies to detect local residual disease in terms of diagnostic accuracy and cost-effectiveness. We built a decision-analytic model using trial data of forty-six patients and scientific literature. We estimated for four strategies the proportion of correct diagnoses, costs concerning diagnostic instruments and the proportion of unnecessary EUA indications. Besides a reference strategy, i.e. EUA for all patients, we considered three imaging strategies consisting of 18 FDG-PET-CT, diffusion-weighted MRI (DW-MRI), or both 18 FDG-PET-CT and DW-MRI followed by EUA after a positive test. The impact of uncertainty was assessed in sensitivity analyses. The EUA strategy led to 96% correct diagnoses. Expected costs were €468 per patient whereas 89% of EUA indications were unnecessary. The DW-MRI strategy was the least costly strategy, but also led to the lowest proportion of correct diagnoses, i.e. 93%. The PET-CT strategy and combined imaging strategy were dominated by the EUA strategy due to respectively a smaller or equal proportion of correct diagnoses, at higher costs. However, the combination of PET-CT and DW-MRI had the highest sensitivity. All imaging strategies considerably reduced (unnecessary) EUA indications and its associated burden compared to the EUA strategy. Because the combined PET-CT and DW-MRI strategy costs only an additional €927 per patient, it is preferred over immediate EUA since it reaches the same diagnostic accuracy in detecting local residual disease while leading to substantially less unnecessary EUA indications. However, if healthcare resources are limited, DW-MRI is the strategy of choice because of lower
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Proceedings of the 1990 International Meeting on Reduced Enrichment for Research and Test Reactors
Energy Technology Data Exchange (ETDEWEB)
1993-07-01
The global effort to reduce, and possibly, eliminate the international traffic in highly-enriched uranium caused by its use in research reactors requires extensive cooperation and free exchange of information among all participants. To foster this free exchange of information, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the thirteenth of a series which began in 1978. The common effort brought together, past, a large number of specialists from many countries. On hundred twenty-three participants from 26 countries, including scientists, reactor operators, and personnel from commercial fuel suppliers, research centers, and government organizations, convened in Newport, Rhode Island to discuss their results, their activities, and their plans relative to converting research reactors to low-enriched fuels. As more and more reactors convert to the use of low-enriched uranium, the emphasis of our effort has begun to shift from research and development to tasks more directly related to implementation of the new fuels and technologies that have been developed, and to refinements of those fuels and technologies. It is appropriate, for this reason, that the emphasis of this meeting was placed on safety and on conversion experiences. This individual papers in this report have been cataloged separately.
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Proceedings of the 1990 International Meeting on Reduced Enrichment for Research and Test Reactors
International Nuclear Information System (INIS)
1993-07-01
The global effort to reduce, and possibly, eliminate the international traffic in highly-enriched uranium caused by its use in research reactors requires extensive cooperation and free exchange of information among all participants. To foster this free exchange of information, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at Argonne National Laboratory, sponsored this meeting as the thirteenth of a series which began in 1978. The common effort brought together, past, a large number of specialists from many countries. On hundred twenty-three participants from 26 countries, including scientists, reactor operators, and personnel from commercial fuel suppliers, research centers, and government organizations, convened in Newport, Rhode Island to discuss their results, their activities, and their plans relative to converting research reactors to low-enriched fuels. As more and more reactors convert to the use of low-enriched uranium, the emphasis of our effort has begun to shift from research and development to tasks more directly related to implementation of the new fuels and technologies that have been developed, and to refinements of those fuels and technologies. It is appropriate, for this reason, that the emphasis of this meeting was placed on safety and on conversion experiences. This individual papers in this report have been cataloged separately
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Elective penicillin skin testing in a pediatric outpatient setting.
Jost, Barbara Capes; Wedner, H James; Bloomberg, Gordon R
2006-12-01
Adverse reactions associated with penicillin-type antibiotics are common in pediatric practice, leading to the subsequent unnecessary use of alternative antibiotics. IgE-mediated penicillin allergy represents only a fraction of these adverse reactions. To examine (1) the trend of penicillin skin test reactivity during a recent 10-year interval, (2) the relative distribution of specific reagents related to a positive skin test result, and (3) skin test reactivity as a function of reaction history. Penicillin testing using 3 reagents--benzylpenicilloyl polylysine, penicillin G, and sodium penicilloate (penicillin A)--was conducted in a prospective study of 359 consecutive patients referred to an outpatient pediatric allergy clinic between January 1, 1993, and May 31, 2003. We also retrospectively reviewed penicillin skin test results for 562 children previously tested between January 1, 1979, and December 31, 1992. Between 1993 and 2003, the prevalence of penicillin skin test sensitivity markedly declined. Of all the positive skin test results between 1979 and 2002, either penicillin G or sodium penicilloate or both identified 34%, with sodium penicilloate alone responsible for 8.5%. The rate of positive skin test reactions was not significantly different between patients with vs without a history of suggestive IgE-mediated reactions. A marked decline in penicillin skin test sensitivity in the pediatric age group is identified. The minor determinant reagents penicillin G and sodium penicilloate are both necessary for determining potential penicillin allergy. Relating history alone to potential penicillin sensitivity is unreliable in predicting the presence or absence of a positive skin test result.
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Testing quantised inertia on emdrives with dielectrics
McCulloch, M. E.
2017-05-01
Truncated-cone-shaped cavities with microwaves resonating within them (emdrives) move slightly towards their narrow ends, in contradiction to standard physics. This effect has been predicted by a model called quantised inertia (MiHsC) which assumes that the inertia of the microwaves is caused by Unruh radiation, more of which is allowed at the wide end. Therefore, photons going towards the wide end gain inertia, and to conserve momentum the cavity must move towards its narrow end, as observed. A previous analysis with quantised inertia predicted a controversial photon acceleration, which is shown here to be unnecessary. The previous analysis also mispredicted the thrust in those emdrives with dielectrics. It is shown here that having a dielectric at one end of the cavity is equivalent to widening the cavity at that end, and when dielectrics are considered, then quantised inertia predicts these results as well as the others, except for Shawyer's first test where the thrust is predicted to be the right size but in the wrong direction. As a further test, quantised inertia predicts that an emdrive's thrust can be enhanced by using a dielectric at the wide end.
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Yokoi, S.; Tsuruoka, H.; Nanjo, K.; Hirata, N.
2012-12-01
Collaboratory for the Study of Earthquake Predictability (CSEP) is a global project on earthquake predictability research. The final goal of this project is to search for the intrinsic predictability of the earthquake rupture process through forecast testing experiments. The Earthquake Research Institute, the University of Tokyo joined CSEP and started the Japanese testing center called as CSEP-Japan. This testing center provides an open access to researchers contributing earthquake forecast models applied to Japan. Now more than 100 earthquake forecast models were submitted on the prospective experiment. The models are separated into 4 testing classes (1 day, 3 months, 1 year and 3 years) and 3 testing regions covering an area of Japan including sea area, Japanese mainland and Kanto district. We evaluate the performance of the models in the official suite of tests defined by CSEP. The total number of experiments was implemented for approximately 300 rounds. These results provide new knowledge concerning statistical forecasting models. We started a study for constructing a 3-dimensional earthquake forecasting model for Kanto district in Japan based on CSEP experiments under the Special Project for Reducing Vulnerability for Urban Mega Earthquake Disasters. Because seismicity of the area ranges from shallower part to a depth of 80 km due to subducting Philippine Sea plate and Pacific plate, we need to study effect of depth distribution. We will develop models for forecasting based on the results of 2-D modeling. We defined the 3D - forecasting area in the Kanto region with test classes of 1 day, 3 months, 1 year and 3 years, and magnitudes from 4.0 to 9.0 as in CSEP-Japan. In the first step of the study, we will install RI10K model (Nanjo, 2011) and the HISTETAS models (Ogata, 2011) to know if those models have good performance as in the 3 months 2-D CSEP-Japan experiments in the Kanto region before the 2011 Tohoku event (Yokoi et al., in preparation). We use CSEP
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Kang, Jidong; Gianetto, James A.; Tyson, William R.
2018-03-01
Fracture toughness measurement is an integral part of structural integrity assessment of pipelines. Traditionally, a single-edge-notched bend (SE(B)) specimen with a deep crack is recommended in many existing pipeline structural integrity assessment procedures. Such a test provides high constraint and therefore conservative fracture toughness results. However, for girth welds in service, defects are usually subjected to primarily tensile loading where the constraint is usually much lower than in the three-point bend case. Moreover, there is increasing use of strain-based design of pipelines that allows applied strains above yield. Low-constraint toughness tests represent more realistic loading conditions for girth weld defects, and the corresponding increased toughness can minimize unnecessary conservatism in assessments. In this review, we present recent developments in low-constraint fracture toughness testing, specifically using single-edgenotched tension specimens, SENT or SE(T). We focus our review on the test procedure development and automation, round-robin test results and some common concerns such as the effect of crack tip, crack size monitoring techniques, and testing at low temperatures. Examples are also given of the integration of fracture toughness data from SE(T) tests into structural integrity assessment.
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Age-specific reference ranges of serum prostate-specific antigen in Iranian men
Directory of Open Access Journals (Sweden)
Gholamreza Pourmand
2015-08-01
Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.
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Ashton-Miller, J A; Yeh, M W; Richardson, J K; Galloway, T
1996-05-01
To test the hypothesis that use of a cane in the nondominant hand during challenging balance tasks would significantly decrease loss of balance in patients with peripheral neuropathy while transferring from bipedal to unipedal stance on an unsteady surface. Nonrandomized control study. Tertiary-care institution. Eight consecutive patients with peripheral neuropathy (PN) and eight age- and gender-matched controls (C) with a mean (SD) age of 65 (8.2) years. Subjects were asked to transfer their weight onto their right foot, despite a rapid +/- 2 degrees or +/- 4 degrees frontal plane tilt of the support surface at 70% of weight transfer, and balance unipedally for at least 3 seconds. The efficacy of their weight transfer was evaluated over 112 consecutive randomized and blocked trials by calculating loss of balance as failure rates (%FR) with and without visual feedback, and with and without use of a cane in the nondominant (left) hand. Results were analyzed using a 2 x 2 x 2 x 2 x 2 repeated-measures analysis of variance (rm-ANOVA) and post hoc t tests. The rm-ANOVA showed that the FR of the PN subjects (47.6% [18.1%]) was significantly higher than C (29.2% [15.2%], p = .036). Removing visual feedback, simulating the dark of night, increased the FR fourfold (p = .000). Use of a cane in the contralateral nondominant hand significantly reduced the FR (p = .000), particularly in the PN group (cane x disease interaction: p = .055). Post hoc t tests showed that with or without visual feedback, the cane reduced the FR of the PN group fourfold and enabled them to perform more reliably than matched controls not using a cane (p = .011). An inversion perturbation resulted in a higher FR than an eversion perturbation (p = .007). The PN group employed larger mean peak cane forces (21.9% BW) than C (13.6% BW) in restoring their balance (p = .000). Use of a cane by PN patients significantly reduced their risk of losing balance on unstable surfaces, especially under low
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Tests for evaluating sites for disposal of low-level radioactive waste
International Nuclear Information System (INIS)
Lutton, R.J.; Butler, D.K.; Meade, R.B.; Patrick, D.M.; Strong, A.B.; Taylor, H.M. Jr.
1982-12-01
This report, the second of a series, identifies the tests and other means of evaluating or documenting the important characteristics of sites for disposal of low-level radioactive waste. The specific parameters were identified and explained in regard to their importance in characterizing disposal facilities in the previous report. More than half of the tests and procedures are standard methods recognized and used nationwide, most conspicuously the numerous chemical tests. Other tests are commonly used methods recognized widely as state of the art, e.g., geological and geophysical methods. The basis for choosing these state-of-the-art methods is discussed, and the concepts and procedures themselves are reviewed in the absence of standards for ready reference. Besides standards and state-of-the-art practices a third category of methods involves the use of existing data sources or recognized correlations in place of new testing or documentation. It is particularly important that mapping, logging, sampling, testing, interpretation, and analysis be conducted by technically qualified and professionally motivated personnel using appropriate equipment and facilities, and general guidance is provided in this direction. There will be cases where site-specific testing and measurement are indicated to be unnecessary on a technical basis. This report calls attention to the usual subordinate role of such parameters and their only infrequent need for testing
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New scoring system for intra-abdominal injury diagnosis after blunt trauma.
Shojaee, Majid; Faridaalaee, Gholamreza; Yousefifard, Mahmoud; Yaseri, Mehdi; Arhami Dolatabadi, Ali; Sabzghabaei, Anita; Malekirastekenari, Ali
2014-01-01
An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (scoretool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.
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Ginsburg, Brett C.; Lamb, R. J.
2015-01-01
In reinstatement studies (a common preclinical procedure for studying relapse), incubation occurs (longer abstinence periods result in more responding). This finding is discordant with the clinical literature. Identifying determinants of incubation could aid in interpreting reinstatement and identifying processes involved in relapse. Reinstated responding was examined in rats trained to respond for ethanol and food under a multiple concurrent schedule (Component 1: ethanol FR5, food FR150; Component 2: ethanol FR5, food FR5–alternating across the 30-min session). Ethanol consumption was then reduced for 1 or 16 sessions either by suspending training (rats remained in home cage) or by providing alternative reinforcement (only Component 2 stimuli and contingencies were presented throughout the session). In the next session, stimuli associated with Component 1 were presented and responses recorded but ethanol and food were never delivered. Two test conditions were studied: fixed-ratio completion either produced ethanol- or food-associated stimuli (signaled) or had no programmed consequence (unsignaled). Incubation of ethanol responding was observed only after suspended training during signaled test sessions. Incubation of food responding was also observed after suspended training. These results are most consistent with incubation resulting from a degradation of feedback functions limiting extinction responding, rather than an increased motivation. PMID:25595114
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Randomized test of an implementation intention-based tool to reduce stress-induced eating.
O'Connor, Daryl B; Armitage, Christopher J; Ferguson, Eamonn
2015-06-01
Stress may indirectly contribute to disease (e.g. cardiovascular disease, cancer) by producing deleterious changes to diet. The purpose of this study was to test the effectiveness of a stress management support (SMS) tool to reduce stress-related unhealthy snacking and to promote stress-related healthy snacking. Participants were randomized to complete a SMS tool with instruction to link stressful situations with healthy snack alternatives (experimental) or a SMS tool without a linking instruction (control). On-line daily reports of stressors and snacking were completed for 7 days. Daily stressors were associated with unhealthy snack consumption in the control condition but not in the experimental condition. Participants highly motivated towards healthy eating consumed a greater number of healthy snacks in the experimental condition on stressful days compared to participants in the experimental condition with low and mean levels of motivation. This tool is an effective, theory driven, intervention that helps to protect against stress-induced high-calorie snack consumption.
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[Necessary and unnecessary treatment options for hemorrhoids].
Zindel, Joel; Inglin, Roman; Brügger, Lukas
2014-12-01
Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the
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Security 2020 Reduce Security Risks This Decade
Howard, Doug; Schneier, Bruce
2010-01-01
Identify real security risks and skip the hype After years of focusing on IT security, we find that hackers are as active and effective as ever. This book gives application developers, networking and security professionals, those that create standards, and CIOs a straightforward look at the reality of today's IT security and a sobering forecast of what to expect in the next decade. It debunks the media hype and unnecessary concerns while focusing on the knowledge you need to combat and prioritize the actual risks of today and beyond.IT security needs are constantly evolving; this guide examine
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Pérez, Ashley; Santamaria, E Karina; Operario, Don
2017-12-15
Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.
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DEFF Research Database (Denmark)
Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars
2014-01-01
and Neck Surgery during three comparable time intervals 2006-2007, 2007-2008, and 2011-2012 (groups 1-3) were investigated. We recorded the time from patient referral, to first consultation and final diagnosis. The first interval was before initiation of the "package solution", the second just after......In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... procedures. The purpose of this study is to present a model for fast track handling of patients suspicious of cancer in the head and neck region and to evaluate the effect of implementation on the diagnostic work up time. Patients with suspicion of HNC referred to the same university department of ENT Head...
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Schwartz, A; Gospodarowicz, M K; Khalili, K; Pintilie, M; Goddard, S; Keller, A; Tsang, R W
2006-02-01
The purpose of this study was to assist with resource planning by examining the pattern of physician utilization of imaging procedures for lymphoma patients in a dedicated oncology hospital. The proportion of imaging tests ordered for routine follow up with no specific clinical indication was quantified, with specific attention to CT scans. A 3-month audit was performed. The reasons for ordering all imaging procedures (X-rays, CT scans, ultrasound, nuclear scan and MRI) were determined through a retrospective chart review. 411 lymphoma patients had 686 assessments (sets of imaging tests) and 981 procedures (individual imaging tests). Most procedures were CT scans (52%) and chest radiographs (30%). The most common reasons for ordering imaging were assessing response (23%), and investigating new symptoms (19%). Routine follow up constituted 21% of the assessments (142/686), and of these, 82% were chest radiographs (116/142), while 24% (34/142) were CT scans. With analysis restricted to CT scans (296 assessments in 248 patients), the most common reason for ordering CT scans were response evaluation (40%), and suspicion of recurrence and/or new symptom (23%). Follow-up CT scans done with no clinical indication comprised 8% (25/296) of all CT assessments. Staging CT scans were under-represented at 6% of all assessments. Imaging with CT scans for follow up of asymptomatic patients is infrequent. However, scans done for staging new lymphoma patients were unexpectedly low in frequency, due to scans done elsewhere prior to referral. This analysis uncovered utilization patterns, helped resource planning and provided data to reduce unnecessary imaging procedures.
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Prevalence of the use of cancer related self-tests by members of the public: a community survey
Directory of Open Access Journals (Sweden)
Marriott John
2006-08-01
Full Text Available Abstract Background Self-tests are those where an individual can obtain a result without recourse to a health professional, by getting a result immediately or by sending a sample to a laboratory that returns the result directly. Self-tests can be diagnostic, for disease monitoring, or both. There are currently tests for more than 20 different conditions available to the UK public, and self-testing is marketed as a way of alerting people to serious health problems so they can seek medical help. Almost nothing is known about the extent to which people self-test for cancer or why they do this. Self-tests for cancer could alter perceptions of risk and health behaviour, cause psychological morbidity and have a significant impact on the demand for healthcare. This study aims to gain an understanding of the frequency of self-testing for cancer and characteristics of users. Methods Cross-sectional survey. Adults registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that will collect socio-demographic information and basic data regarding previous and potential future use of self-test kits. The only exclusions will be people who the GP feels it would be inappropriate to send a questionnaire, for example because they are unable to give informed consent. Freepost envelopes will be included and non-responders will receive one reminder. Standardised prevalence rates will be estimated. Discussion Cancer related self-tests, currently available from pharmacies or over the Internet, include faecal occult blood tests (related to bowel cancer, prostate specific antigen tests (related to prostate cancer, breast cancer kits (self examination guide and haematuria tests (related to urinary tract cancers. The effect of an increase in self-testing for cancer is unknown but may be considerable: it may affect the delivery of population based screening programmes; empower patients or cause unnecessary anxiety
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SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit
International Nuclear Information System (INIS)
LaFrance, M; Marsh, S; Hicks, R; O’Donnell-Moran, G
2015-01-01
Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits
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SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit
Energy Technology Data Exchange (ETDEWEB)
LaFrance, M; Marsh, S; Hicks, R; O’Donnell-Moran, G [Baystate Health Systems, Inc., Springfield, MA (United States)
2015-06-15
Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits.
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Can Appealing to Patient Altruism Reduce Overuse of Health Care Services? An Experimental Survey.
Riggs, Kevin R; Ubel, Peter A; Saloner, Brendan
2017-07-01
A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown. To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings. Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults). U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys. In the control version of the vignettes, the physician's rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service. Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes. A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P < 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084). In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism
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Treatability Test Plan for an In Situ Biostimulation Reducing Barrier
Energy Technology Data Exchange (ETDEWEB)
Truex, Michael J.; Vermeul, Vince R.; Long, Philip E.; Brockman, Fred J.; Oostrom, Mart; Hubbard, Susan; Borden, Robert C.; Fruchter, Jonathan S.
2007-07-21
This treatability test plan supports a new, integrated strategy to accelerate cleanup of chromium in the Hanford 100 Areas. This plan includes performing a field-scale treatability test for bioreduction of chromate, nitrate, and dissolved oxygen. In addition to remediating a portion of the plume and demonstrating reduction of electron acceptors in the plume, the data from this test will be valuable for designing a full-scale bioremediation system to apply at this and other chromium plumes at Hanford.
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Carvin, Rebecca; Good, Laura W.; Fitzpatrick, Faith A.; Diehl, Curt; Songer, Katherine; Meyer, Kimberly J.; Panuska, John C.; Richter, Steve; Whalley, Kyle
2018-01-01
This study tested a focused strategy for reducing phosphorus (P) and sediment loads in agricultural streams. The strategy involved selecting small watersheds identified as likely to respond relatively quickly, and then focusing conservation practices on high-contributing fields within those watersheds. Two 5,000 ha (12,360 ac) watersheds in the Driftless Area of south central Wisconsin, previously ranked in the top 6% of similarly sized Wisconsin watersheds for expected responsiveness to conservation efforts to reduce high P and sediment loads, were chosen for the study. The stream outlets from both watersheds were monitored from October of 2006 through September of 2016 for streamflow and concentrations of sediment, total P, and, beginning in October of 2009, total dissolved P. Fields and pastures having the highest potential P delivery to the streams in each watershed were identified using the Wisconsin P Index (Good et al. 2012). After three years of baseline monitoring (2006 to 2009), farmers implemented both field- and farm-based conservation practices in one watershed (treatment) as a means to reduce sediment and P inputs to the stream from the highest contributing areas, whereas there were no out-of-the-ordinary conservation efforts in the second watershed (control). Implementation occurred primarily in 2011 and 2012. In the four years following implementation of conservation practices (2013 through 2016), there was a statistically significant reduction in storm-event suspended sediment loads in the treatment watershed compared to the control watershed when the ground was not frozen (p = 0.047). While there was an apparent reduction in year-round suspended sediment event loads, it was not statistically significant at the 95% confidence level (p = 0.15). Total P loads were significantly reduced for runoff events (p < 0.01) with a median reduction of 50%. Total P and total dissolved P concentrations for low-flow conditions were also significantly reduced (p
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Testing a flexible method to reduce false monsoon onsets.
Directory of Open Access Journals (Sweden)
Mathew Alexander Stiller-Reeve
Full Text Available To generate information about the monsoon onset and withdrawal we have to choose a monsoon definition and apply it to data. One problem that arises is that false monsoon onsets can hamper our analysis, which is often alleviated by smoothing the data in time or space. Another problem is that local communities or stakeholder groups may define the monsoon differently. We therefore aim to develop a technique that reduces false onsets for high-resolution gridded data, while also being flexible for different requirements that can be tailored to particular end-users. In this study, we explain how we developed our technique and demonstrate how it successfully reduces false onsets and withdrawals. The presented results yield improved information about the monsoon length and its interannual variability. Due to this improvement, we are able to extract information from higher resolution data sets. This implies that we can potentially get a more detailed picture of local climate variations that can be used in more local climate application projects such as community-based adaptations.
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DEFF Research Database (Denmark)
Aabenhus, Rune; Jensen, Jens Ulrik Stæhr; Jørgensen, Karsten Juhl
2014-01-01
' recovery and expose them to potential side effects. Furthermore, as a causal link exists between antibiotic use and antibiotic resistance, reducing unnecessary antibiotic use is a key factor in controlling this important problem. Antibiotic resistance puts increasing burdens on healthcare services...... forms part of the acute phase response to acute tissue injury regardless of the aetiology (infection, trauma and inflammation) and may in the correct clinical context be used as a surrogate marker of infection, possibly assisting the doctor in the clinical management of ARIs. OBJECTIVES: To assess......-of-care biomarker (e.g. C-reactive protein) to guide antibiotic treatment of ARIs in primary care can reduce antibiotic use, although the degree of reduction remains uncertain. Used as an adjunct to a doctor's clinical examination this reduction in antibiotic use did not affect patient-reported outcomes, including...
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Treatability Test Plan for an In Situ Biostimulation Reducing Barrier
Energy Technology Data Exchange (ETDEWEB)
Truex, Michael J.; Vermeul, Vince R.; Long, Philip E.; Brockman, Fred J.; Oostrom, Mart; Hubbard, Susan; Borden, Robert C.; Fruchter, Jonathan S.
2007-10-26
This treatability test plan supports a new, integrated strategy to accelerate cleanup of chromium in the 100 Areas at the Hanford Site. This plan includes performing a field-scale treatability test for bioreduction of chromate, nitrate, and dissolved oxygen. In addition to remediating a portion of the plume and demonstrating reduction of electron acceptors in the plume, the data from this test will be valuable for designing a full-scale bioremediation system to apply at this and other chromium plumes at the Hanford Site.
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International Nuclear Information System (INIS)
Hernandez, G.M.; Jacklin, A.K.
1992-01-01
Aqueduct was the name assigned to the series of underground nuclear weapons tests conducted at the Nevada Test Site (NTS) from October 1, 1989, through September 30, 1990. This report includes those experiments publicly announced. Remote radiation measurements were taken during and after each nuclear event by a telemetry system. Reynolds Electrical ampersand Engineering Co., Inc. (REECO) Health Protection Department (HPD) Radiation Protection Technicians (RPTS) with portable radiation detection instruments surveyed reentry routes into ground zeros (GZ) before other planned entries were made. Continuous surveillance was provided while personnel were in radiation areas and appropriate precautions were taken to protect persons from unnecessary exposure to radiation and toxic gases. Protective clothing and equipment were issued as needed. Complete radiological safety and industrial hygiene (IH) coverage was provided during drilling and mineback operations. Telemetered and portable radiation detector measurements are listed. Detection instrumentation used is described and specific operational procedures are defined
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Virtual Turbine Engine Test Bench Using MGET Test Device
Kho, Seonghee; Kong, Changduk; Ki, Jayoung
2015-05-01
Test device using virtual engine simulator can help reduce the number of engine tests through tests similar to the actual engine tests and repeat the test under the same condition, and thus reduce the engine maintenance and operating costs [1]. Also, as it is possible to easily implement extreme conditions in which it is hard to conduct actual tests, it can prevent engine damages that may happen during the actual engine test under such conditions. In this study, an upgraded MGET test device was developed that can conduct both real and virtual engine test by applying real-time engine model to the existing MGET test device that was developed and has been sold by the Company. This newly developed multi-purpose MGET test device is expected to be used for various educational and research purposes.
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Directory of Open Access Journals (Sweden)
Colbourne Lynne
2006-10-01
Full Text Available Abstract Background Bowel cancer is common and is a major cause of death. Meta-analysis of randomised controlled trials estimates that screening for colorectal cancer using faecal occult blood (FOB test reduces mortality from colorectal cancer by 16%. However, FOB testing has a low positive predictive value, with associated unnecessary cost, risk and anxiety from subsequent investigation, and is unacceptable to a proportion of the target population. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP-9 have been found to be associated with colorectal cancer, and this can be measured from a blood sample. Serum MMP-9 is potentially an accurate, low risk and cost-effective population screening tool. This study aims to evaluate the accuracy of serum MMP-9 as a test for colorectal cancer in a primary care population. Methods/Design People aged 50 to 69 years, who registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that asks about symptoms. Respondents who describe any colorectal symptoms (except only abdominal bloating and/or anal symptoms and are prepared to provide a blood sample for MMP9 estimation and undergo a colonoscopy (current gold standard investigation will be recruited at GP based clinics by a research nurse. Those unfit for colonoscopy will be excluded. Colonoscopies will be undertaken in dedicated research clinics. The accuracy of MMP-9 will be assessed by comparing the MMP-9 level with the colonoscopy findings, and the combination of factors (e.g. symptoms and MMP-9 level that best predict a diagnosis of malignancy (invasive disease or polyps will be determined. Discussion Colorectal cancer is a major cause of morbidity and mortality. Most colorectal cancers arise from adenomas and there is a period for early detection by screening, but available tests have risks, are unacceptable to many, have high false positive rates or are expensive. This study will
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Reducing animal experimentation in foot-and-mouth disease vaccine potency tests.
Reeve, Richard; Cox, Sarah; Smitsaart, Eliana; Beascoechea, Claudia Perez; Haas, Bernd; Maradei, Eduardo; Haydon, Daniel T; Barnett, Paul
2011-07-26
The World Organisation for Animal Health (OIE) Terrestrial Manual and the European Pharmacopoeia (EP) still prescribe live challenge experiments for foot-and-mouth disease virus (FMDV) immunogenicity and vaccine potency tests. However, the EP allows for other validated tests for the latter, and specifically in vitro tests if a "satisfactory pass level" has been determined; serological replacements are also currently in use in South America. Much research has therefore focused on validating both ex vivo and in vitro tests to replace live challenge. However, insufficient attention has been given to the sensitivity and specificity of the "gold standard"in vivo test being replaced, despite this information being critical to determining what should be required of its replacement. This paper aims to redress this imbalance by examining the current live challenge tests and their associated statistics and determining the confidence that we can have in them, thereby setting a standard for candidate replacements. It determines that the statistics associated with the current EP PD(50) test are inappropriate given our domain knowledge, but that the OIE test statistics are satisfactory. However, it has also identified a new set of live animal challenge test regimes that provide similar sensitivity and specificity to all of the currently used OIE tests using fewer animals (16 including controls), and can also provide further savings in live animal experiments in exchange for small reductions in sensitivity and specificity. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Reduction of entrance surface dose depending on shielding methods for panoramagraphy
Energy Technology Data Exchange (ETDEWEB)
Choi, Jung Hyun; Han, DongKyoon [Dept. of Radiological Science, The Graduate School, Eulji University, Sungnam (Korea, Republic of); Kim, Sung Chul [Dept. of Radiological, Science Gachon, University, Incheon (Korea, Republic of)
2015-09-15
Panoramagraphy was the second most used intraoral radiography utilized in Korea, resulting in 17.8% in university dental hospitals, 24.8% in dental hospitals, and 31.4% in dental clinics. Depending on increased demand like orthodontics and implant, panoromagraphy tends to consistently increase. This study were used lead glasses and lead shielding to reduce unnecessary radiation to the eyeballs and thyroid. ESD was 41.4% when radiation was shielded with the lead glasses while reducing 47.3% of ESD by shielding the X-ray tube area with shielding lead. There was no statistically significant difference. The lead glasses is appropriated to reduce unnecessary radiation exposure to the eyeballs.
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Reduction of entrance surface dose depending on shielding methods for panoramagraphy
International Nuclear Information System (INIS)
Choi, Jung Hyun; Han, DongKyoon; Kim, Sung Chul
2015-01-01
Panoramagraphy was the second most used intraoral radiography utilized in Korea, resulting in 17.8% in university dental hospitals, 24.8% in dental hospitals, and 31.4% in dental clinics. Depending on increased demand like orthodontics and implant, panoromagraphy tends to consistently increase. This study were used lead glasses and lead shielding to reduce unnecessary radiation to the eyeballs and thyroid. ESD was 41.4% when radiation was shielded with the lead glasses while reducing 47.3% of ESD by shielding the X-ray tube area with shielding lead. There was no statistically significant difference. The lead glasses is appropriated to reduce unnecessary radiation exposure to the eyeballs
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Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test.
Pisani, Anthony R; Wyman, Peter A; Gurditta, Kunali; Schmeelk-Cone, Karen; Anderson, Carolyn L; Judd, Emily
2018-05-31
Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students' own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the
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Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults.
Milward, Joanna; Deluca, Paolo; Drummond, Colin; Watson, Rod; Dunne, Jacklyn; Kimergård, Andreas
2017-08-08
Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As "Digital Natives," young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. The first theme, "Functionality" referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, "Design" described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, "Content" described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. ©Joanna Milward, Paolo Deluca, Colin Drummond, Rod Watson, Jacklyn Dunne, Andreas Kimerg
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NDT: Replication avoids unnecessary replacement of power plant components
International Nuclear Information System (INIS)
Neubauer, B.; Wedel, U.
1984-01-01
Effective fracture prevention for components operating at high temperatures can be achieved without sacrificing useful life. This is done by nondestructive-metallographic examination at crack-susceptible locations of the components. Creep microcracks approximately one micron in size can be detected. RWTUV experience shows that, in general, the components need not be replaced or repaired until these microcracks have grown to form small creep macrocracks. The long prewarning period before macrocracks form provides assurance of safe operation for the full useful life of the components tested. The economic benefit achieved is considerable. Replication techniques have been widely applied by the authors in operating power plants since 1977. This nondestructive-evaluation method involves polishing small areas of selected piping-system components, preparing replicas of the polished areas, and examining the replicas under microscope for evidence of cavities, microcracks, or macrocracks
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Understanding the impact of genetic testing for inherited retinal dystrophy.
Combs, Ryan; McAllister, Marion; Payne, Katherine; Lowndes, Jo; Devery, Sophie; Webster, Andrew R; Downes, Susan M; Moore, Anthony T; Ramsden, Simon; Black, Graeme; Hall, Georgina
2013-11-01
The capability of genetic technologies is expanding rapidly in the field of inherited eye disease. New genetic testing approaches will deliver a step change in the ability to diagnose and extend the possibility of targeted treatments. However, evidence is lacking about the benefits of genetic testing to support service planning. Here, we report qualitative data about retinal dystrophy families' experiences of genetic testing in United Kingdom. The data were part of a wider study examining genetic eye service provision. Twenty interviewees from families in which a causative mutation had been identified by a genetic eye clinic were recruited to the study. Fourteen interviewees had chosen to have a genetic test and five had not; one was uncertain. In-depth telephone interviews were conducted allowing a thorough exploration of interviewees' views and experiences of the benefits of genetic counselling and testing. Transcripts were analysed using thematic analysis. Both affected and unaffected interviewees expressed mainly positive views about genetic testing, highlighting benefits such as diagnostic confirmation, risk information, and better preparation for the future. Negative consequences included the burden of knowledge, moral dilemmas around reproduction, and potential impact on insurance. The offer of genetic testing was often taken up, but was felt unnecessary in some cases. Interviewees in the study reported many benefits, suggesting genetic testing should be available to this patient group. The benefits and risks identified will inform future evaluation of models of service delivery. This research was part of a wider study exploring experiences of families with retinal dystrophy.
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Hu, Xiaoqing; Bergström, Zara M; Bodenhausen, Galen V; Rosenfeld, J Peter
2015-07-01
The present study investigated the extent to which people can suppress unwanted autobiographical memories in a memory-detection context involving a mock crime. Participants encoded sensorimotor-rich memories by enacting a lab-based crime (stealing a ring) and received instructions to suppress memory of the crime in order to evade guilt detection in a brain-wave-based concealed-information test. Aftereffects of suppression on automatic memory processes were measured in an autobiographical Implicit Association Test. Results showed that suppression attenuated brain-wave activity (the P300) associated with crime-relevant memory retrieval, which rendered waveforms from innocent and guilty participants indistinguishable. However, the two groups could nevertheless be discriminated via the late-posterior-negative slow wave, which may reflect the need to monitor response conflict arising between voluntary suppression and automatic recognition processes. Finally, extending recent findings that suppression can impair implicit memory processes, we provide novel evidence that suppression reduces automatic cognitive biases often associated with actual autobiographical memories. © The Author(s) 2015.
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International Nuclear Information System (INIS)
Bruno, Sergio; De Benedictis, Michele; La Scala, Massimo; Wangensteen, Ivar
2006-01-01
The paper is aimed at showing how demand-side policies for increasing inner demand elasticity could help in reducing market inefficiencies generated by transfer limits on interconnections, with a special regard to energy imports dependent countries. In order to develop the studies in a realistic environment, a model for the Italian electricity market has been developed. Test results show effects of variations in demand elasticity on the national social surplus and congestion costs. It will be shown how an increase of demand elasticity can counterbalance the need of additional transfer capacity in reducing cross-border congestions. (author)
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Advanced automated gain adjustments for in-vivo ultrasound imaging
DEFF Research Database (Denmark)
Moshavegh, Ramin; Hemmsen, Martin Christian; Martins, Bo
2015-01-01
Automatic gain adjustments are necessary on the state-of-the-art ultrasound scanners to obtain optimal scan quality, while reducing the unnecessary user interactions with the scanner. However, when large anechoic regions exist in the scan plane, the sudden and drastic variation of attenuations in....... Wilcoxon signed-rank test was then applied to the ratings provided by radiologists. The average VAS score was highly positive 12.16 (p-value: 2.09 x 10-23) favoring the gain-adjusted scans with the proposed algorithm....
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Energy conservation and management system using efficient building automation
Ahmed, S. Faiz; Hazry, D.; Tanveer, M. Hassan; Joyo, M. Kamran; Warsi, Faizan A.; Kamarudin, H.; Wan, Khairunizam; Razlan, Zuradzman M.; Shahriman A., B.; Hussain, A. T.
2015-05-01
In countries where the demand and supply gap of electricity is huge and the people are forced to endure increasing hours of load shedding, unnecessary consumption of electricity makes matters even worse. So the importance and need for electricity conservation increases exponentially. This paper outlines a step towards the conservation of energy in general and electricity in particular by employing efficient Building Automation technique. It should be noted that by careful designing and implementation of the Building Automation System, up to 30% to 40% of energy consumption can be reduced, which makes a huge difference for energy saving. In this study above mentioned concept is verified by performing experiment on a prototype experimental room and by implementing efficient building automation technique. For the sake of this efficient automation, Programmable Logic Controller (PLC) is employed as a main controller, monitoring various system parameters and controlling appliances as per required. The hardware test run and experimental findings further clarifies and proved the concept. The added advantage of this project is that it can be implemented to both small and medium level domestic homes thus greatly reducing the overall unnecessary load on the Utility provider.
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Argnani, Fiorenza; Di Camillo, Mauro; Marinaro, Vanessa; Foglietta, Tiziana; Avallone, Veronica; Cannella, Carlo; Vernia, Piero
2008-10-28
To evaluate the prevalence of lactose intolerance (LI) following a load of 12.5 g in patients diagnosed as high-grade malabsorbers using the hydrogen breath test (HBT)-25. Ninety patients showing high-grade malabsorption at HBT-25 were submitted to a second HBT with a lactose load of 12.5 g. Peak hydrogen production, area under the curve of hydrogen excretion and occurrence of symptoms were recorded. Only 16 patients (17.77%) with positive HBT-25 proved positive at HBT-12.5. Hydrogen production was lower as compared to HBT-25 (peak value 21.55 parts per million (ppm) +/- 29.54 SD vs 99.43 ppm +/- 40.01 SD; P lactose and a strict lactose restriction on the basis of a "standard" HBT is, in most instances, unnecessary. Thus, the 25 g lactose tolerance test should probably be substituted by the 12.5 g test in the diagnosis of LI, and in providing dietary guidelines to patients with suspected lactose malabsorption/intolerance.
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Elevated phenylalanine on newborn screening: follow-up testing may reveal undiagnosed galactosaemia.
Shakespeare, Lynette; Downing, Melanie; Allen, Joyce; Casbolt, Ann-Marie; Ellin, Sheila; Maloney, Martin; Race, Gillian; Bonham, Jim
2010-11-01
Introduction Newborn screening for phenylketonuria (PKU) can reveal other conditions which lead to an increased blood spot phenylalanine (Phe) concentration. We have investigated the proportion of blood spot samples that gave a positive screen due to clinically significant conditions other than PKU, compared the positive predictive value (PPV) of our referral Phe cut-off with that recommended by the UK Newborn Screening Programme Centre (UKNSPC) (>210 and >240 μmol/L, respectively) and evaluated the effectiveness of reflex testing for galactosaemia using a lower blood spot Phe cut-off concentration of 130 μmol/L. All blood spot samples that screened positive, for an increased Phe concentration, between April 2001 and March 2008, were identified from the records of the Sheffield Newborn Screening Laboratory and the diagnoses noted. In addition, all cases of galactosaemia detected in or notified to our screening laboratory within this time were also examined and the screened Phe concentrations compared. Out of 438,674 babies who were screened, 67 had Phe concentration >210 μmol/L (15 per 100,000). Of these, 40 had PKU or persistent hyperphenylalaninaemia with a Phe concentration identified by screening between 270 and 2350 μmol/L. A further 11 were diagnosed with another clinically significant disorder: galactosaemia (n = 8), biopterin defects (n = 2), tyrosinaemia Type 1 (n = 1). In addition, 16 had transient elevations in Phe. In total, nine cases of galactosaemia were identified, of whom, three had Phe concentrations 240 μmol/L) will not affect the detection rate of classical PKU, but will improve the PPV from 76% to 80%. The use of a lower cut-off (130 μmol/L) for reflex galactosaemia testing enables the timely identification of asymptomatic cases that benefit particularly from early treatment, without prompting any unnecessary clinical referrals or delaying any referrals. This intervention may reduce mortality in this vulnerable group.
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DEFF Research Database (Denmark)
Marstrand, Peter; Axelsson, Anna; Thune, Jens Jakob
2016-01-01
-CAG) (81%), exercise stress test (47%), late potentials (54%), electrophysiological study (44%), pharmacological provocation (44%), and/or myocardial biopsy (16%). Family screening was indicated for 53 probands (67%) prior to CMR. After full workup, only 43 cases (54%) warranted evaluation of relatives (19......AIMS: Guidelines recommend evaluation of family members of sudden cardiac death victims. However, initiation of cascade screening in families with uncertain diagnoses is not cost-effective and may cause unnecessary concern. For these reasons, we set out to assess to what extent cardiac magnetic...... resonance imaging (CMR) would increase the diagnostic precision and thereby possibly change the indication for family screening in patients with ventricular tachyarrhythmias. METHODS AND RESULTS: We retrospectively collected data from 79 patients hospitalized with aborted cardiac arrest (resuscitated from...
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East, Christine E; Kane, Stefan C; Davey, Mary-Ann; Kamlin, C Omar; Brennecke, Shaun P
2015-11-03
The rate of caesarean sections around the world is rising each year, reaching epidemic proportions. Although many caesarean sections are performed for concerns about fetal welfare on the basis of abnormal cardiotocography, the majority of babies are shown to be well at birth, meaning that the operation, with its inherent short and long term risks, could have been avoided without compromising the baby's health. Previously, fetal scalp blood sampling for pH estimation was performed in the context of an abnormal cardiotocograph, to improve the identification of babies in need of expedited delivery. This test has largely been replaced by lactate measurement, although its validity is yet to be established through a randomised controlled trial. This study aims to test the hypothesis that the performance of fetal scalp blood lactate measurement for women in labour with an abnormal cardiotocograph will reduce the rate of birth by caesarean section from 38 % to 25 % (a 35 % relative reduction). Prospective unblinded randomised controlled trial conducted at a single tertiary perinatal centre. Women labouring with a singleton fetus in cephalic presentation at 37 or more weeks' gestation with ruptured membranes and with an abnormal cardiotocograph will be eligible. Participants will be randomised to one of two groups: fetal monitoring by cardiotocography alone, or cardiotocography augmented by fetal scalp blood lactate analysis. Decisions regarding the timing and mode of delivery will be made by the treating team, in accordance with hospital protocols. The primary study endpoint is caesarean section with secondary outcomes collected from maternal, fetal and neonatal clinical course and morbidities. A cost effectiveness analysis will also be performed. A sample size of 600 will provide 90 % power to detect the hypothesised difference in the proportion of women who give birth by caesarean section. This world-first trial is adequately powered to determine the impact of fetal
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Break the fast? Update on patient preparation for cholesterol testing.
Naugler, Christopher; Sidhu, Davinder
2014-10-01
To provide an update on the clinical usefulness of nonfasting versus fasting lipid testing to improve patient compliance, patient safety, and clinical assessment in cholesterol testing. Recommendations are identified as supported by good, fair, and poor (conflicting or insufficient) evidence, according to the classifications adopted by the Canadian Task Force on Preventive Health Care. Screening for dyslipidemia as a risk factor for coronary artery disease and management of lipid-lowering medications are key parts of primary care. Recent evidence has questioned the fasting requirement for lipid testing. In population-based studies, total cholesterol, high-density lipoprotein cholesterol, and non-low-density lipoprotein cholesterol all varied by an average of 2% with fasting status. For routine screening, nonfasting cholesterol measurement is now a reasonable alternative to a fasting cholesterol measurement. For patients with diabetes, the fasting requirement might be an important safety issue because of problems with hypoglycemia. For the monitoring of triglyceride and low-density lipoprotein cholesterol levels in patients taking lipid-lowering medications, fasting becomes more important. Fasting for routine lipid level determinations is largely unnecessary and unlikely to affect patient clinical risk stratification, while nonfasting measurement might improve patient compliance and safety. Copyright© the College of Family Physicians of Canada.
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Cumming, John M.; De Miranda, Michael A.
2012-01-01
Retroactive interference (RI) in list learning occurs when the learning of a second list of words interferes with the recall of the first learned list. Having the lists be thematically different can reduce retroactive interference within list learning; however, this study demonstrates how RI can be reduced when the lists contain similar words.…
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Biochemical characterization of cholesterol-reducing Eubacterium.
Mott, G E; Brinkley, A W; Mersinger, C L
1980-12-01
We characterized two isolates of cholesterol-reducing Eubacterium by conducting conventional biochemical tests and by testing various sterols and glycerolipids as potential growth factors. In media containing cholesterol and plasmenylethanolamine, the tests for nitrate reduction, indole production, and gelatin and starch hydrolyses were negative, and no acid was produced from any of 22 carbohydrates. Both isolates hydrolyzed esculin to esculetin, indicating beta-glycosidase activity. In addition to plasmenylethanolamine, five other lipids which contain an alkenyl ether residue supported growth of Eubacterium strain 403 in a lecithin-cholesterol base medium. Of six steroids tested, cholesterol, cholest-4-en-3-one, cholest-4-en-3 beta-ol (allocholesterol), and androst-5-en-3 beta-ol-17-one supported growth of Eubacterium strain 403. All four steroids were reduced to the 3 beta-ol, 5 beta-H products. The delta 5 steroids cholest-5-en-3 alpha-ol (epicholesterol) and 22,23-bisnor-5-cholenic acid-3-beta-ol were not reduced and did not support growth of the Eubacterium strain.
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Face Perception and Test Reliabilities in Congenital Prosopagnosia in Seven Tests
Directory of Open Access Journals (Sweden)
Janina Esins
2016-01-01
Full Text Available Congenital prosopagnosia, the innate impairment in recognizing faces, is a very heterogeneous disorder with different phenotypical manifestations. To investigate the nature of prosopagnosia in more detail, we tested 16 prosopagnosics and 21 controls with an extended test battery addressing various aspects of face recognition. Our results show that prosopagnosics exhibited significant impairments in several face recognition tasks: impaired holistic processing (they were tested amongst others with the Cambridge Face Memory Test (CFMT as well as reduced processing of configural information of faces. This test battery also revealed some new findings. While controls recognized moving faces better than static faces, prosopagnosics did not exhibit this effect. Furthermore, prosopagnosics had significantly impaired gender recognition—which is shown on a groupwise level for the first time in our study. There was no difference between groups in the automatic extraction of face identity information or in object recognition as tested with the Cambridge Car Memory Test. In addition, a methodological analysis of the tests revealed reduced reliability for holistic face processing tests in prosopagnosics. To our knowledge, this is the first study to show that prosopagnosics showed a significantly reduced reliability coefficient (Cronbach’s alpha in the CFMT compared to the controls. We suggest that compensatory strategies employed by the prosopagnosics might be the cause for the vast variety of response patterns revealed by the reduced test reliability. This finding raises the question whether classical face tests measure the same perceptual processes in controls and prosopagnosics.
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How to reduce errors in applying impairment tests
Petersen, Christian; Plenborg, Thomas
2007-01-01
Fair value accounting has become predominant in accounting as a vast number of IAS/IFRS standards are based on fair value accounting, including IAS 36 Impairment of assets. Fair value accounting for goodwill is technically challenging, since market prices are not observable. Thus, valuation technologies must be applied in order to test goodwill for impairment. While prior research on goodwill has concentrated on either the (dis)advantages for each accounting procedure for goodwill or exami...
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Consumer detection and acceptability of reduced-sodium bread.
La Croix, Kimberly W; Fiala, Steven C; Colonna, Ann E; Durham, Catherine A; Morrissey, Michael T; Drum, Danna K; Kohn, Melvin A
2015-06-01
Bread is the largest contributor of Na to the American diet and excess Na consumption contributes to premature death and disability. We sought to determine the Na level at which consumers could detect a difference between reduced-Na bread and bread with typical Na content, and to determine if consumer sensory acceptability and purchase intent differed between reduced-Na bread and bread with typical Na content. Difference testing measured ability to detect differences in control bread and reduced-Na bread using two-alternative forced choice testing. Acceptability was measured using a nine-point hedonic scale and purchase intent was measured using a five-point purchase intent scale. Difference and acceptability testing were conducted in Portland, OR, USA in January 2013. Eighty-two consumers participated in difference testing and 109 consumers participated in acceptability testing. Consumers did not detect a difference in saltiness between the control bread and the 10 % reduced-Na bread, but did detect a difference between the control bread and bread reduced in Na content by 20 % and 30 %. Na reductions had no effect on consumer acceptability of sensory characteristics, including overall liking, appearance, aroma, flavour, sweetness, salt level and texture, or purchase intent. Reducing Na levels by up to 30 % in the sandwich bread tested did not affect consumer liking or purchase intent of the product. These results support national recommendations for small, incremental Na reductions in the food supply over time and assure bread manufacturers that sensory characteristics and consumer purchase intent of their products will be preserved after Na reductions occur.
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A premature demise for RERTR [Reduced Enrichment for Research and Test Reactors programme]?
International Nuclear Information System (INIS)
Rydell, R.J.
1990-01-01
A common commitment from France, Belgium, Germany and the US to eliminate highly enriched uranium from their research reactors is needed to help guard against this material falling into the wrong hands. In the US, an essential part of this commitment would be rekindling the weakened Reduced Enrichment for Research and Test Reactors programme (RERTR). This is an American initiative to develop low-enrichment uranium fuel for research reactors that have previously required weapons-usable material. Underway since 1978 at Argonne National Laboratory, RERTR has achieved some impressive results: the development of higher density, low enriched fuels that are suitable for use at over 90% of the world's research reactors; a net reduction of US exports of highly enriched uranium (HEU) from the annual 700kg levels in the late 1970s to a 1990 level of just over 100kg; the encouragement of international scientific co-operation aimed at developing new fuels and facilitating the conversion of existing reactors to these fuels. However, in recent years, the US commitment to RERTR has been declining -budgets have fallen and advanced fuel development work has terminated. (author)
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Dynamic Optimization for IPS2 Resource Allocation Based on Improved Fuzzy Multiple Linear Regression
Directory of Open Access Journals (Sweden)
Maokuan Zheng
2017-01-01
Full Text Available The study mainly focuses on resource allocation optimization for industrial product-service systems (IPS2. The development of IPS2 leads to sustainable economy by introducing cooperative mechanisms apart from commodity transaction. The randomness and fluctuation of service requests from customers lead to the volatility of IPS2 resource utilization ratio. Three basic rules for resource allocation optimization are put forward to improve system operation efficiency and cut unnecessary costs. An approach based on fuzzy multiple linear regression (FMLR is developed, which integrates the strength and concision of multiple linear regression in data fitting and factor analysis and the merit of fuzzy theory in dealing with uncertain or vague problems, which helps reduce those costs caused by unnecessary resource transfer. The iteration mechanism is introduced in the FMLR algorithm to improve forecasting accuracy. A case study of human resource allocation optimization in construction machinery industry is implemented to test and verify the proposed model.
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Directory of Open Access Journals (Sweden)
Leopoldo Magacho
2006-04-01
auxiliary test in glaucoma diagnosis. Despite the small sample size, concurrent use of prostaglandin analogues apparently reduces the test's sensitivity.
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Elastodynamic spot testing - assessing serviceability of aging elastomer parts
International Nuclear Information System (INIS)
Gracie, B.; Metcalfe, R.; Wensel, R.
1995-01-01
The properties of all polymers change with time as a function of their environment. Traditional practice has been to replace these parts according to generic time limits based on estimates of worst case material properties and conditions. This is overly-conservative in many cases, and creates unnecessary maintenance work and costs for replacement and disposal. Much of this could be avoided if the serviceability of elastomeric parts such as seals, diaphragms, gaskets, cable insulation and hoses could be reassessed on a routine basis. Elastodynamic spot testing offers a way to do this. Parts can be sampled while in service or storage to compare their as-new and used (or aged) elastodynamic properties. This data can usually be correlated with the results of functional tests to prove that material properties have not degraded to the point where the part could fail. This spot testing is similar to a micro-hardness test, but includes stress-relaxation and subsequent recovery. It provides a nondestructive means to assess the effective age of the material at a point, or several points, on a part. Sampling of hardness alone is rarely sufficient to know whether a part is still functional because this overlooks the material's viscoelastic and strength properties. An elastodynamic spot tester has been used to test different sizes, shapes and hardnesses of elastomeric parts at different levels of strain, i.e., indentation depths. An initial test program has given informative relaxation and recovery data, showing repeatability and comparing well with finite element analysis of the indentation process. Tests of aged 0-rings and diaphragms have revealed different elastodynamic properties, depending on the elastomer compound and aging conditions. (author)
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Mixed waste characterization and certification at the Nevada Test Site
International Nuclear Information System (INIS)
Kawamura, T.A.; Dodge, R.L.; Fitzsimmons, P.K.
1988-01-01
The Radioactive Waste Management Project at the Nevada Test Site (NTS) was recently granted interim status by the state of Nevada to receive mixed waste. The RCRA Part B permit application has been revised and submitted to the state. Preliminary indications are that the permit will be granted. In conjunction with revision of the Part B permit application, pertinent DOE guidelines governing waste acceptance criteria and waste characterization were also revised. The guidelines balance the need for full characterization of hazardous constituents with ALARA precepts. Because it is not always feasible to obtain a full chemical analysis without undue or unnecessary radiological exposure of personnel, process knowledge is considered an acceptable method of waste characterization. A balance of administrative controls and verification procedures, as well as careful documentation and high standards of quality assurance, are essential to the characterization and certification program developed for the NTS
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1995-10-01
off convention • Eliminate the civil use of HEU (includes RERTR ) • Reduce stockpiles of civil HEU and plutonium • Promote alternatives to the...these countries. ANL supports the Department’s Reduced Enrichment for Research and Test Reactor ( RERTR ) Program by providing the technical means to...scientists and engineers at 60 institutes in Russia, Ukraine, Kazakhstan and Belarus. The United States and Russia have agreed to pursue a joint RERTR
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The impact of repeat-testing of common chemistry analytes at critical concentrations.
Onyenekwu, Chinelo P; Hudson, Careen L; Zemlin, Annalise E; Erasmus, Rajiv T
2014-12-01
Early notification of critical values by the clinical laboratory to the treating physician is a requirement for accreditation and is essential for effective patient management. Many laboratories automatically repeat a critical value before reporting it to prevent possible misdiagnosis. Given today's advanced instrumentation and quality assurance practices, we questioned the validity of this approach. We performed an audit of repeat-testing in our laboratory to assess for significant differences between initial and repeated test results, estimate the delay caused by repeat-testing and to quantify the cost of repeating these assays. A retrospective audit of repeat-tests for sodium, potassium, calcium and magnesium in the first quarter of 2013 at Tygerberg Academic Laboratory was conducted. Data on the initial and repeat-test values and the time that they were performed was extracted from our laboratory information system. The Clinical Laboratory Improvement Amendment criteria for allowable error were employed to assess for significant difference between results. A total of 2308 repeated tests were studied. There was no significant difference in 2291 (99.3%) of the samples. The average delay ranged from 35 min for magnesium to 42 min for sodium and calcium. At least 2.9% of laboratory running costs for the analytes was spent on repeating them. The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.
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Tilton-Weaver, L.C.; Burk, W.J.; Kerr, M.; Stattin, H.
2013-01-01
We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers.
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Inconvenient and Unnecessary? Regulations in the U.S. Taxi Industry
Directory of Open Access Journals (Sweden)
Johnson Colton
2017-12-01
Full Text Available A Certificate of Public Convenience and Necessity (CPCN is a common requirement for a new business owner in services such as utilities, communications, healthcare, and transportation. However, studies have called into question the effectiveness and purpose of these laws when applied in certain industries. This study chronicles the development of and justifications provided for the enactment of CPCN laws. It then empirically tests the effectiveness of these laws in the taxi industry. This paper finds no evidence that the CPCN laws in the taxi industry are meeting their objectives. Some evidence suggests that CPCN laws achieve the opposite of their intention.
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A compliance testing program for diagnostic X-ray equipment
International Nuclear Information System (INIS)
Hutchinson, D.E.; Cobb, B.J.; Jacob, C.S.
1999-01-01
Compliance testing is nominally that part of a quality assurance program dealing with those aspects of X-ray equipment performance that are subject to radiation control legislation. Quality assurance programs for medical X-ray equipment should be an integral part of the quality culture in health care. However while major hospitals and individual medical centers may implement such programs with some diligence, much X-ray equipment can remain unappraised unless there is a comprehensive regulatory inspection program or some form of compulsion on the equipment owner to implement a testing program. Since the late 1950s all X-ray equipment in the State of Western Australia has been inspected by authorized officers acting on behalf of the Radiological Council, the regulatory authority responsible for administration of the State's Radiation Safety Act. However, economic constraints, coupled with increasing X-ray equipment numbers and a geographically large State have significantly affected the inspection rate. Data available from inspections demonstrate that regular compliance and performance checks are essential in order to ensure proper performance and to minimize unnecessary patient and operator dose. To ensure that diagnostic X-ray equipment complies with accepted standards and performance criteria, the regulatory authority introduced a compulsory compliance testing program for all medical, dental and chiropractic diagnostic X-ray equipment effective from 1 January 1997
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Kurien, Regi; Chrisolyte, Shipra; Rupa, V
2009-09-01
To assess eustachian tubal function (ETF) preoperatively in patients with chronic suppurative otitis media (CSOM) with central perforation by performing the inflation-deflation test. To correlate the results of the inflation-deflation test with the finding of aditus patency or block in patients with CSOM STUDY DESIGN: Prospective, cohort Tertiary care hospital Eighty adult patients with chronic suppurative otitis media and central perforation were recruited into the study. There were 45 males and 35 females. All patients underwent preoperative inflation-deflation test followed by cortical mastoidectomy and tympanoplasty. The patency of the aditus was assessed intraoperatively. Equalization of pressure on inflation-deflation test and intraoperative assessment of aditus patency Of a total of 80 patients, 49 patients were found to have discharging ears and 31 had dry ears at the time of surgery. In dry ears the inflation-deflation test had a sensitivity of 93% in predicting aditus patency although the specificity was lower at 67%. In discharging ears the sensitivity in predicting aditus patency was 72% and the specificity was 67%. The eustachian tube inflation-deflation test is a sensitive test for predicting aditus patency in patients with dry ears but less so in patients with discharging ears. Hence, it could be used in the former to avoid unnecessary exploration of the mastoid.
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Nikitovic-Jokic, Milica; Holubowich, Corinne
2016-01-01
Background Screening with mammography can detect breast cancer early, before clinical symptoms appear. Some cancers, however, are not captured with mammography screening alone. Among women at high risk for breast cancer, magnetic resonance imaging (MRI) has been suggested as a safe adjunct (supplemental) screening tool that can detect breast cancers missed on screening mammography, potentially reducing the number of deaths associated with the disease. However, the use of adjunct screening tests may also increase the number of false-positive test results, which may lead to unnecessary follow-up testing, as well as patient stress and anxiety. We investigated the benefits and harms of MRI as an adjunct to mammography compared with mammography alone for screening women at less than high risk (average or higher than average risk) for breast cancer. Methods We searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Centre for Reviews and Dissemination (CRD) Health Technology Assessment Database, and National Health Service (NHS) Economic Evaluation Database, from January 2002 to January 2016, for evidence of effectiveness, harms, and diagnostic accuracy. Only studies evaluating the use of screening breast MRI as an adjunct to mammography in the specified populations were included. Results No studies in women at less than high risk for breast cancer met our inclusion criteria. Conclusions It remains uncertain if the use of adjunct screening breast MRI in women at less than high risk (average or higher than average risk) for breast cancer will reduce breast cancer–related mortality without significant increases in unnecessary follow-up testing and treatment. PMID:27990198
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[Exercise laryngoscopy: a new method for the differential diagnosis of dyspnea on exertion].
Tervonen, Hanna; Iljukov, Sergei; Niskanen, Minna-Liisa; Vilkman, Erkki; Sovijärvi, Anssi; Aaltonen, Leena-Maija
2011-01-01
Exertional dyspnea originating from the laryngeal level can be established with certainty only if the paradoxical vocal cord adduction is observed during dyspnea. We have developed a novel diagnostic method, exercise laryngoscopy, which involves observation of the larynx with a flexible endoscope applied via the nose during a bicycle ergometry test. It has been our aim to improve the differential diagnosis of dyspnea on exertion and thus also reduce unnecessary antiasthmatic medication. Exercise laryngoscopy allows examination in the out-patient clinics because the method is well tolerated.
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Energy Technology Data Exchange (ETDEWEB)
Raj, Baldev [Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102 (India); Jayakumar, T., E-mail: tjk@igcar.gov.in [Indira Gandhi Centre for Atomic Research, Kalpakkam 603 102 (India)
2011-10-01
For the development of Reduced Activation Ferritic-Martensitic Steel (RAFMS), for the Indian Test Blanket Module for ITER, a 3-phase programme has been adopted. The first phase consists of melting and detailed characterization of a laboratory scale heat conforming to Eurofer 97 composition, to demonstrate the capability of the Indian industry for producing fusion grade steel. In the second phase which is currently in progress, the chemical composition will be optimized with respect to tungsten and tantalum for better combination of mechanical properties. Characterization of the optimized commercial scale India-specific RAFM steel will be carried out in the third phase. The first phase of the programme has been successfully completed and the tensile, impact and creep properties are comparable with Eurofer 97. Laser and electron beam welding parameters have been optimized and welding consumables were developed for Narrow Gap - Gas Tungsten Arc welding and for laser-hybrid welding.
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Generalized Reduced Rank Tests using the Singular Value Decomposition
F.R. Kleibergen (Frank); R. Paap (Richard)
2003-01-01
textabstractWe propose a novel statistic to test the rank of a matrix. The rank statistic overcomes deficiencies of existing rank statistics, like: necessity of a Kronecker covariance matrix for the canonical correlation rank statistic of Anderson (1951), sensitivity to the ordering of the variables
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Good practices for cost effective maintenance of nuclear power plants
International Nuclear Information System (INIS)
1997-02-01
This publication is organized around five areas that were identified by the utilities and government organizations who contributed to this report as most important to them. They are: Increasing production through maintenance activities related to improved plant material condition, reduced duration of planned outages, use of on-line maintenance and reduced frequency of forced outages; reducing workload through avoiding unnecessary regulatory burden and using reliability centered maintenance and condition monitoring; improving maintenance processes through better planning and scheduling, use of information management systems, graduated work controls, and appropriate post-maintenance testing; improving productivity through better teamwork, greater sharing of resources, and better radiation management associated with maintenance; measuring performance of maintenance activities through such tools as performance measures and benchmarking. Figs, tabs
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Generalized reduced rank tests using the singular value decomposition
Kleibergen, F.R.; Paap, R.
2002-01-01
We propose a novel statistic to test the rank of a matrix. The rank statistic overcomes deficiencies of existing rank statistics, like: necessity of a Kronecker covariance matrix for the canonical correlation rank statistic of Anderson (1951), sensitivity to the ordering of the variables for the LDU
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Sleep can reduce proactive interference.
Abel, Magdalena; Bäuml, Karl-Heinz T
2014-01-01
Sleep has repeatedly been connected to processes of memory consolidation. While extensive research indeed documents beneficial effects of sleep on memory, little is yet known about the role of sleep for interference effects in episodic memory. Although two prior studies reported sleep to reduce retroactive interference, no sleep effect has previously been found for proactive interference. Here we applied a study format differing from that employed by the prior studies to induce a high degree of proactive interference, and asked participants to encode a single list or two interfering lists of paired associates via pure study cycles. Testing occurred after 12 hours of diurnal wakefulness or nocturnal sleep. Consistent with the prior work, we found sleep in comparison to wake did not affect memory for the single list, but reduced retroactive interference. In addition we found sleep reduced proactive interference, and reduced retroactive and proactive interference to the same extent. The finding is consistent with the view that arising benefits of sleep are caused by the reactivation of memory contents during sleep, which has been suggested to strengthen and stabilise memories. Such stabilisation may make memories less susceptible to competition from interfering memories at test and thus reduce interference effects.
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76 FR 69595 - Application of Third Party Testing Requirements; Reducing Third Party Testing Burdens
2011-11-08
... material change in the product's design or manufacturing process, including the sourcing of component parts...)) defines a ``children's product,'' in relevant part, as a consumer product designed or intended primarily... testing by a third party) be designed to show the similarity between the products? Also, sampling...
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International Nuclear Information System (INIS)
Vesely, W.E.
1999-01-01
Principles of resource-effectiveness and regulatory-effectiveness are presented which systematically compare the resources expended on a requirement or activity versus its risk importance. To evaluate resource-effectiveness and regulatory-effectiveness, cost-benefit analysis principles are generalized to resource versus risk importance principles. It is shown that by applying resource-importance analyses, current requirements and activities can be systematically evaluated for their resource-effectiveness and their risk-consistency. Strategies can then be developed to maximize both resource-effectiveness and risk-consistency which reduces unnecessary burdens while maintaining risk or reducing risk. The principles, approaches, and implementation schemes which are presented provide a systematic process for evaluating and optimizing resource-effectiveness and regulatory-effectiveness. The illustrations that are presented show that current NRC and industry actions are not resource-effective. By improving their resource-effectiveness and risk-consistency, significant burden reductions are achievable while risk, e.g. core damage frequency, is maintained or is reduced. The illustrations show that by optimizing industry resources and NRC resources with regard to their risk-effectiveness, significant burden reductions are achievable for both the industry and NRC. Algorithms and software exist for broad-scale implementations. Because of the burden reductions which are identified and the improvements in risk-consistency which result, resource-importance analysis should be the first step in risk-informed applications. Resource-importance analysis is so important and can provide such large benefits that it needs to be carried out on all current requirements that are addressed by risk-informed applications
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Thermal anchoring of wires in large scale superconducting coil test experiment
International Nuclear Information System (INIS)
Patel, Dipak; Sharma, A.N.; Prasad, Upendra; Khristi, Yohan; Varmora, Pankaj; Doshi, Kalpesh; Pradhan, S.
2013-01-01
Highlights: • We addressed how thermal anchoring in large scale coil test is different compare to small cryogenic apparatus? • We did precise estimation of thermal anchoring length at 77 K and 4.2 K heat sink in large scale superconducting coil test experiment. • We addressed, the quality of anchoring without covering entire wires using Kapton/Teflon tape. • We obtained excellent results in temperature measurement without using GE Varnish by doubling estimated anchoring length. -- Abstract: Effective and precise thermal anchoring of wires in cryogenic experiment is mandatory to measure temperature in milikelvin accuracy and to avoid unnecessary cooling power due to additional heat conduction from room temperature (RT) to operating temperature (OT) through potential, field, displacement and stress measurement instrumentation wires. Instrumentation wires used in large scale superconducting coil test experiments are different compare to cryogenic apparatus in terms of unique construction and overall diameter/area due to errorless measurement in large time-varying magnetic field compare to small cryogenic apparatus, often shielded wires are used. Hence, along with other variables, anchoring techniques and required thermal anchoring length are entirely different in this experiment compare to cryogenic apparatus. In present paper, estimation of thermal anchoring length of five different types of instrumentation wires used in coils test campaign at Institute for Plasma Research (IPR), India has been discussed and some temperature measurement results of coils test campaign have been presented
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Taira, Yasuyuki; Hayashida, Naomi; Tsuchiya, Rimi; Yamaguchi, Hitoshi; Takahashi, Jumpei; Kazlovsky, Alexander; Urazalin, Marat; Rakhypbekov, Tolebay; Yamashita, Shunichi; Takamura, Noboru
2013-01-01
For the current on-site evaluation of the environmental contamination and contributory external exposure after the accident at the Chernobyl Nuclear Power Plant (CNPP) and the nuclear tests at the Semipalatinsk Nuclear Testing Site (SNTS), the concentrations of artificial radionuclides in soil samples from each area were analyzed by gamma spectrometry. Four artificial radionuclides (241Am, 134Cs, 137Cs, and 60Co) were detected in surface soil around CNPP, whereas seven artificial radionuclides (241Am, 57Co, 137Cs, 95Zr, 95Nb, 58Co, and 60Co) were detected in surface soil around SNTS. Effective doses around CNPP were over the public dose limit of 1 mSv/y (International Commission on Radiological Protection, 1991). These levels in a contaminated area 12 km from Unit 4 were high, whereas levels in a decontaminated area 12 km from Unit 4 and another contaminated area 15 km from Unit 4 were comparatively low. On the other hand, the effective doses around SNTS were below the public dose limit. These findings suggest that the environmental contamination and effective doses on the ground definitely decrease with decontamination such as removing surface soil, although the effective doses of the sampling points around CNPP in the present study were all over the public dose limit. Thus, the remediation of soil as a countermeasure could be an extremely effective method not only for areas around CNPP and SNTS but also for areas around the Fukushima Dai-ichi Nuclear Power Plant (FNPP), and external exposure levels will be certainly reduced. Long-term follow-up of environmental monitoring around CNPP, SNTS, and FNPP, as well as evaluation of the health effects in the population residing around these areas, could contribute to radiation safety and reduce unnecessary exposure to the public. PMID:23469013
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Directory of Open Access Journals (Sweden)
Yasuyuki Taira
Full Text Available For the current on-site evaluation of the environmental contamination and contributory external exposure after the accident at the Chernobyl Nuclear Power Plant (CNPP and the nuclear tests at the Semipalatinsk Nuclear Testing Site (SNTS, the concentrations of artificial radionuclides in soil samples from each area were analyzed by gamma spectrometry. Four artificial radionuclides ((241Am, (134Cs, (137Cs, and (60Co were detected in surface soil around CNPP, whereas seven artificial radionuclides ((241Am, (57Co, (137Cs, (95Zr, (95Nb, (58Co, and (60Co were detected in surface soil around SNTS. Effective doses around CNPP were over the public dose limit of 1 mSv/y (International Commission on Radiological Protection, 1991. These levels in a contaminated area 12 km from Unit 4 were high, whereas levels in a decontaminated area 12 km from Unit 4 and another contaminated area 15 km from Unit 4 were comparatively low. On the other hand, the effective doses around SNTS were below the public dose limit. These findings suggest that the environmental contamination and effective doses on the ground definitely decrease with decontamination such as removing surface soil, although the effective doses of the sampling points around CNPP in the present study were all over the public dose limit. Thus, the remediation of soil as a countermeasure could be an extremely effective method not only for areas around CNPP and SNTS but also for areas around the Fukushima Dai-ichi Nuclear Power Plant (FNPP, and external exposure levels will be certainly reduced. Long-term follow-up of environmental monitoring around CNPP, SNTS, and FNPP, as well as evaluation of the health effects in the population residing around these areas, could contribute to radiation safety and reduce unnecessary exposure to the public.
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Taira, Yasuyuki; Hayashida, Naomi; Tsuchiya, Rimi; Yamaguchi, Hitoshi; Takahashi, Jumpei; Kazlovsky, Alexander; Urazalin, Marat; Rakhypbekov, Tolebay; Yamashita, Shunichi; Takamura, Noboru
2013-01-01
For the current on-site evaluation of the environmental contamination and contributory external exposure after the accident at the Chernobyl Nuclear Power Plant (CNPP) and the nuclear tests at the Semipalatinsk Nuclear Testing Site (SNTS), the concentrations of artificial radionuclides in soil samples from each area were analyzed by gamma spectrometry. Four artificial radionuclides ((241)Am, (134)Cs, (137)Cs, and (60)Co) were detected in surface soil around CNPP, whereas seven artificial radionuclides ((241)Am, (57)Co, (137)Cs, (95)Zr, (95)Nb, (58)Co, and (60)Co) were detected in surface soil around SNTS. Effective doses around CNPP were over the public dose limit of 1 mSv/y (International Commission on Radiological Protection, 1991). These levels in a contaminated area 12 km from Unit 4 were high, whereas levels in a decontaminated area 12 km from Unit 4 and another contaminated area 15 km from Unit 4 were comparatively low. On the other hand, the effective doses around SNTS were below the public dose limit. These findings suggest that the environmental contamination and effective doses on the ground definitely decrease with decontamination such as removing surface soil, although the effective doses of the sampling points around CNPP in the present study were all over the public dose limit. Thus, the remediation of soil as a countermeasure could be an extremely effective method not only for areas around CNPP and SNTS but also for areas around the Fukushima Dai-ichi Nuclear Power Plant (FNPP), and external exposure levels will be certainly reduced. Long-term follow-up of environmental monitoring around CNPP, SNTS, and FNPP, as well as evaluation of the health effects in the population residing around these areas, could contribute to radiation safety and reduce unnecessary exposure to the public.
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Maintenance proficiency evaluation test bank
International Nuclear Information System (INIS)
Maier, Loran
2003-01-01
The Maintenance Proficiency Evaluation Test Bank (MPETB) is an Electric Power Research Institute- (EPRJ-) operated, utility-sponsored means of developing, maintaining, and disseminating secure, high-quality written and performance maintenance proficiency tests. EPRTs charter is to ensure that all tests and test items that go into the Test Bank have been validated, screened for reliability, and evaluated to high standards of psychometric excellence. Proficiency tests of maintenance personnel.(mechanics, electricians, and instrumentation and control [I and C] technicians) are most often used to determine if an experienced employee is capable of performing maintenance tasks without further training. Such tests provide objective evidence for decisions to exempt an employee from what, for the employee, is unnecessary training. This leads to considerable savings in training costs and increased productivity because supervisors can assign personnel to tasks at which their competence is proven. The ultimate objective of proficiency evaluation is to ensure that qualified maintenance personnel are available to meet the maintenance requirements of the plant Numerous task-specific MPE tests (both written and performance) have been developed and validated using the EPRI MPE methodology by the utilities participating in the MPETB project A task-specific MPE consists of a multiple-choice written examination and a multi-step performance evaluation that can be used to assess an individual's present knowledge and skill level for a given maintenance task. The MPETB contains MPEs and test items for the mechanical, electrical, and I and C classifications that are readily available to participating utilities. Presently, utilities are placing emphasis on developing MPEs to evaluate outage-related maintenance tasks that demonstrate the competency and qualifications of plant and contractor personnel before the start of outage work. Utilities are also using the MPE methodology and process to
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Tilton-Weaver, Lauree C.; Burk, William J.; Kerr, Margaret; Stattin, Håkan
2013-01-01
We tested whether parents can reduce affiliation with delinquent peers through 3 forms of peer management: soliciting information, monitoring rules, and communicating disapproval of peers. We examined whether peer management interrupted 2 peer processes: selection and influence of delinquent peers. Adolescents' feelings of being overcontrolled by…
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International Nuclear Information System (INIS)
Mullen, O.W.; Eubank, B.F.
1986-09-01
Grenadier was the name assigned to the series of underground nuclear experiments conducted at the Nevada Test Site from October 1, 1984 through September 30, 1985. This report includes those experiments publicly announced. Remote radiation measurements were taken during and after each nuclear experiment by a telemetry system. Monitors with portable radiation detection instruments surveyed reentry routes into ground zeros before other planned entries were made. Continuous surveillance was provided while personnel were in radiation areas and appropriate precautions were taken to protect persons from unnecessary exposure to radiation and toxic gases. Protective clothing and equipment were issued as needed. Complete radiological safety and industrial hygiene coverage was provided during drilling and mineback operations. Telemetered and portable radiation detector measurements are listed. Detection instrumentation used is described and specific operational procedures are defined
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International Nuclear Information System (INIS)
Tanigawa, H.; Hirose, T.; Shiba, K.; Kasada, R.; Wakai, E.; Serizawa, H.; Kawahito, Y.; Jitsukawa, S.; Kimura, A.; Kohno, Y.; Kohyama, A.; Katayama, S.; Mori, H.; Nishimoto, K.; Klueh, R.L.; Sokolov, M.A.; Stoller, R.E.; Zinkle, S.J.
2008-01-01
Reduced activation ferritic/martensitic steels (RAFMs) are recognized as the primary candidate structural materials for fusion blanket systems. The RAFM F82H was developed in Japan with emphasis on high-temperature properties and weldability. Extensive irradiation studies have conducted on F82H, and it has the most extensive available database of irradiated and unirradiated properties of all RAFMs. The objective of this paper is to review the R and D status of F82H and to identify the key technical issues for the fabrication of an ITER test blanket module (TBM) suggested from the recent research achievements in Japan. This work clarified that the primary issues with F82H involve welding techniques and the mechanical properties of weld joints. This is the result of the distinctive nature of the joint caused by the phase transformation that occurs in the weld joint during cooling, and its impact on the design of a TBM will be discussed
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Statin use and reduced cancer-related mortality
DEFF Research Database (Denmark)
Nielsen, Sune F; Nordestgaard, Børge G; Bojesen, Stig E
2012-01-01
A reduction in the availability of cholesterol may limit the cellular proliferation required for cancer growth and metastasis. We tested the hypothesis that statin use begun before a cancer diagnosis is associated with reduced cancer-related mortality.......A reduction in the availability of cholesterol may limit the cellular proliferation required for cancer growth and metastasis. We tested the hypothesis that statin use begun before a cancer diagnosis is associated with reduced cancer-related mortality....
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Low Nonfasting Triglycerides and Reduced All-Cause Mortality
DEFF Research Database (Denmark)
Thomsen, Mette; Varbo, Anette; Tybjærg-Hansen, Anne
2014-01-01
BACKGROUND: Increased nonfasting plasma triglycerides marking increased amounts of cholesterol in remnant lipoproteins are important risk factors for cardiovascular disease, but whether lifelong reduced concentrations of triglycerides on a genetic basis ultimately lead to reduced all......-cause mortality is unknown. We tested this hypothesis. METHODS: Using individuals from the Copenhagen City Heart Study in a mendelian randomization design, we first tested whether low concentrations of nonfasting triglycerides were associated with reduced all-cause mortality in observational analyses (n = 13 957......); second, whether genetic variants in the triglyceride-degrading enzyme lipoprotein lipase, resulting in reduced nonfasting triglycerides and remnant cholesterol, were associated with reduced all-cause mortality (n = 10 208). RESULTS: During a median 24 and 17 years of 100% complete follow-up, 9991...
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Mixed waste characterization and certification at the Nevada Test Site
International Nuclear Information System (INIS)
Kawamura, T.A.; Dodge, R.L.; Fitzsimmons, P.K.
1988-01-01
The Radioactive Waste Management Project (RWMP) at the Nevada Test Site (NTS) was recently granted interim status by the state of Nevada to receive mixed waste (MW). The RCRA Part B permit application has been revised and submitted to the state. Preliminary indications are that the permit will be granted. In conjunction with revision of the Part B Permit application, pertinent DOE guidelines governing waste acceptance criteria (WAC) and waste characterization were also revised. The guidelines balance the need for full characterization of hazardous constituents with as low as reasonably achievable (ALARA) precepts. Because it is not always feasible to obtain a full chemical analysis without undue or unnecessary radiological exposure of personnel, process knowledge is considered an acceptable method of waste characterization. A balance of administrative controls and verification procedures, as well as careful documentation and high standards of quality assurance, are essential to the characterization and certification program developed for the NTS
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Tc-99m DTPA renal function tests and diuretic renogram in the dilated upper urinary tract
Energy Technology Data Exchange (ETDEWEB)
Sakagami, Yoshinari; Yamaguchi, Osamu; Suzuki, Takayuki; Kameoka, Hiroshi; Shiraiwa, Yasuo; Suzuki, Akira (Fukushima Medical Coll. (Japan))
1992-09-01
The authors studied patients with dilated upper urinary tracts (16 patients) using radioisotopic split renal function tests and diuretic renogram with [sup 99]mTc-diethylenetriaminepentaacetic acid (Tc-99m DTPA). The etiology was ureteropelvic function stenosis, 11; primary megaureter, 3; ureteral stenosis, 1; and aberrant vessel, 1. Response to diuresis was classified into 3 groups: i.e., obstructive pattern, non-obstructive pattern and partial obstructive pattern. In the non-obstructive group, split renal function was good, and thus an operation was not indicated. In the obstructive group, split renal function was significantly decreased and these patients underwent surgery. In the partial obstructive group, if function of the obstructed kidney was approximately the same as that of the non-obstructed side, then surgery was considered unnecessary. (author).
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Tc-99m DTPA renal function tests and diuretic renogram in the dilated upper urinary tract
International Nuclear Information System (INIS)
Sakagami, Yoshinari; Yamaguchi, Osamu; Suzuki, Takayuki; Kameoka, Hiroshi; Shiraiwa, Yasuo; Suzuki, Akira
1992-01-01
The authors studied patients with dilated upper urinary tracts (16 patients) using radioisotopic split renal function tests and diuretic renogram with 99 mTc-diethylenetriaminepentaacetic acid (Tc-99m DTPA). The etiology was ureteropelvic function stenosis, 11; primary megaureter, 3; ureteral stenosis, 1; and aberrant vessel, 1. Response to diuresis was classified into 3 groups: i.e., obstructive pattern, non-obstructive pattern and partial obstructive pattern. In the non-obstructive group, split renal function was good, and thus an operation was not indicated. In the obstructive group, split renal function was significantly decreased and these patients underwent surgery. In the partial obstructive group, if function of the obstructed kidney was approximately the same as that of the non-obstructed side, then surgery was considered unnecessary. (author)
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Parallelize Automated Tests in a Build and Test Environment
Durairaj, Selva Ganesh
2016-01-01
This thesis investigates the possibilities of finding solutions, in order to reduce the total time spent for testing and waiting times for running multiple automated test cases in a test framework. The “Automated Test Framework”, developed by Axis Communications AB, is used to write the functional tests to test both hardware and software of a resource. The functional tests that tests the software is considered in this thesis work. In the current infrastructure, tests are executed sequentially...
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Uliana, Gustavo Nadal; Tambara, Elizabeth Milla; Baretta, Giorgio Alfredo Pedroso
2015-01-01
The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student's t-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ(2) test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was αpain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. We conclude that the use of remifentanil at doses of 0.2mg/kg and 0.3mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
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Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy.
Sethi, Monica; Zagzag, Jonathan; Patel, Karan; Magrath, Melissa; Somoza, Eduardo; Parikh, Manish S; Saunders, John K; Ude-Welcome, Aku; Schwack, Bradley F; Kurian, Marina S; Fielding, George A; Ren-Fielding, Christine J
2016-03-01
Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy. A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses. A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8%), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7%) cases, while 221 (14.3%) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1%) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1%, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1-67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative. Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.
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Low-Cost, Class D Testing of Spacecraft Photovoltaic Systems Can Reduce Risk
Forgione, Joshua B.; Kojima, Gilbert K.; Hanel, Robert; Mallinson, Mark V.
2014-01-01
The end-to-end verification of a spacecraft photovoltaic power generation system requires light! Specifically, the standard practice for doing so is the Large Area Pulsed Solar Simulation (LAPSS). A LAPSS test can characterize a photovoltaic system's efficiency via its response to rapidly applied impulses of simulated sunlight. However, a Class D program on a constrained budget and schedule may not have the resources to ship an entire satellite for a LAPSS test alone. Such was the case with the Lunar Atmospheric and Dust Environment Explorer (LADEE) program, which was also averse to the risk of hardware damage during shipment. When the Electrical Power System (EPS) team was denied a spacecraft-level LAPSS test, the lack of an end-to-end power generation test elevated to a project-level technical risk. The team pulled together very limited resources to not only eliminate the risk, but build a process to monitor the health of the system through mission operations. We discuss a process for performing a low-cost, end-to-end test of the LADEE photovoltaic system. The approach combines system-level functional test, panel-level performance results, and periodic inspection (and repair) up until launch. Following launch, mission operations tools are utilized to assess system performance based on a scant amount of data. The process starts in manufacturing at the subcontractor. The panel manufacturer provides functional test and LAPSS data on each individual panel. We apply an initial assumption that the per-panel performance is sufficient to meet the power generation requirements. The manufacturer's data is also carried as the performance allocation for each panel during EPS system modeling and initial mission operations. During integration and test, a high-power, professional theater lamp system provides simulated sunlight to each panel on the spacecraft, thereby permitting a true end-to-end system test. A passing test results in a step response to nearly full-rated current
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Dairy heifer manure management, dietary phosphorus, and soil test P effects on runoff phosphorus.
Jokela, William E; Coblentz, Wayne K; Hoffman, Patrick C
2012-01-01
Manure application to cropland can contribute to runoff losses of P and eutrophication of surface waters. We conducted a series of three rainfall simulation experiments to assess the effects of dairy heifer dietary P, manure application method, application rate, and soil test P on runoff P losses from two successive simulated rainfall events. Bedded manure (18-21% solids) from dairy heifers fed diets with or without supplemental P was applied on a silt loam soil packed into 1- by 0.2-m sheet metal pans. Manure was either surface-applied or incorporated (Experiment 1) or surface-applied at two rates (Experiment 2) to supply 26 to 63 kg P ha. Experiment 3 evaluated runoff P from four similar nonmanured soils with average Bray P1-extractable P levels of 11, 29, 51, and 75 mg kg. We measured runoff quantity, total P (TP), dissolved reactive P (DRP), and total and volatile solids in runoff collected for 30 min after runoff initiation from two simulated rain events (70 mm h) 3 or 4 d apart. Manure incorporation reduced TP and DRP concentrations and load by 85 to 90% compared with surface application. Doubling the manure rate increased runoff DRP and TP concentrations an average of 36%. In the same experiment, P diet supplementation increased water-extractable P in manure by 100% and increased runoff DRP concentration threefold. Concentrations of solids, TP, and DRP in runoff from Rain 2 were 25 to 75% lower than from Rain 1 in Experiments 1 and 2. Runoff DRP from nonmanured soils increased quadratically with increasing soil test P. These results show that large reductions in P runoff losses can be achieved by incorporation of manure, avoiding unnecessary diet P supplementation, limiting manure application rate, and managing soils to prevent excessive soil test P levels. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
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Automated test data generation for branch testing using incremental
Indian Academy of Sciences (India)
Cost of software testing can be reduced by automated test data generation to find a minimal set of data that has maximum coverage. Search-based software testing (SBST) is one of the techniques recently used for automated testing task. SBST makes use of control flow graph (CFG) and meta-heuristic search algorithms to ...
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Miller, Matthieu B; Gustin, Mae S
2013-06-01
Industrial gold mining is a significant source of mercury (Hg) emission to the atmosphere. To investigate ways to reduce these emissions, reclamation and dust and mercury control methods used at open pit gold mining operations in Nevada were studied in a laboratory setting. Using this information along with field data, and building off previous work, total annual Hg emissions were estimated for two active gold mines in northern Nevada. Results showed that capping mining waste materials with a low-Hg substrate can reduce Hg emissions from 50 to nearly 100%. The spraying of typical dust control solutions often results in higher Hg emissions, especially as materials dry after application. The concentrated application of a dithiocarbamate Hg control reagent appears to reduce Hg emissions, but further testing mimicking the actual distribution of this chemical within an active leach solution is needed to make a more definitive assessment.
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Energy Technology Data Exchange (ETDEWEB)
Haack, R. (Still Otto GmbH, Bochum (Germany, F.R.)); Schreiter, K.D. (Siemens AG, Erlangen (Germany, F.R.). Bereich Anlagentechnik)
An important step in the coking process is the cooling of the red hot coke. This is mainly done by dowsing with water. The result is the emission of pollutant gases and the waste of heat energy. Disadvantages of this kind can be reduced by the use of a coke drying and cooling plant. This requires, however, because of its complex technology, a tried and tested automation system. A homogeneous solution to the problems faced by the automation system is found in the SIMATIC S5-150U automation unit which was delivered with the coke drying and cooling plant for Pohang (Korea) from the firm Still Otto GmbH in Bochum. This is the largest of its kind. (orig.).
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Reduced turning frequency and delayed poultry manure addition reduces N loss from sugarcane compost.
Bryndum, S; Muschler, R; Nigussie, A; Magid, J; de Neergaard, A
2017-07-01
Composting is an effective method to recycle biodegradable waste as soil amendment in smallholder farming systems. Although all essential plant nutrients are found in compost, a substantial amount of nitrogen is lost during composting. This study therefore investigated the potential of reducing N losses by (i) delaying the addition of nitrogen-rich substrates (i.e. poultry manure), and (ii) reducing the turning frequency during composting. Furthermore, we tested the effect of compost application method on nitrogen mineralization. Sugarcane-waste was composted for 54days with addition of poultry manure at the beginning (i.e. early addition) or after 21days of composting (delayed addition). The compost pile was then turned either every three or nine days. Composts were subsequently applied to soil as (i) homogeneously mixed, or (ii) stratified, and incubated for 28days to test the effect of compost application on nitrogen mineralization. The results showed that delayed addition of poultry manure reduced total nitrogen loss by 33% and increased mineral nitrogen content by >200% compared with early addition. Similarly, less frequent turning reduced total N loss by 12% compared with frequent turning. Stratified placement of compost did not enhance N mineralization compared to a homogeneous mixing. Our results suggested that simple modifications of the composting process (i.e. delayed addition and/or turning frequency) could significantly reduce N losses and improve the plant-nutritional value of compost. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Ye, Junrong; Xiao, Aixiang; Yu, Lin; Guo, Jianxiong; Lei, Huawei; Wei, Hongmei; Luo, Wei
2018-06-01
The purpose of this article was to synthesize the evidence regarding the reduction of physical restraint, and to seek some practical recommendations based on the current situation in China. Nine databases were retrieved; these were PubMed, CINAHL, MEDLINE, Trip Database, PsysINFO, Cochrane Library, CNKI (Chinese database), Wanfang (Chinese database) and CBM (Chinese database) respectively. The selected articles were screened manually, and the identified researches were appraised through Review manager 5.3. Eight studies (four randomized controlled trials and four quasi-experimental studies) published between June 2013 and May 2017 were selected. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. The outcome of meta-analysis suggested staff training reduced the duration (IV=-0.88; 95% CIs=-1.65 to -0.10; Z=2.22; p=0.03) and adverse effect (RR, 0.16; 95% CIs=0.09 to 0.30; Z=5.96; pstaff training had no effects on the incidence of physical restraint. (RR, 1.01; 95% CIs=0.45 to 2.24; Z=0.02; p=0.99) CONCLUSION: Staff training was an effective measure to minimize the duration and adverse effects of physical restraint. More studies are needed to examine the effectiveness of staff training in relation to reduce the prevalence of physical restraint. Furthermore, considering the nurse's education background in China, it is recommended to conduct a compulsory training program to reduce the unnecessary restraint. Copyright © 2017 Elsevier Inc. All rights reserved.
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Directory of Open Access Journals (Sweden)
Michele Pinelli
Full Text Available MODY2 is the most prevalent monogenic form of diabetes in Italy with an estimated prevalence of about 0.5-1.5%. MODY2 is potentially indistinguishable from other forms of diabetes, however, its identification impacts on patients' quality of life and healthcare resources. Unfortunately, DNA direct sequencing as diagnostic test is not readily accessible and expensive. In addition current guidelines, aiming to establish when the test should be performed, proved a poor detection rate. Aim of this study is to propose a reliable and easy-to-use tool to identify candidate patients for MODY2 genetic testing. We designed and validated a diagnostic flowchart in the attempt to improve the detection rate and to increase the number of properly requested tests. The flowchart, called 7-iF, consists of 7 binary "yes or no" questions and its unequivocal output is an indication for whether testing or not. We tested the 7-iF to estimate its clinical utility in comparison to the clinical suspicion alone. The 7-iF, in a prospective 2-year study (921 diabetic children showed a precision of about the 76%. Using retrospective data, the 7-iF showed a precision in identifying MODY2 patients of about 80% compared to the 40% of the clinical suspicion. On the other hand, despite a relatively high number of missing MODY2 patients, the 7-iF would not suggest the test for 90% of the non-MODY2 patients, demonstrating that a wide application of this method might 1 help less experienced clinicians in suspecting MODY2 patients and 2 reducing the number of unnecessary tests. With the 7-iF, a clinician can feel confident of identifying a potential case of MODY2 and suggest the molecular test without fear of wasting time and money. A Qaly-type analysis estimated an increase in the patients' quality of life and savings for the health care system of about 9 million euros per year.
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The Choosing Wisely campaign - don't throw the baby out with the bathwater.
Plebani, Mario; Chiozza, Maria Laura; Scibetta, Domenico
2016-03-01
The goal of the Choosing Wisely campaign launched in 2009 by the American Board of Internal Medicine (ABIM) Foundation is to promote dialog on avoiding wasteful or unnecessary medical tests, treatments and procedures. Originating in 2009, the Choosing Wisely initiative involved three primary care specialties in a project aiming to develop "Top Five" lists, which were to be "specialty-specific enumerations of achievable practice changes to improve patient health through better treatment choices, reduced risks and reduced costs. The initiative soon became global, many specialty societies outside the US joining. Some time later, however, data collected demonstrated that a reduction had been achieved only for a few low-value tests and procedures, thus highlighting the need for a more evidence-based approach for identifying low-value practices and for evaluating the efficacy of this initiative over time.
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Directory of Open Access Journals (Sweden)
Sailer-Hoeck Michaela
2010-10-01
Full Text Available Abstract The antinuclear antibody test (ANA is a much overused test in pediatrics. The ANA does have a role in serologic testing but it should be a very limited one. It is often ordered as a screening test for rheumatic illnesses in a primary care setting. However, since it has low specificity and sensitivity for most rheumatic and musculoskeletal illnesses in children, it should not be ordered as a screening test for non-specific complaints such as musculoskeletal pain. It should only be used as a diagnostic test for children with probable Systemic Lupus Erythematosus (SLE or Mixed Connective Tissue Disease, (MCTD and other possible overlap-like illnesses. Such children should have developed definite signs and symptoms of a disease before the ANA is ordered. This review presents data supporting these conclusions and a review of the ANA literature in adults and children. By limiting ANA testing, primary care providers can avoid needless venipuncture pain, unnecessary referrals, extra medical expenses, and most importantly, significant parental anxieties. It is best not to do the ANA test in most children but if it ordered and is positive in a low titer (
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Thrombophilia and assisted reproduction technology-any detrimental impact or unnecessary overuse?
Ata, Baris; Urman, Bulent
2016-10-01
The aim of this study is to provide an overview of the studies investigating a possible association between thrombophilia and assisted reproductive technology (ART) outcome. This is a literature review. Congenital thrombophilias (CoT) are reported to be associated with pregnancy loss. However, the association between CoT and early pregnancy loss is weak and does not necessarily support causation. CoT are more likely to be associated with late fetal loss. Even though data pooled from case-control and cohort studies suggest an increased risk of ART failure in women with CoTs, there seems no association when the analysis is confined to better quality cohort studies. The evidence supporting anticoagulation to improve ART outcome in CoT carriers is weak. Likewise, studies on antiphospholipid antibodies (APAs) and ART outcome suffer from multiple methodological limitations and a detrimental impact of APA positivity is controversial. Empirical administration of heparin or low molecular weight heparin to women with recurrent ART failures is supported by weak evidence. Importantly, thrombophilias are likely to increase thrombotic complications after ovarian stimulation for ART. Current evidence does not support routinely testing for or treatment of thrombophilia in the setting of ART nor in couples with implantation failure. A careful personal and family history should be obtained and a risk assessment for thrombotic complications should be made in every woman undergoing ovarian stimulation. If positive, testing for thrombophilia is warranted.
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Constraining Elementary Teachers' Work:Dilemmas and Paradoxes Created by State Mandated Testing
Directory of Open Access Journals (Sweden)
Sandra Mathison
2003-09-01
Full Text Available There are frequent reports of the challenges to teacher professionalism associated with high stakes and mandated testing (McNeil, 2000. So, we were not surprised in this year-long study of two elementary schools in upstate New York to hear teachers talk about the many ways the 4th grade tests in English Language Arts, Mathematics and Science undermine their ability to do their jobs with integrity. We came to understand in more nuanced ways the ongoing tension created by teachers' desires to be professionals, to act with integrity, and at the same time to give every child a chance to succeed. What we found in these schools is that the high stakes tests continually forced teachers to act in ways they did not think were professional and often resulted in creating instructional environments that teachers did not think were conducive to student success. The teachers at these elementary schools are not radicals. They do not seek complete autonomy, they do not eschew the need for accountability (even bureaucratic accountability, they find some virtue in state mandated tests, they are content within centralized systems that proscribe some aspects of their work. But, they also perceive themselves as professionals with both the responsibility and capability of doing their jobs well and in the best interests of their students. New York State's outcomes based bureaucratic accountability system tests their resolve, makes them angry or frustrated, and requires unnecessary compromises in their work.
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Tepetam, Fatma Merve; Çiftaslan, Nezihe; Oruç, Özlem; Duman, Dildar; Ağca, Meltem; Bulut, İsmet; Çolakoğlu, Bahattin
2016-08-01
Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20-29 or >55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9 %) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1-2 min after administration of CM (telephonically). Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.
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Galileo battery testing and the impact of test automation
Pertuch, W. T.; Dils, C. T.
1985-01-01
Test complexity, changes of test specifications, and the demand for tight control of tests led to the development of automated testing used for Galileo and other projects. The use of standardized interfacing, i.e., IEEE-488, with desktop computers and test instruments, resulted in greater reliability, repeatability, and accuracy of both control and data reporting. Increased flexibility of test programming has reduced costs by permitting a wide spectrum of test requirements at one station rather than many stations.
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Barnes, Geoffrey D; Misirliyan, Sevan; Kaatz, Scott; Jackson, Elizabeth A; Haymart, Brian; Kline-Rogers, Eva; Kozlowski, Jay; Krol, Gregory; Froehlich, James B; Sales, Anne
2017-07-14
Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative. Using a mixed-methods approach, we conducted post-implementation semi-structured interviews with a total of eight anticoagulation nurse or pharmacist staff members at five participating clinic sites to assess barriers and facilitators to de-implementing frequent international normalized ratio (INR) laboratory testing among patients with stable warfarin control. Interview guides were based on the Tailored Implementation for Chronic Disease (TICD) framework. Informed by interview themes, a survey was developed and administered to all anticoagulation clinical staff (n = 62) about their self-reported utilization of less frequent INR testing and specific barriers to de-implementing the standard (more frequent) INR testing practice. From the interviews, four themes emerged congruent with TICD domains: (1) staff overestimating their actual use of less frequent INR testing (individual health professional factors), (2) barriers to appropriate patient engagement (incentives and resources), (3) broad support for an electronic medical record flag to identify potentially eligible patients (incentives and resources), and (4) the importance of personalized nurse/pharmacist feedback (individual health professional factors). In the survey (65% response rate), staff report offering less
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Dijkstra, M.T.M.; Beersma, B.; Cornelissen, R.A.W.M.
2012-01-01
To test and extend the emerging Activity Reduces Conflict-Associated Strain (ARCAS) model, we predicted that the relationship between task conflict and employee strain would be weakened to the extent that people experience high organization-based self-esteem (OBSE). A survey among Dutch employees
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Dijkstra, M.T.M.; Beersma, B.; Cornelissen, R. A. W. M.
2012-01-01
To test and extend the emerging Activity Reduces Conflict-Associated Strain (ARCAS) model, we predicted that the relationship between task conflict and employee strain would be weakened to the extent that people experience high organization-based self-esteem (OBSE). A survey among Dutch employees
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The retrieval efficiency test of descriptors and free vocabulary terms in INIS on-line search
International Nuclear Information System (INIS)
Ebinuma, Yukio; Takahashi, Satoko
1981-01-01
The test was done for 1) search topics with appropriate descriptors, 2) search topics with considerably broader descriptors, 3) search topics with no appropriate descriptors. As to (1) and (2) the retrieval efficiency was the same both on descriptor system and on keyword system (descriptors + free terms), and the search formulas were easily constructed. As to (3) the descriptor system ensured the recall ratio but decreased the precision ratio. On the other hand the keyword system made the construction of search formulas easy and resulted in good retrieval efficiency. The search system which is available both for full match method of descriptors and truncation method of keywords is desirable because each method can be selected according to the searcher's strategy and search topics. Free-term system seems unnecessary. (author)
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Biochemical characterization of cholesterol-reducing Eubacterium.
Mott, G E; Brinkley, A W; Mersinger, C L
1980-01-01
We characterized two isolates of cholesterol-reducing Eubacterium by conducting conventional biochemical tests and by testing various sterols and glycerolipids as potential growth factors. In media containing cholesterol and plasmenylethanolamine, the tests for nitrate reduction, indole production, and gelatin and starch hydrolyses were negative, and no acid was produced from any of 22 carbohydrates. Both isolates hydrolyzed esculin to esculetin, indicating beta-glycosidase activity. In addit...
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[Genetically modified food--unnecessary controversy?].
Tchórz, Michał; Radoniewicz-Chagowska, Anna; Lewandowska-Stanek, Hanna; Szponar, Elzbieta; Szponar, Jarosław
2012-01-01
Fast development of genetic engineering and biotechnology allows use of genetically modified organisms (GMO) more and more in different branches of science and economy. Every year we can see an increase of food amount produced with the use of modification of genetic material. In our supermarkets we can find brand new types of plants, products including genetically modified ingredients or meat from animals fed with food containing GMO. This article presents general information about genetically modified organisms, it also explains the range of genetic manipulation, use of newly developed products and current field area for GMO in the world. Based on scientific data the article presents benefits from development of biotechnology in reference to modified food. It also presents the voice of skeptics who are extremely concerned about the impact of those organisms on human health and natural environment. Problems that appear or can appear as a result of an increase of GMO are very important not only from a toxicologist's or a doctor's point of view but first of all from the point of view of ordinary consumers--all of us.
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Acoustics SIMOPS: managing the unnecessary
Energy Technology Data Exchange (ETDEWEB)
Hanton, Samuel John [Nautronix Marine Technology Solutions, Rio de Janeiro, RJ (Brazil)
2012-07-01
Time is money, and offshore operations are expensive. The desire therefore, is to increase efficiency through the condensing of schedules. This inevitably leads to SIMOPS of some degree, and this paper discusses SIMOPS along with, more specifically, the challenges they provide to acoustic positioning. (author)
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International Nuclear Information System (INIS)
Namba, Kosuke; Shirai, Koji; Saegusa, Toshiari
2009-01-01
In this study, to confirm the sealing performance of a metal cask subjected to impact force due to possible commercial aircraft crash against a spent fuel storage facility, the horizontal impact test was carried out. In the test, an aircraft engine missile with a speed of 57.3 m/s attacked the reduced scale metal cask containing helium gas, which stands vertically. Then the leak rate and sliding displacement of the lid were measured. The leak rate increased rapidly and reached to 4.0 x 10 -6 Pa·m 3 /sec. After that, the leak rate decreased slowly and converged to 1.0x10 -6 Pa·m 3 /sec after 20 hours from the impact test. The leak rate of a full scale cask was evaluated using that of reduced scale cask obtained by the test. Then the leak rate of the full scale cask was 3.5x10 -5 Pa·m 3 /sec. This result showed that the sealing performance of the full scale metal cask would not be affected immediately by the horizontal impact of the aircraft engine with a speed of 57.3 m/s. (author)
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Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
2016-11-01
Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
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DEFF Research Database (Denmark)
F. Strykowski, David; Nielsen, Anni Brit Sternhagen; Llor, Carles
2015-01-01
Background. In acute exacerbation of chronic obstructive pulmonary disease (AECOPD) antibiotic overprescribing leads to antimicrobial resistance and underprescribing may cause poor patient outcomes. Objective. This study aimed to evaluate changes in over- and underprescribing of antibiotics after...... = 0.075). No statistically significant changes were found in the PIG. Conclusion. Antibiotic overprescribing was only reduced when CRP test was available. Simultaneously, underprescribing was not significantly increased, but this could be due to sample size limitations....
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Sumner, Anne E; Luercio, Marcella F; Frempong, Barbara A; Ricks, Madia; Sen, Sabyasachi; Kushner, Harvey; Tulloch-Reid, Marshall K
2009-02-01
The disposition index, the product of the insulin sensitivity index (S(I)) and the acute insulin response to glucose, is linked in African Americans to chromosome 11q. This link was determined with S(I) calculated with the nonlinear regression approach to the minimal model and data from the reduced-sample insulin-modified frequently-sampled intravenous glucose tolerance test (Reduced-Sample-IM-FSIGT). However, the application of the nonlinear regression approach to calculate S(I) using data from the Reduced-Sample-IM-FSIGT has been challenged as being not only inaccurate but also having a high failure rate in insulin-resistant subjects. Our goal was to determine the accuracy and failure rate of the Reduced-Sample-IM-FSIGT using the nonlinear regression approach to the minimal model. With S(I) from the Full-Sample-IM-FSIGT considered the standard and using the nonlinear regression approach to the minimal model, we compared the agreement between S(I) from the Full- and Reduced-Sample-IM-FSIGT protocols. One hundred African Americans (body mass index, 31.3 +/- 7.6 kg/m(2) [mean +/- SD]; range, 19.0-56.9 kg/m(2)) had FSIGTs. Glucose (0.3 g/kg) was given at baseline. Insulin was infused from 20 to 25 minutes (total insulin dose, 0.02 U/kg). For the Full-Sample-IM-FSIGT, S(I) was calculated based on the glucose and insulin samples taken at -1, 1, 2, 3, 4, 5, 6, 7, 8,10, 12, 14, 16, 19, 22, 23, 24, 25, 27, 30, 40, 50, 60, 70, 80, 90, 100, 120, 150, and 180 minutes. For the Reduced-Sample-FSIGT, S(I) was calculated based on the time points that appear in bold. Agreement was determined by Spearman correlation, concordance, and the Bland-Altman method. In addition, for both protocols, the population was divided into tertiles of S(I). Insulin resistance was defined by the lowest tertile of S(I) from the Full-Sample-IM-FSIGT. The distribution of subjects across tertiles was compared by rank order and kappa statistic. We found that the rate of failure of resolution of S(I) by
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Programming MapReduce with Scalding
Chalkiopoulos, Antonios
2014-01-01
This book is an easy-to-understand, practical guide to designing, testing, and implementing complex MapReduce applications in Scala using the Scalding framework. It is packed with examples featuring log-processing, ad-targeting, and machine learning. This book is for developers who are willing to discover how to effectively develop MapReduce applications. Prior knowledge of Hadoop or Scala is not required; however, investing some time on those topics would certainly be beneficial.
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John B. Loomis; Hung Le Trong; Armando González-Cabán
2009-01-01
We estimate a marginal benefit function for using prescribed burning and mechanical fuel reduction programs to reduce acres burned by wildfire in three states. Since each state had different acre reductions, a statistically significant coefficient on the reduction in acres burned is also a split sample scope test frequently used as an indicator of the internal validity...
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Reduced turning frequency and delayed poultry manure addition reduces N loss from sugarcane compost
DEFF Research Database (Denmark)
Bryndum, Sofie; Muschler, R.; Nigatu, Abebe Nigussie
2017-01-01
Composting is an effective method to recycle biodegradable waste as soil amendment in smallholder farming systems. Although all essential plant nutrients are found in compost, a substantial amount of nitrogen is lost during composting. This study therefore investigated the potential of reducing N...... losses by (i) delaying the addition of nitrogen-rich substrates (i.e. poultry manure), and (ii) reducing the turning frequency during composting. Furthermore, we tested the effect of compost application method on nitrogen mineralization. Sugarcane-waste was composted for 54days with addition of poultry...... manure at the beginning (i.e. early addition) or after 21days of composting (delayed addition). The compost pile was then turned either every three or nine days. Composts were subsequently applied to soil as (i) homogeneously mixed, or (ii) stratified, and incubated for 28days to test the effect...
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Ates, Gamze; Favyts, Dorien; Hendriks, Giel; Derr, Remco; Mertens, Birgit; Verschaeve, Luc; Rogiers, Vera; Y Doktorova, Tatyana
2016-11-01
To ensure safety for humans, it is essential to characterize the genotoxic potential of new chemical entities, such as pharmaceutical and cosmetic substances. In a first tier, a battery of in vitro tests is recommended by international regulatory agencies. However, these tests suffer from inadequate specificity: compounds may be wrongly categorized as genotoxic, resulting in unnecessary, time-consuming, and expensive in vivo follow-up testing. In the last decade, novel assays (notably, reporter-based assays) have been developed in an attempt to overcome these drawbacks. Here, we have investigated the performance of two in vitro reporter-based assays, Vitotox and ToxTracker. A set of reference compounds was selected to span a variety of mechanisms of genotoxic action and applicability domains (e.g., pharmaceutical and cosmetic ingredients). Combining the performance of the two assays, we achieved 93% sensitivity and 79% specificity for prediction of gentoxicity for this set of compounds. Both assays permit quick high-throughput analysis of drug candidates, while requiring only small quantities of the test substances. Our study shows that these two assays, when combined, can be a reliable method for assessment of genotoxicity hazard. Copyright © 2016 Elsevier B.V. All rights reserved.
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Stereotype threat can reduce older adults' memory errors.
Barber, Sarah J; Mather, Mara
2013-01-01
Stereotype threat often incurs the cost of reducing the amount of information that older adults accurately recall. In the current research, we tested whether stereotype threat can also benefit memory. According to the regulatory focus account of stereotype threat, threat induces a prevention focus in which people become concerned with avoiding errors of commission and are sensitive to the presence or absence of losses within their environment. Because of this, we predicted that stereotype threat might reduce older adults' memory errors. Results were consistent with this prediction. Older adults under stereotype threat had lower intrusion rates during free-recall tests (Experiments 1 and 2). They also reduced their false alarms and adopted more conservative response criteria during a recognition test (Experiment 2). Thus, stereotype threat can decrease older adults' false memories, albeit at the cost of fewer veridical memories, as well.
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De Steur, Hans; Wesana, Joshua; Dora, Manoj K; Pearce, Darian; Gellynck, Xavier
2016-12-01
The interest to reduce food losses and wastes has grown considerably in order to guarantee adequate food for the fast growing population. A systematic review was used to show the potential of Value Stream Mapping (VSM) not only to identify and reduce food losses and wastes, but also as a way to establish links with nutrient retention in supply chains. The review compiled literature from 24 studies that applied VSM in the agri-food industry. Primary production, processing, storage, food service and/or consumption were identified as susceptible hotspots for losses and wastes. Results further revealed discarding and nutrient loss, most especially at the processing level, as the main forms of loss/waste in food, which were adapted to four out of seven lean manufacturing wastes (i.e. defect, unnecessary inventory, overproduction and inappropriate processing). This paper presents the state of the art of applying lean manufacturing practices in the agri-food industry by identifying lead time as the most applicable performance indicator. VSM was also found to be compatible with other lean tools such as Just-In-Time and 5S which are continuous improvement strategies, as well as simulation modelling that enhances adoption. In order to ensure successful application of lean practices aimed at minimizing food or nutrient losses and wastes, multi-stakeholder collaboration along the entire food supply chain is indispensable. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?
Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca
2016-04-01
Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.
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International Nuclear Information System (INIS)
Han, C.-F.; Lin, J.-F.; Chung, C.-K.; Wu, B.-H.
2008-01-01
A general mechanical model, which is composed of the mechanical models employed to describe the contact behaviors and deformations arising in all layers (including the substrate), is successfully developed in the present study for multilayer specimens in order to evaluate the contact projected area by a theoretical model, and thus the hardness and reduced modulus, using nanoindentation tests. The governing differential equations for the depth solutions of the indenter tip formed at all layers of the specimen under their contact load are developed individually. The influence of the material properties of the substrate on a multilayer specimen's hardness and reduced modulus at various indentation depths can thus be evaluated. Transition and pop-in occurred at depths near, but still before, the C (top layer)/a-Si (buffer layer) interface and the a-Si/Si (substrate) interface, respectively. Using the present analysis, the depths corresponding to the transition and pop-in behaviors can be predicted effectively
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Hopkins, Heidi; Bruxvoort, Katia J; Cairns, Matthew E; Chandler, Clare I R; Leurent, Baptiste; Ansah, Evelyn K; Baiden, Frank; Baltzell, Kimberly A; Björkman, Anders; Burchett, Helen E D; Clarke, Siân E; DiLiberto, Deborah D; Elfving, Kristina; Goodman, Catherine; Hansen, Kristian S; Kachur, S Patrick; Lal, Sham; Lalloo, David G; Leslie, Toby; Magnussen, Pascal; Jefferies, Lindsay Mangham; Mårtensson, Andreas; Mayan, Ismail; Mbonye, Anthony K; Msellem, Mwinyi I; Onwujekwe, Obinna E; Owusu-Agyei, Seth; Reyburn, Hugh; Rowland, Mark W; Shakely, Delér; Vestergaard, Lasse S; Webster, Jayne; Wiseman, Virginia L; Yeung, Shunmay; Schellenberg, David; Staedke, Sarah G; Whitty, Christopher J M
2017-03-29
Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants 522 480 children and adults with acute febrile illness. Interventions Rapid diagnostic tests for malaria. Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive
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Collaborative Testing: Cognitive and Interpersonal Processes Related to Enhanced Test Performance
Kapitanoff, Susan H.
2009-01-01
Research has demonstrated that collaborative testing, working on tests in groups, leads to improved test scores but the mechanism by which this occurs has not been specified. Three factors were proposed as mediators: cognitive processes, interpersonal interactions and reduced test-anxiety. Thirty-three students completed a multiple-choice exam…
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2011-02-22
... Labor, as part of its continuing effort to reduce paperwork and respondent (i.e., employer) burden... businesses, and to reduce to the maximum extent feasible unnecessary duplication of efforts in obtaining... to implement preventive maintenance procedures consisting of regularly scheduled inspections of at...
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Burden of Illness in Hereditary Angioedema
DEFF Research Database (Denmark)
Bygum, Anette; Aygören-Pürsün, Emel; Beusterien, Kathleen
2015-01-01
of HAE on health-related quality of life (HRQoL): (i) unnecessary treatments and procedures, (ii) symptom triggers, (iii) attack impacts, (iv) caregiver impacts, and (v) long-term impacts. Patients for example experienced unnecessary medical procedures due to diagnostic delays, anxiety and fear about...... attacks, and passing HAE to children, reduced work/school productivity, and limited career/educational achievement. Patient caregivers also experienced worry and work/activity interruption during the attacks. In conclusion, a conceptual model was developed illustrating the hypothesized relationships among...
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Energy Technology Data Exchange (ETDEWEB)
Koren, K [Statens Institutt for Straalehygiene, Oslo (Norway); Wuehrmann, A H [Alabama Univ., Birmingham (USA)
1977-01-01
The booklet deals with all aspects of the use of X rays in dentistry. The recommendations made are designed to reduce unnecessary exposure of the patient, will result in the production of superior radiographs and assist in eliminating unnecessary exposure of the operator himself. Separate chapters deal with the following topics: the need for radiation protection, delegation of responsibility, radiographic equipment, radiographic film, radiographic techniques, film processing and handling, patient doses (adults and children), general radiation protection and monitoring, educational standards.
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Meddings, Jennifer; Rogers, Mary A M; Macy, Michelle; Saint, Sanjay
2010-09-01
Prolonged catheterization is the primary risk factor for catheter-associated urinary tract infection (CAUTI). Reminder systems are interventions used to prompt the removal of unnecessary urinary catheters. To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis. Studies were identified in MEDLINE, the Cochrane Library, Biosis, the Web of Science, EMBASE, and CINAHL through August 2008. Only interventional studies that used reminders to physicians or nurses that a urinary catheter was in use or stop orders to prompt catheter removal in hospitalized adults were included. A total of 6679 citations were identified; 118 articles were reviewed, and 14 articles met the selection criteria. The rate of CAUTI (episodes per 1000 catheter-days) was reduced by 52% (P SMD) in the duration of catheterization was -1.11 overall (P = 070), including a statistically significant decrease in studies that used a stop order (SMD, -0.30; P = .001) but not in those that used a reminder (SMD, -1.54; P = .071). Recatheterization rates were similar in control and intervention groups. Urinary catheter reminders and stop orders appear to reduce the rate of CAUTI and should be strongly considered to enhance the safety of hospitalized patients.
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Pochron, Sharon; Nikakis, Jacqueline; Illuzzi, Kyra; Baatz, Andrea; Demirciyan, Loriana; Dhillon, Amritjot; Gaylor, Thomas; Manganaro, Alexa; Maritato, Nicholas; Moawad, Michael; Singh, Rajwinder; Tucker, Clara; Vaughan, Daniel
2018-04-01
Solid waste management struggles with the sustainable disposal of used tires. One solution involves shredding used tires into crumb rubber and using the material as infill for artificial turf. However, crumb rubber contains hydrocarbons, organic compounds, and heavy metals, and it travels into the environment. Earthworms living in soil contaminated with virgin crumb rubber gained 14% less body weight than did earthworms living in uncontaminated soil, but the impact of aged crumb rubber on the earthworms is unknown. Since many athletic fields contain aged crumb rubber, we compared the body weight, survivorship, and longevity in heat and light stress for earthworms living in clean topsoil to those living in topsoil contaminated with aged crumb rubber. We also characterized levels of metals, nutrients, and micronutrients of both soil treatments and compared those to published values for soil contaminated with virgin crumb rubber. Consistent with earlier research, we found that contaminated soil did not inhibit microbial respiration rates. Aged crumb rubber, like new crumb rubber, had high levels of zinc. However, while exposure to aged crumb rubber did not reduce earthworm body weight as did exposure to new crumb rubber, exposure to aged crumb rubber reduced earthworm survival time during a stress test by a statistically significant 38 min (16.2%) relative to the survival time for worms that had lived in clean soil. Aged crumb rubber and new crumb rubber appear to pose similar toxic risks to earthworms. This study suggests an environmental cost associated with the current tire-recycling solution.
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Improving Realism in Reduced Gravity Simulators
Cowley, Matthew; Harvil, Lauren; Clowers, Kurt; Clark, Timothy; Rajulu, Sudhakar
2010-01-01
Since man was first determined to walk on the moon, simulating the lunar environment became a priority. Providing an accurate reduced gravity environment is crucial for astronaut training and hardware testing. This presentation will follow the development of reduced gravity simulators to a final comparison of environments between the currently used systems. During the Apollo program era, multiple systems were built and tested, with several NASA centers having their own unique device. These systems ranged from marionette-like suspension devices where the subject laid on his side, to pneumatically driven offloading harnesses, to parabolic flights. However, only token comparisons, if any, were made between systems. Parabolic flight allows the entire body to fall at the same rate, giving an excellent simulation of reduced gravity as far as the biomechanics and physical perceptions are concerned. While the effects are accurate, there is limited workspace, limited time, and high cost associated with these tests. With all mechanical offload systems only the parts of the body that are actively offloaded feel any reduced gravity effects. The rest of the body still feels the full effect of gravity. The Partial Gravity System (Pogo) is the current ground-based offload system used to training and testing at the NASA Johnson Space Center. The Pogo is a pneumatic type system that allows for offloaded motion in the z-axis and free movement in the x-axis, but has limited motion in the y-axis. The pneumatic system itself is limited by cylinder stroke length and response time. The Active Response Gravity Offload System (ARGOS) is a next generation groundbased offload system, currently in development, that is based on modern robotic manufacturing lines. This system is projected to provide more z-axis travel and full freedom in both the x and y-axes. Current characterization tests are underway to determine how the ground-based offloading systems perform, how they compare to parabolic
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Genomic Testing and Therapies for Breast Cancer in Clinical Practice
Haas, Jennifer S.; Phillips, Kathryn A.; Liang, Su-Ying; Hassett, Michael J.; Keohane, Carol; Elkin, Elena B.; Armstrong, Joanne; Toscano, Michele
2011-01-01
Purpose: Given the likely proliferation of targeted testing and treatment strategies for cancer, a better understanding of the utilization patterns of human epidermal growth factor receptor 2 (HER2) testing and trastuzumab and newer gene expression profiling (GEP) for risk stratification and chemotherapy decision making are important. Study Design: Cross-sectional. Methods: We performed a medical record review of women age 35 to 65 years diagnosed between 2006 and 2007 with invasive localized breast cancer, identified using claims from a large national health plan (N = 775). Results: Almost all women received HER2 testing (96.9%), and 24.9% of women with an accepted indication received GEP. Unexplained socioeconomic differences in GEP use were apparent after adjusting for age and clinical characteristics; specifically, GEP use increased with income. For example, those in the lowest income category (< $40,000) were less likely than those with an income of $125,000 or more to receive GEP (odds ratio, 0.34; 95% CI, 0.16 to 0.73). A majority of women (57.7%) with HER2-positive disease received trastuzumab; among these women, differences in age and clinical characteristics were not apparent, although surprisingly, those in the lowest income category were more likely than those in the high-income category to receive trastuzumab (P = .02). Among women who did not have a positive HER2 test, 3.9% still received trastuzumab. Receipt of adjuvant chemotherapy increased as GEP score indicated greater risk of recurrence. Conclusion: Identifying and eliminating unnecessary variation in the use of these expensive tests and treatments should be part of quality improvement and efficiency programs. PMID:21886507
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International Nuclear Information System (INIS)
Caldwell, T.B.
1997-01-01
A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel
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International Nuclear Information System (INIS)
Brown, Sally; Christensen, Barbara; Lombi, Enzo; McLaughlin, Mike; McGrath, Steve; Colpaert, Jan; Vangronsveld, Jaco
2005-01-01
An international inter-laboratory research program investigated the effectiveness of in situ remediation of soils contaminated by cadmium, lead and zinc, measuring changes in soil and soil solution chemistry, plants and soil microbiota. A common soil, from mine wastes in Jasper County MO, was used. The soil was pH 5.9, had low organic matter (1.2 g kg -1 C) and total Cd, Pb, and Zn concentrations of 92, 5022, and 18 532 mg kg -1 , respectively. Amendments included lime, phosphorus (P), red mud (RM), cyclonic ashes (CA), biosolids (BIO), and water treatment residuals (WTR). Both soil solution and NH 4 NO 3 extractable metals were decreased by all treatments. Phytotoxicity of metals was reduced, with plants grown in P treatments having the highest yields and lowest metal concentration (0.5, 7.2 and 406 mg kg -1 Cd, Pb, and Zn). Response of soil micro-organisms was similar to plant responses. Phosphorus addition reduced the physiologically based extraction test Pb from 84% of total Pb extracted in the untreated soil to 34.1%. - Addition of phosphorus to Pb, Zn and Cd contaminated mine waste was able to reduce metal toxicity for a range of biological endpoints
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Voicu, Rodica-Cristina; Zandi, Muaiyd Al; Müller, Raluca; Wang, Changhai
2017-11-01
This paper reports the results of numerical nonlinear electro-thermo-mechanical analysis and experimental testing of a polymeric microgripper designed using electrothermal actuators. The simulation work was carried out using a finite element method (FEM) and a commercial software (Coventorware 2014). The biocompatible SU-8 polymer was used as structural material for the fabrication of the microgripper. The metallic micro-heater was encapsulated in the polymeric actuation structures of the microgripper to reduce the undesirable out-of-plane displacement of the microgripper tips, and to electrically isolate the micro-heater, and to reduce the mechanical stress as well as to improve the thermal efficiency. The electro- thermo-mechanical analysis of the actuator considers the nonlinear temperature-dependent properties of the SU-8 polymer and the gold thin film layers used for the micro-heater fabrication. An optical characterisation of the microgripper based on an image tracking approach shows the thermal response and the good repeatability. The average deflection is ~11 µm for an actuation current of ~17 mA. The experimentally obtained tip deflection and the heater temperature at different currents are both shown to be in good agreement with the nonlinear electro-thermo-mechanical simulation results. Finally, we demonstrate the capability of the microgripper by capture and manipulation of cotton fibres.
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Successful testing of an emergency diesel generator engine at very low load
International Nuclear Information System (INIS)
Killinger, A.; Loeper, St.
2001-01-01
For more than 30 years, the nuclear power industry has been concerned about the ability of emergency diesel generator sets (EDGs) to operate for extended periods of time at low loads (typically less than 33% of design rating) and still be capable of meeting their design safety requirement. Most diesel engine manufacturers today still caution owners and operators to avoid running their diesel engines for extended periods of time at low loads. At one nuclear power plant, the emergency electrical bus arrangement only required approximately 25% of the EDG's design rating, which necessitated that the plant operators monitor EDG operating hours and periodically increase electrical load. In order to eliminate the plant operations burden of periodically loading the EDGs, the nuclear power plant decided to conduct a low-load test of a ''spare'' diesel engine. A SACM Model UD45V16S5D diesel engine was returned to the factory in Mulhouse, France where the week long testing at rated speed and 3% of design rating was completed. The test demonstrated that the engine was capable of operating for seven days (168 hours) at very low loads, with no loss of performance and no unusual internal wear or degradation. The planning and inspections associated with preparing the diesel engine for the test, the engine monitoring performed during the test, the final test results, and the results and material condition of the engine following the test are described. The successful diesel engine low-load test resulted in the elimination of unnecessary nuclear power plant operation restrictions that were based on old concerns about long-term, low-load operation of diesel engines. The paper describes the significance of this diesel engine test to the nuclear power plant and the entire nuclear power industry. (author)
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Food allergies in children: a comparison of parental reports and skin prick test results
Directory of Open Access Journals (Sweden)
Camilia Metadea Aji Savitri
2018-04-01
Full Text Available Background Food allergy is common in children and its prevalence is generally on the rise. Imprecise parental reports about reactions to particular foods can lead to unnecessary restrictions. Since children have specific growth requirements, such nutritional restrictions may have disturbing effects on children’s growth and development. Objective To compare parental reports on food reactions to skin prick test results in their children. Method Retrospective, cross sectional study using patient’s medical record data during one-year study period. Data were analyzed manually and statistically, to assess the degree of agreement (Kappa’s coefficient and significance (P. Results We collected data from 154 subjects aged 0-18 years. For every allergen assessed, parents reported more food reactions than positive skin prick test results. Allergy incidence were caused, in order, by cow’s milk and chicken (25.3%, eggs (22.1%, chocolate (20.1%, fruits (14.3%, seafood (13%, and saltwater fish (1.9%. Kappa coefficient are all poor (0.05 except for chicken (P=0.02. Conclusion Most parents tend to overestimate which food cause reactions in their children, as reactions reported were not necessarily allergenic. Therefore, every patient experiencing allergy reactions should undergo skin prick testing to confirm the possibility of allergy.
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Energy Technology Data Exchange (ETDEWEB)
Nascimento, Samira R.V.; Lira, Carlos A.B.O.; Lapa, Celso M.F.; Lima, Fernando R.A.; Bezerra, Jair L.; Silva, Mário A.B., E-mail: cabol@ufpe.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Centro de Tecnologia e Geociências. Departamento de Energia Nuclear; Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Centro Regional de Ciências Nucleares do Nordeste (CRCN/CNEN-PE), Recife, PE (Brazil)
2017-11-01
The conception and the project of a 1:200 reduced scale test facility have been developed in earlier researches. Such a facility aims to investigate boron homogenization process inside the pressurizer of an iPWR (integral PWR) by considering water mixing from this component with that coming from the reactor core. For this kind of reactor, the pressurizer is located at the top of the pressure vessel demanding the need of identifying the proper mechanisms in order to warrant an adequate homogenization for the water mixture. Once the installation of the experimental setup was concluded, its behavior has been analyzed by considering the concentration of a tracer diluted in the circulation water, whose measurements were obtained at the pressurizer outlet orifices. Two experiments representing boration(boron concentration increase)/deboration(boron concentration decrease) scenarios have been accomplished. Sample acquisition was carried out for every ten minutes during a total time equal to 180 minutes. Results showed that the combination of Fractional Scaling Analysis with local Froude number consisted of an appropriate methodology to provide the reduced scale test facility parameters, inasmuch the measured concentrations from the experiments reproduced the theoretical behavior with sufficient accuracy. (author)
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International Nuclear Information System (INIS)
Nascimento, Samira R.V.; Lira, Carlos A.B.O.; Lapa, Celso M.F.; Lima, Fernando R.A.; Bezerra, Jair L.; Silva, Mário A.B.
2017-01-01
The conception and the project of a 1:200 reduced scale test facility have been developed in earlier researches. Such a facility aims to investigate boron homogenization process inside the pressurizer of an iPWR (integral PWR) by considering water mixing from this component with that coming from the reactor core. For this kind of reactor, the pressurizer is located at the top of the pressure vessel demanding the need of identifying the proper mechanisms in order to warrant an adequate homogenization for the water mixture. Once the installation of the experimental setup was concluded, its behavior has been analyzed by considering the concentration of a tracer diluted in the circulation water, whose measurements were obtained at the pressurizer outlet orifices. Two experiments representing boration(boron concentration increase)/deboration(boron concentration decrease) scenarios have been accomplished. Sample acquisition was carried out for every ten minutes during a total time equal to 180 minutes. Results showed that the combination of Fractional Scaling Analysis with local Froude number consisted of an appropriate methodology to provide the reduced scale test facility parameters, inasmuch the measured concentrations from the experiments reproduced the theoretical behavior with sufficient accuracy. (author)
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Energy Technology Data Exchange (ETDEWEB)
NONE
1983-08-01
The international effort to develop new fuel materials and designs which will make it feasible to fuel research and test reactors throughout the world with low-enrichment uranium, instead of high-enrichment uranium, has made significant progress during the past year. This progress has taken place at research centers located in many different countries, and is of crucial interest to reactor operators and licensors whose geographical distribution is even more varied. It is appropriate, therefore, that international meetings be held periodically to foster direct communication among the specialists in this area. To achieve this purpose, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the third of a series which begun in 1978. The papers presented at this meeting were divided into sessions according to relevant subject: status of RERTR program and safety issues; development of new fuel types; testing of new fuel elements; specific reactor applications. These proceedings were edited by various members of the RERTR Program.
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International Nuclear Information System (INIS)
1983-08-01
The international effort to develop new fuel materials and designs which will make it feasible to fuel research and test reactors throughout the world with low-enrichment uranium, instead of high-enrichment uranium, has made significant progress during the past year. This progress has taken place at research centers located in many different countries, and is of crucial interest to reactor operators and licensors whose geographical distribution is even more varied. It is appropriate, therefore, that international meetings be held periodically to foster direct communication among the specialists in this area. To achieve this purpose, the Reduced Enrichment Research and Test Reactor (RERTR) Program, at the Argonne National Laboratory, sponsored this meeting as the third of a series which begun in 1978. The papers presented at this meeting were divided into sessions according to relevant subject: status of RERTR program and safety issues; development of new fuel types; testing of new fuel elements; specific reactor applications. These proceedings were edited by various members of the RERTR Program
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Phytosterol glycosides reduce cholesterol absorption in humans
Lin, Xiaobo; Ma, Lina; Racette, Susan B.; Anderson Spearie, Catherine L.; Ostlund, Richard E.
2009-01-01
Dietary phytosterols inhibit intestinal cholesterol absorption and regulate whole body cholesterol excretion and balance. However, they are biochemically heterogeneous and a portion is glycosylated in some foods with unknown effects on biological activity. We tested the hypothesis that phytosterol glycosides reduce cholesterol absorption in humans. Phytosterol glycosides were extracted and purified from soy lecithin in a novel two-step process. Cholesterol absorption was measured in a series of three single-meal tests given at intervals of 2 wk to each of 11 healthy subjects. In a randomized crossover design, participants received ∼300 mg of added phytosterols in the form of phytosterol glycosides or phytosterol esters, or placebo in a test breakfast also containing 30 mg cholesterol-d7. Cholesterol absorption was estimated by mass spectrometry of plasma cholesterol-d7 enrichment 4–5 days after each test. Compared with the placebo test, phytosterol glycosides reduced cholesterol absorption by 37.6 ± 4.8% (P lecithin are bioactive in humans and should be included in methods of phytosterol analysis and tables of food phytosterol content. PMID:19246636
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Using Recall to Reduce False Recognition: Diagnostic and Disqualifying Monitoring
Gallo, David A.
2004-01-01
Whether recall of studied words (e.g., parsley, rosemary, thyme) could reduce false recognition of related lures (e.g., basil) was investigated. Subjects studied words from several categories for a final recognition memory test. Half of the subjects were given standard test instructions, and half were instructed to use recall to reduce false…
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Household methods to reduce 137Cs contents of mushrooms
International Nuclear Information System (INIS)
Kostiainen, E.
2005-01-01
High radiocaesium contents in different species of mushrooms have been observed in areas contaminated by radiocaesium deposition after the Chernobyl accident in 1986. There has been no significant reduction in the 137 Cs contents of mushrooms during the past ten years, besides via radioactive decay. The internal radiation dose received via mushrooms can be reduced by processing mushrooms before consumption. Various household methods were studied to find out their efficiency to reduce 137 Cs contents of mushrooms. The methods tested were the same as normally used in cooking. The tests were made for the species of edible mushrooms widely consumed. The retention factors for the treatments tested were in most cases 0.2-0.3. The efficiency of treatments in reducing the 137 Cs contents increased with larger water volumes and prolonged treatment times
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Mahjani, Behrang; Toor, Salman; Nettelblad, Carl; Holmgren, Sverker
2017-01-01
In quantitative trait locus (QTL) mapping significance of putative QTL is often determined using permutation testing. The computational needs to calculate the significance level are immense, 10 4 up to 10 8 or even more permutations can be needed. We have previously introduced the PruneDIRECT algorithm for multiple QTL scan with epistatic interactions. This algorithm has specific strengths for permutation testing. Here, we present a flexible, parallel computing framework for identifying multiple interacting QTL using the PruneDIRECT algorithm which uses the map-reduce model as implemented in Hadoop. The framework is implemented in R, a widely used software tool among geneticists. This enables users to rearrange algorithmic steps to adapt genetic models, search algorithms, and parallelization steps to their needs in a flexible way. Our work underlines the maturity of accessing distributed parallel computing for computationally demanding bioinformatics applications through building workflows within existing scientific environments. We investigate the PruneDIRECT algorithm, comparing its performance to exhaustive search and DIRECT algorithm using our framework on a public cloud resource. We find that PruneDIRECT is vastly superior for permutation testing, and perform 2 ×10 5 permutations for a 2D QTL problem in 15 hours, using 100 cloud processes. We show that our framework scales out almost linearly for a 3D QTL search.
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International Nuclear Information System (INIS)
Yoo, B.; Lee, Jae Han; Kwon, H. S.
1999-06-01
Through the fabrications and the tests of reduced scale rubber bearing by several times since 1995, the technology related to the bearings has been improved. In this report, several lead rubber bearings (LLRB) with different lead plug diameters, high damping rubber bearing (HLRB), and 3D-LRB made of UNISON NR (natural rubber) compounds are tested to get the hysteretic characteristics of rubber bearings. Specially, the HLRB and 3D-LRB are tested for the vertical deformation characteristics. All the test data are plotted and analyzed to be compared with design target values such as equivalent horizontal stiffness and equivalent damping ration. The variations of the equivalent horizontal stiffness and damping for the lead and the 3D-LRB are evaluated from test data in the range of 25% to 150% of shear strain in horizontal direction. As increasing the lead plug diameter up to 48 mm, the values of yield load, equivalent stiffness, and equivalent damping are increased, and the maximum damping of 31 % are horizontal performance during compression and shear tests. Through the vertical performance tests of HLRB and 3D-LRB, it is reveal that the vertical stiffness of HLRB is 15.57 ton/mm, which is much lower than target value by 1/4, and the vertical stiffness of 3D-LRB show in the range of 2.17 ton/mm to 4.4 ton/mm, which are higher than the design target 1.25 ton/mm by about 2 times. The vertical equivalent damping of HLRB is 11.48%, but the ones of 3D-LRB show large variations between 8 % and 54%. There are no difference between the first and after curves of the vertical hysteresis of 3D-LRB and no dependency of test speed because the dish springs take the vertical behaviors of 3D-LRB. (author). 8 refs., 38 tabs., 47 figs
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Recknagel, Stephan; Snyder, Alice; Blanke, Annemarie; Uhlig, Albrecht; Brüser, Benjamin; Schusser, Gerald Fritz
2015-01-01
Knowledge of tetanus immunity in equine patients is crucial in cases of injuries, elective surgeries, or when effective vaccination protocols are to be designed. The Fassisi® TetaCheck is a stall-side rapid test which was developed to address these issues. The purpose of the present study was to evaluate its performance parameters. To this end, the qualitative test results obtained by two blinded observers were compared to tetanus toxoid antibody levels from 99 serum samples, measured with a double antigen ELISA. Additionally the colour intensities of the test window were quantified using a camera and photo editing software. Assuming that the protective level of tetanus toxoid antibodies is ≥ 0.1 IE/ml, the tetanus quick stick (TQS) showed a sensitivity of 83.6% and a specificity of 100%. almost perfect (K = 0.88). Exchanging the observer did not affect the interpretation of theTQS (K = 0.80; K = 0.84). The definition of five distinct colour intensities of the "test window" enabled a clear differentiation of unprotected individuals from those with a protective immunity. There was a linear relationship between the objectively measured colour intensities and the tetanus toxoid antibody concentration (r2 = 0.74). The TQS thus proved to be a robust and reliable test in the stall-side assessment of tetanus immunity in horses. Its implementation in equine daily practice can help to avoid unnecessary immunizations in adult horses and therefore minimize vaccination side effects.
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Reduced Capacity in a Dichotic Memory Test for Adult Patients with ADHD
Dige, Niels; Maahr, Eija; Backenroth-Ohsako, Gunnel
2010-01-01
Objective: To evaluate whether a dichotic memory test would reveal deficits in short-term working-memory recall and long-term memory recall in a group of adult patients with ADHD. Methods: A dichotic memory test with ipsilateral backward speech distraction in an adult ADHD group (n = 69) and a control group (n = 66) is used to compare performance…
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Directory of Open Access Journals (Sweden)
Ganna Rozhnova
2016-08-01
Full Text Available The WHO's early-release guideline for antiretroviral treatment (ART of HIV infection based on a recent trial conducted in 34 countries recommends starting treatment immediately upon an HIV diagnosis. Therefore, the test-and-treat strategy may become more widely used in an effort to scale up HIV treatment and curb further transmission. Here we examine behavioural determinants of HIV transmission and how heterogeneity in sexual behaviour influences the outcomes of this strategy. Using a deterministic model, we perform a systematic investigation into the effects of various mixing patterns in a population of men who have sex with men (MSM, stratified by partner change rates, on the elimination threshold and endemic HIV prevalence. We find that both the level of overdispersion in the distribution of the number of sexual partners and mixing between population subgroups have a large influence on endemic prevalence before introduction of ART and on possible long term effectiveness of ART. Increasing heterogeneity in risk behavior may lead to lower endemic prevalence levels, but requires higher coverage levels of ART for elimination. Elimination is only feasible for populations with a rather low degree of assortativeness of mixing and requires treatment coverage of almost 80% if rates of testing and treatment uptake by all population subgroups are equal. In this case, for fully assortative mixing and 80% coverage endemic prevalence is reduced by 57%. In the presence of heterogeneity in ART uptake, elimination is easier to achieve when the subpopulation with highest risk behavior is tested and treated more often than the rest of the population, and vice versa when it is less. The developed framework can be used to extract information on behavioral heterogeneity from existing data which is otherwise hard to determine from population surveys.
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O'Connor, C; Kiernan, M G; Finnegan, C; O'Hara, M; Power, L; O'Connell, N H; Dunne, C P
2017-05-04
Rapid detection of patients with carbapenemase-producing Enterobacteriaceae (CPE) is essential for the prevention of nosocomial cross-transmission, allocation of isolation facilities and to protect patient safety. Here, we aimed to design a new laboratory work-flow, utilizing existing laboratory resources, in order to reduce time-to-diagnosis of CPE. A review of the current CPE testing processes and of the literature was performed to identify a real-time commercial polymerase chain reaction (PCR) assay that could facilitate batch testing of CPE clinical specimens, with adequate CPE gene coverage. Stool specimens (210) were collected; CPE-positive inpatients (n = 10) and anonymized community stool specimens (n = 200). Rectal swabs (eSwab™) were inoculated from collected stool specimens and a manual DNA extraction method (QIAamp® DNA Stool Mini Kit) was employed. Extracted DNA was then processed on the Check-Direct CPE® assay. The three step process of making the eSwab™, extracting DNA manually and running the Check-Direct CPE® assay, took method of CPE screening; average time-to-diagnosis of 48/72 h. Utilizing this CPE work-flow would allow a 'same-day' result. Antimicrobial susceptibility testing results, as is current practice, would remain a 'next-day' result. In conclusion, the Check-Direct CPE® assay was easily integrated into a local laboratory work-flow and could facilitate a large volume of CPE screening specimens in a single batch, making it cost-effective and convenient for daily CPE testing.
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Digface characterization test plan (remote testing)
International Nuclear Information System (INIS)
Croft, K.; Hyde, R.; Allen, S.
1993-08-01
The objective of the Digface Characterization (DFC) Remote Testing project is to remotely deploy a sensor head (Mini-Lab) across a digface to determine if it can characterize the contents below the surface. The purpose of this project is to provide a robotics technology that allows removal of workers from hazards, increases speed of operations, and reduces life cycle costs compared to alternate methods and technologies. The Buried Waste Integrated Demonstration (BWID) is funding the demonstration, testing, and evaluation of DFC. This document describes the test plan for the DFC remote deployment demonstration for the BWID. The purposes of the test plan are to establish test parameters so that the demonstration results are deemed useful and usable and perform the demonstration in a safe manner and within all regulatory requirements
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On-line monitoring for calibration reduction
International Nuclear Information System (INIS)
Hoffmann, M.
2005-09-01
On-Line Monitoring evaluates instrument channel performance by assessing its consistency with other plant indications. Elimination or reduction of unnecessary field calibrations can reduce associated labour costs, reduce personnel radiation exposure, and reduce the potential for calibration errors. On-line calibration monitoring is an important technique to implement a state-based maintenance approach and reduce unnecessary field calibrations. In this report we will look at how the concept is currently applied in the industry and what the arising needs are as it becomes more commonplace. We will also look at the PEANO System, a tool developed by the Halden Project to perform signal validation and on-line calibration monitoring. Some issues will be identified that are being addressed in the further development of these tools to better serve the future needs of the industry in this area. An outline for how to improve these points and which aspects should be taken into account is described in detail. (Author)
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Energy Technology Data Exchange (ETDEWEB)
Brown, Sally [Box 352100 University of Washington, Seattle, WA 98195 (United States)]. E-mail: slb@u.washington.edu; Christensen, Barbara [Box 352100 University of Washington, Seattle, WA 98195 (United States); Lombi, Enzo [CSIRO Land and Water PMB, 2 Glen Osmond, Adelaide, South Australia (Australia)]. E-mail: enzo.lombi@csiro.au; McLaughlin, Mike [CSIRO Land and Water PMB, 2 Glen Osmond, Adelaide, South Australia (Australia)]. E-mail: mike.mclaughlin@csiro.au; McGrath, Steve [Rothamsted Research, Harpenden, Herts AL5 2JQ (United Kingdom)]. E-mail: steve.mcgrath@bbsrc.ac.uk; Colpaert, Jan [Limburgs Universitair, Centrum Universitaire Campus, Building D, BE 3590 Diepenbeek (Belgium); Vangronsveld, Jaco [Limburgs Universitair, Centrum Universitaire Campus, Building D, BE 3590 Diepenbeek (Belgium)]. E-mail: jvangron@luc.ac.be
2005-11-15
An international inter-laboratory research program investigated the effectiveness of in situ remediation of soils contaminated by cadmium, lead and zinc, measuring changes in soil and soil solution chemistry, plants and soil microbiota. A common soil, from mine wastes in Jasper County MO, was used. The soil was pH 5.9, had low organic matter (1.2 g kg{sup -1} C) and total Cd, Pb, and Zn concentrations of 92, 5022, and 18 532 mg kg{sup -1}, respectively. Amendments included lime, phosphorus (P), red mud (RM), cyclonic ashes (CA), biosolids (BIO), and water treatment residuals (WTR). Both soil solution and NH{sub 4}NO{sub 3} extractable metals were decreased by all treatments. Phytotoxicity of metals was reduced, with plants grown in P treatments having the highest yields and lowest metal concentration (0.5, 7.2 and 406 mg kg{sup -1} Cd, Pb, and Zn). Response of soil micro-organisms was similar to plant responses. Phosphorus addition reduced the physiologically based extraction test Pb from 84% of total Pb extracted in the untreated soil to 34.1%. - Addition of phosphorus to Pb, Zn and Cd contaminated mine waste was able to reduce metal toxicity for a range of biological endpoints.
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Gray, Richard W; French, Stephen J; Robinson, Tristan M; Yeomans, Martin R
2003-02-01
The role of gastric volume in the short-term control of eating in humans remains unclear, with some studies reporting that food volume alone can reduce appetite but others finding no such effect. A recent study in our laboratory, found effects of preload volume on subjective appetite (hunger, fullness) but not intake, and found effects of preload energy on intake but not appetite. That study used an interval of 30 min between serving preloads and the test meal, and the present study attempted to maximise the effects of the volume manipulation by removing the delay between the preload and test meal. We administered four soup-based preloads varying in volume (150 and 450 ml) using water, and energy density (1.4 and 4.2 kJ/ml) using maltodextrin, producing three energy levels (209, 629, 629 and 1886 kJ; repeated measures). These were followed immediately by an unlimited hot pasta lunch, during which food weight was monitored continuously by computer. Increasing soup volume at constant energy (629 kJ) reduced appetite ratings, but not intake. In contrast, increasing soup energy at constant volume (450 ml) reduced intake, without affecting appetite. The discrepancies between our results and other reported studies suggest that volume is more influential when intakes are large, or that there may be a threshold concentration for nutrients in the GI tract before volume alone is tangibly expressed in subsequent eating.
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Directory of Open Access Journals (Sweden)
M. Guêné-Nanchen
2017-09-01
Full Text Available Sphagnum farming is defined as the sustainable production of non-decomposed Sphagnum biomass on a cyclical and renewable basis. In this article, the influence and necessity of mowing graminoid plants to optimise Sphagnum growth in Sphagnum farming basins are examined. Repeated mowing was applied to reduce graminoid plant cover at two different stages of the production cycle (one-year-old and seven-year-old Sphagnum moss carpet at the beginning of the experiment at an experimental Sphagnum farm in eastern Canada. Sphagnum growth (cover, biomass, moss layer thickness was measured after three years of mowing. In addition, a greenhouse experiment was carried out to determine whether there is a threshold for graminoid plant cover beyond which mowing becomes necessary. Sphagnum cover and biomass were not affected by repeated mowing, even if mowing reduced the cover of graminoid plants. Thus, it appears that mowing is unnecessary if the dominant vascular species is a graminoid plant such as Eriophorum angustifolium, which accumulates minimal amounts of litter. Furthermore, high cover of Eriophorum angustifolium (up to 85 % did not affect Sphagnum cover in a density-controlled greenhouse experiment. When the specific goal is Sphagnum fibre production, decisions about control of graminoid plants should be made after considering the cover, life form and litter accumulation potentials of the dominant graminoid species involved.
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Sapp, Marty
1996-01-01
Examines the effects of 3 different types of therapy in reducing the worry and emotional components associated with test anxiety among undergraduate (n=45) and graduate (n=45) students. Relaxation therapy was more effective with graduate students, while undergraduates responded more to supportive counseling. (JPS)
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Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; Entwistle, Vikki A
2016-01-01
Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different. Design A grounded theory study. Setting Primary care practices in Australia and the UK. Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included. Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening. Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed. PMID:27920082
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Schumacher, Sophie; Kemps, Eva; Tiggemann, Marika
2017-06-01
The elaborated-intrusion theory of desire proposes that craving is a two-stage process whereby initial intrusions about a desired target are subsequently elaborated with mental imagery. The present study tested whether the craving reduction strategies of cognitive defusion and guided imagery could differentially target the intrusion and elaboration stages, respectively, and thus differentially impact the craving process. Participants were randomly assigned to a cognitive defusion, a guided imagery or a mind-wandering control condition. Pre- and post-intervention chocolate-related thoughts, intrusiveness of thoughts, vividness of imagery, craving intensity, and chocolate consumption were compared. Experiment 1 recruited a general sample of young women (n = 94), whereas Experiment 2 recruited a sample of chocolate cravers who wanted to reduce their chocolate consumption (n = 97). Across both experiments, cognitive defusion lowered intrusiveness of thoughts, vividness of imagery and craving intensity. Guided imagery reduced chocolate-related thoughts, intrusiveness, vividness and craving intensity for chocolate cravers (Experiment 2), but not for the general sample (Experiment 1). There were no group differences in chocolate consumption in either experiment. Results add to existing evidence supporting the elaborated-intrusion theory of desire in the food domain, and suggest that acceptance- and imagery-based techniques have potential for use in combatting problematic cravings. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Molinos, Luis; Zalacain, Rafael; Menéndez, Rosario; Reyes, Soledad; Capelastegui, Alberto; Cillóniz, Catia; Rajas, Olga; Borderías, Luis; Martín-Villasclaras, Juan J; Bello, Salvador; Alfageme, Inmaculada; Rodríguez de Castro, Felipe; Rello, Jordi; Ruiz-Manzano, Juan; Gabarrús, Albert; Musher, Daniel M; Torres, Antoni
2015-10-01
Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate≥125 bpm, systolic blood pressureantibiotic treatment; pleuritic chest pain; chills; pleural effusion; and blood urea nitrogen≥30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.
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Grant, Devon A; Honn, Kimberly A; Layton, Matthew E; Riedy, Samantha M; Van Dongen, Hans P A
2017-06-01
The psychomotor vigilance test (PVT) is widely used to measure reduced alertness due to sleep loss. Here, two newly developed, 3-min versions of the psychomotor vigilance test, one smartphone-based and the other tablet-based, were validated against a conventional 10-min laptop-based PVT. Sixteen healthy participants (ages 22-40; seven males, nine females) completed a laboratory study, which included a practice and a baseline day, a 38-h total sleep deprivation (TSD) period, and a recovery day, during which they performed the three different versions of the PVT every 3 h. For each version of the PVT, the number of lapses, mean response time (RT), and number of false starts showed statistically significant changes across the sleep deprivation and recovery days. The number of lapses on the laptop was significantly correlated with the numbers of lapses on the smartphone and tablet. The mean RTs were generally faster on the smartphone and tablet than on the laptop. All three versions of the PVT exhibited a time-on-task effect in RTs, modulated by time awake and time of day. False starts were relatively rare on all three PVTs. For the number of lapses, the effect sizes across 38 h of TSD were large for the laptop PVT and medium for the smartphone and tablet PVTs. These results indicate that the 3-min smartphone and tablet PVTs are valid instruments for measuring reduced alertness due to sleep deprivation and restored alertness following recovery sleep. The results also indicate that the loss of sensitivity on the 3-min PVTs may be mitigated by modifying the threshold defining lapses.
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How do we reduce plasma transfusion in Rhode Island?
Nixon, Christian P; Tavares, Maria F; Sweeney, Joseph D
2017-08-01
Plasma transfusions are given to patients with coagulopathy, either prophylactically, before an invasive procedure; or therapeutically, in the presence of active bleeding; and as an exchange fluid in therapeutic plasma exchange for disorders such as thrombotic thrombocytopenic purpura. There is consensus that many prophylactic plasma transfusions are non-efficacious, and the misdiagnosis of thrombotic thrombocytopenic purpura results in unnecessary therapeutic plasma exchange. Beginning in 2001, programs to reduce plasma transfusion in the three major teaching hospitals in Rhode Island were initiated. The programs evolved through the establishment of guidelines, education for key prescribers of plasma, screening of plasma prescriptions, and engagement of individual prescribing physicians for out-of-guidelines prescriptions with modification or cancellation. Establishment of an in-house ADAMTS13 (ADAM metallopeptidase with thrombospondin type 1, motif 13) assay in 2013 was used to prevent therapeutic plasma exchange in patients with non-thrombotic thrombocytopenic purpura microangiopathy. Transfusion service data were gathered at the hospital level regarding blood component use, hospital data for discharges, inpatient mortality, and mean case-mix index, and, at the state level, for units of plasma shipped from the community blood center to in-state hospitals. Between 2006 and 2016, a reduction in plasma use from 11,805 to 2677 units (a 77% decrease) was observed in the three hospitals and was mirrored in the state as a whole. This decline was not associated with any increase in red blood cell transfusion. Inpatient mortality either declined or was unchanged. An active program focused on education and interdiction can achieve a large decrease in plasma transfusions without evidence of patient harm. © 2017 AABB.
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Phytosterol glycosides reduce cholesterol absorption in humans.
Lin, Xiaobo; Ma, Lina; Racette, Susan B; Anderson Spearie, Catherine L; Ostlund, Richard E
2009-04-01
Dietary phytosterols inhibit intestinal cholesterol absorption and regulate whole body cholesterol excretion and balance. However, they are biochemically heterogeneous and a portion is glycosylated in some foods with unknown effects on biological activity. We tested the hypothesis that phytosterol glycosides reduce cholesterol absorption in humans. Phytosterol glycosides were extracted and purified from soy lecithin in a novel two-step process. Cholesterol absorption was measured in a series of three single-meal tests given at intervals of 2 wk to each of 11 healthy subjects. In a randomized crossover design, participants received approximately 300 mg of added phytosterols in the form of phytosterol glycosides or phytosterol esters, or placebo in a test breakfast also containing 30 mg cholesterol-d7. Cholesterol absorption was estimated by mass spectrometry of plasma cholesterol-d7 enrichment 4-5 days after each test. Compared with the placebo test, phytosterol glycosides reduced cholesterol absorption by 37.6+/-4.8% (Pphytosterol esters 30.6+/-3.9% (P=0.0001). These results suggest that natural phytosterol glycosides purified from lecithin are bioactive in humans and should be included in methods of phytosterol analysis and tables of food phytosterol content.
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Yu, Xiao-Ying; Barnett, J. Matthew; Amidan, Brett G.; Recknagle, Kurtis P.; Flaherty, Julia E.; Antonio, Ernest J.; Glissmeyer, John A.
2018-03-01
The ANSI/HPS N13.1-2011 standard requires gaseous tracer uniformity testing for sampling associated with stacks used in radioactive air emissions. Sulfur hexafluoride (SF6), a greenhouse gas with a high global warming potential, has long been the gas tracer used in such testing. To reduce the impact of gas tracer tests on the environment, nitrous oxide (N2O) was evaluated as a potential replacement to SF6. The physical evaluation included the development of a test plan to record percent coefficient of variance and the percent maximum deviation between the two gases while considering variables such as fan configuration, injection position, and flow rate. Statistical power was calculated to determine how many sample sets were needed, and computational fluid dynamic modeling was utilized to estimate overall mixing in stacks. Results show there are no significant differences between the behaviors of the two gases, and SF6 modeling corroborated N2O test results. Although, in principle, all tracer gases should behave in an identical manner for measuring mixing within a stack, the series of physical tests guided by statistics was performed to demonstrate the equivalence of N2O testing to SF6 testing in the context of stack qualification tests. The results demonstrate that N2O is a viable choice leading to a four times reduction in global warming impacts for future similar compliance driven testing.
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Sludge displacement verification for reducing grout report
International Nuclear Information System (INIS)
Caldwell, T.B.; Langton, C.A.
1997-01-01
To support the closure of HLW tanks at SRS, a reducing grout was developed that is formulated to reduce the mobility of radionuclides left in each tank. During non-radioactive flow tests of the grout, it was discovered that, in addition to its desired properties, the grout has the ability to move residual waste a considerable distance across the tank floor
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Redesign of negatively charged 111In-DTPA-octreotide derivative to reduce renal radioactivity.
Oshima, Nobuhiro; Akizawa, Hiromichi; Kawashima, Hidekazu; Zhao, Songji; Zhao, Yan; Nishijima, Ken-Ichi; Kitamura, Yoji; Arano, Yasushi; Kuge, Yuji; Ohkura, Kazue
2017-05-01
Radiolabeled octreotide derivatives have been studied as diagnostic and therapeutic agents for somatostatin receptor-positive tumors. To prevent unnecessary radiation exposure during their clinical application, the present study aimed to develop radiolabeled peptides which could reduce radioactivity levels in the kidney at both early and late post-injection time points by introducing a negative charge with an acidic amino acid such as L-aspartic acid (Asp) at a suitable position in 111 In-DTPA-conjugated octreotide derivatives. Biodistribution of the radioactivity was evaluated in normal mice after administration of a novel radiolabeled peptide by a counting method. The radiolabeled species remaining in the kidney were identified by comparing their HPLC data with those obtained by alternative synthesis. The designed and synthesized radiolabeled peptide 111 In-DTPA-d-Phe -1 -Asp 0 -d-Phe 1 -octreotide exhibited significantly lower renal radioactivity levels than those of the known 111 In-DTPA-d-Phe 1 -octreotide at 3 and 24h post-injection. The radiolabeled species in the kidney at 24h after the injection of new octreotide derivative represented 111 In-DTPA-d-Phe-OH and 111 In-DTPA-d-Phe-Asp-OH as the metabolites. Their radiometabolites and intact 111 In-DTPA-conjugated octreotide derivative were observed in urine within 24h post-injection. The present study provided a new example of an 111 In-DTPA-conjugated octreotide derivative having the characteristics of both reduced renal uptake and shortened residence time of radioactivity in the kidney. It is considered that this kinetic control was achieved by introducing a negative charge on the octreotide derivative thereby suppressing the reabsorption in the renal tubules and affording the radiometabolites with appropriate lipophilicity. Copyright © 2017 Elsevier Inc. All rights reserved.
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Redesign of negatively charged 111In-DTPA-octreotide derivative to reduce renal radioactivity
International Nuclear Information System (INIS)
Oshima, Nobuhiro; Akizawa, Hiromichi; Kawashima, Hidekazu; Zhao, Songji; Zhao, Yan; Nishijima, Ken-ichi; Kitamura, Yoji; Arano, Yasushi; Kuge, Yuji; Ohkura, Kazue
2017-01-01
Introduction: Radiolabeled octreotide derivatives have been studied as diagnostic and therapeutic agents for somatostatin receptor-positive tumors. To prevent unnecessary radiation exposure during their clinical application, the present study aimed to develop radiolabeled peptides which could reduce radioactivity levels in the kidney at both early and late post-injection time points by introducing a negative charge with an acidic amino acid such as L-aspartic acid (Asp) at a suitable position in 111 In-DTPA-conjugated octreotide derivatives. Methods: Biodistribution of the radioactivity was evaluated in normal mice after administration of a novel radiolabeled peptide by a counting method. The radiolabeled species remaining in the kidney were identified by comparing their HPLC data with those obtained by alternative synthesis. Results: The designed and synthesized radiolabeled peptide 111 In-DTPA-D-Phe −1 -Asp 0 -D-Phe 1 -octreotide exhibited significantly lower renal radioactivity levels than those of the known 111 In-DTPA-D-Phe 1 -octreotide at 3 and 24 h post-injection. The radiolabeled species in the kidney at 24 h after the injection of new octreotide derivative represented 111 In-DTPA-D-Phe-OH and 111 In-DTPA-D-Phe-Asp-OH as the metabolites. Their radiometabolites and intact 111 In-DTPA-conjugated octreotide derivative were observed in urine within 24 h post-injection. Conclusion: The present study provided a new example of an 111 In-DTPA-conjugated octreotide derivative having the characteristics of both reduced renal uptake and shortened residence time of radioactivity in the kidney. It is considered that this kinetic control was achieved by introducing a negative charge on the octreotide derivative thereby suppressing the reabsorption in the renal tubules and affording the radiometabolites with appropriate lipophilicity.
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Long, Gerald M.
2014-01-01
Two versions of a senior-level capstone course with differing note-taking strategies were compared. In one semester, a traditional student note-taking format was used; in another semester, student note-taking was rendered unnecessary by providing students with complete instructor notes. Student performance in the course as well as student opinions…
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Development of Test-Analysis Models (TAM) for correlation of dynamic test and analysis results
Angelucci, Filippo; Javeed, Mehzad; Mcgowan, Paul
1992-01-01
The primary objective of structural analysis of aerospace applications is to obtain a verified finite element model (FEM). The verified FEM can be used for loads analysis, evaluate structural modifications, or design control systems. Verification of the FEM is generally obtained as the result of correlating test and FEM models. A test analysis model (TAM) is very useful in the correlation process. A TAM is essentially a FEM reduced to the size of the test model, which attempts to preserve the dynamic characteristics of the original FEM in the analysis range of interest. Numerous methods for generating TAMs have been developed in the literature. The major emphasis of this paper is a description of the procedures necessary for creation of the TAM and the correlation of the reduced models with the FEM or the test results. Herein, three methods are discussed, namely Guyan, Improved Reduced System (IRS), and Hybrid. Also included are the procedures for performing these analyses using MSC/NASTRAN. Finally, application of the TAM process is demonstrated with an experimental test configuration of a ten bay cantilevered truss structure.
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Design and Test of Semi-Active Vibration-Reducing System for Lathe
Directory of Open Access Journals (Sweden)
Hongsheng Hu
2014-09-01
Full Text Available In this paper, its theory design, analysis and test system of semi-active vibration controlling system used for precision machine have been done. Firstly, lathe bed and spindle entity were modeled by using UG software; Then modes of the machine bed and the key components of spindle were obtained by using ANSYS software; Finally, harmonic response analysis of lathe spindle under complex load was acquired, which provided a basis of MR damper’s structure optimization design for a certain type of precision machine. In order to prove its effectives, a prototype semi-active vibration controlling lathe with MR damper was developed. Tests have been done, and comparison results between passive vibration isolation equipment and semi-active vibration controlling equipment proved its good performances of MR damper.
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RERTR program progress in qualifying reduced-enrichment fuels
International Nuclear Information System (INIS)
Snelgrove, James L.
1983-01-01
In order to provide the technical means for reducing the enrichment of uranium used to fuel research and test reactors, the U.S. Reduced Enrichment Research and Test Reactor (RERTR) Program has been engaged in the development and testing of higher-uranium-density fuels than had been used previously. This fuel development effort included work to increase the density of fuels which were being used at the time the Program began and work on a fuel with the potential for much higher density. The ultimate goal of the fuel development and testing phase of the Program is to 'qualify' the fuel for use. A fuel is considered qualified when a sufficient data base for the fuel exists that it can be approved by regulating bodies for use in reactors. To convert a core to the use of reduced-enrichment fuel it is necessary to show that the core will behave properly during normal and off-normal operating conditions and to show that the fuel will behave properly to a reasonable margin beyond the conditions expected during normal operation. It is this latter area that this paper will address. The main characteristics to be considered in evaluating the performance of a fuel are its swelling, its blister-threshold temperature, and its metallurgical appearance. Data for the qualification of the reduced-enrichment fuels being developed by the RERTR Program are obtained from examination of miniature fuel plates (miniplates) which successfully pass the irradiation screening tests and from examinations of full-sized fuel elements. This paper will summarize the miniplate data reported in other papers presented during this meeting and will give the status of full-sized element irradiations. Finally, the current status of qualification of the various fuel types will be discussed and some projections of the future will be given
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Improvements to Technical Specifications surveillance requirements
International Nuclear Information System (INIS)
Lobel, R.; Tjader, T.R.
1992-12-01
In August 1983 an NRC task group was formed to investigate problems with surveillance testing required by Technical Specifications, and to recommend approaches to effect improvements. NUREG-1024 (''Technical Specifications-Enhancing Safety Impact'') resulted, and it contained recommendations to review the basis for test frequencies; to ensure that the tests promote safety and do not degrade equipment; and to review surveillance tests so that they do not unnecessarily burden personnel. The Technical Specifications Improvement Program (TSIP) was established in December 1984 to provide the framework for rewriting and improving the Technical Specifications. As an element of the TSIP, all Technical Specifications surveillance requirements were comprehensively examined as recommended in NUREG-1024. The results of that effort are presented in this report. The study found that while some testing at power is essential to verify equipment and system operability, safety can be improved, equipment degradation decreased, and unnecessary personnel burden relaxed by reducing the amount of testing at power
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EPA Releases Draft Policy to Reduce Animal Testing for Skin Sensitization
The document, Draft Interim Science Policy: Use of Alternative Approaches for Skin Sensitization as a Replacement for Laboratory Animal Testing, describes the science behind the non-animal alternatives that can now be used to identify skin sensitization.
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Triple Test in Carcinoma Breast
Sameer; Mukherjee, Arindam
2014-01-01
Introduction: The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of “TRIPLE TEST”in diagnosis of carcinoma breast in rural labour class population. Materials and Methods: The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Result: Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4th decade) followed by 27.5% in 51-60 years age group (5th decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of
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2011-03-29
... Labor, as part of its continuing effort to reduce paperwork and respondent (i.e., employer) burden... those operating small businesses, and to reduce to the maximum extent feasible unnecessary duplication...,764 hours). This decrease is due to a drop in the job opening and labor turnover rate from 3.7 percent...
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Proceedings: Instrumentation and control test reduction workshop
International Nuclear Information System (INIS)
1991-09-01
Instrumentation and control (I ampersand C) surveillance and testing is a significant contributor to operations and management costs. Several techniques to eliminate or reduce manual testing requirements could reduce costs while improving plant safety and performance. I ampersand C test reduction was the subject of this 1991 workshop. The workshop covered test elimination, test reduction, test automation, and relevant standards and benefits. The conclusions of the workshop were the following: More utility information sharing is important. There is a significant amount of information available throughout the industry, but it is not available in a concise, useable form. An I ampersand C utility users group is needed to address items such as instrument calibration reduction, set-point methodologies, and other current I ampersand C issues. The workshop was well received. The timing is right to initiate actions to reduce testing
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Utility of repeat testing of critical values: a Q-probes analysis of 86 clinical laboratories.
Lehman, Christopher M; Howanitz, Peter J; Souers, Rhona; Karcher, Donald S
2014-06-01
A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result. To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test. Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing. Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care. Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.
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Predicting Bobsled Pushing Ability from Various Combine Testing Events.
Tomasevicz, Curtis L; Ransone, Jack W; Bach, Christopher W
2018-03-12
The requisite combination of speed, power, and strength necessary for a bobsled push athlete coupled with the difficulty in directly measuring pushing ability makes selecting effective push crews challenging. Current practices by USA Bobsled and Skeleton (USABS) utilize field combine testing to assess and identify specifically selected performance variables in an attempt to best predict push performance abilities. Combine data consisting of 11 physical performance variables were collected from 75 subjects across two winter Olympic qualification years (2009 and 2013). These variables were sprints of 15-, 30-, and 60 m, a flying 30 m sprint, a standing broad jump, a shot toss, squat, power clean, body mass, and dry-land brake and side bobsled pushes. Discriminant Analysis (DA) in addition to Principle Component Analysis (PCA) was used to investigate two cases (Case 1: Olympians vs. non-Olympians; Case 2: National Team vs. non-National Team). Using these 11 variables, DA led to a classification rule that proved capable of identifying Olympians from non-Olympians and National Team members from non-National Team members with 9.33% and 14.67% misclassification rates, respectively. The PCA was used to find similar test variables within the combine that provided redundant or useless data. After eliminating the unnecessary variables, DA on the new combinations showed that 8 (Case 1) and 20 (Case 2) other combinations with fewer performance variables yielded misclassification rates as low as 6.67% and 13.33% respectively. Utilizing fewer performance variables can allow governing bodies in many other sports to create more appropriate combine testing that maximize accuracy, while minimizing irrelevant and redundant strategies.
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Reducing tilt-to-length coupling for the LISA test mass interferometer
Tröbs, M.; Schuster, S.; Lieser, M.; Zwetz, M.; Chwalla, M.; Danzmann, K.; Fernández Barránco, G.; Fitzsimons, E. D.; Gerberding, O.; Heinzel, G.; Killow, C. J.; Perreur-Lloyd, M.; Robertson, D. I.; Schwarze, T. S.; Wanner, G.; Ward, H.
2018-05-01
Objects sensed by laser interferometers are usually not stable in position or orientation. This angular instability can lead to a coupling of angular tilt to apparent longitudinal displacement—tilt-to-length coupling (TTL). In LISA this is a potential noise source for both the test mass interferometer and the long-arm interferometer. We have experimentally investigated TTL coupling in a setup representative for the LISA test mass interferometer and used this system to characterise two different imaging systems (a two-lens design and a four-lens design) both designed to minimise TTL coupling. We show that both imaging systems meet the LISA requirement of ±25 μm rad‑1 for interfering beams with relative angles of up to ±300 μrad. Furthermore, we found a dependency of the TTL coupling on beam properties such as the waist size and location, which we characterised both theoretically and experimentally.
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Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities
Directory of Open Access Journals (Sweden)
Michelo Charles
2010-06-01
Full Text Available Abstract Background Low uptake of voluntary HIV counselling and testing (VCT in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. We investigated the acceptability of home-based delivery of counselling and HIV testing in urban and rural populations in Zambia where VCT has been offered mostly from local clinics. Methods A population-based HIV survey was conducted in selected communities in 2003 (n = 5035. All participants stating willingness to be HIV tested were offered VCT at home and all counselling was conducted in the participants' homes. In the urban area post-test counselling and giving of results were done the following day whereas in rural areas this could take 1-3 weeks. Results Of those who indicated willingness to be HIV tested, 76.1% (95%CI 74.9-77.2 were counselled and received the test result. Overall, there was an increase in the proportion ever HIV tested from 18% before provision of home-based VCT to 38% after. The highest increase was in rural areas; among young rural men aged 15-24 years up from 14% to 42% vs. for urban men from 17% to 37%. Test rates by educational attainment changed from being positively associated to be evenly distributed after home-based VCT. Conclusions A high uptake was achieved by delivering HIV counselling and testing at home. The highest uptakes were seen in rural areas, in young people and groups with low educational attainment, resulting in substantial reductions in existing inequalities in accessing VCT services.
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Helicopter-Ship Qualification Testing
Hoencamp, A.
2015-01-01
The goal of this research project is to develop a novel test methodology which can be used for optimizing cost and time efficiency of helicopter-ship qualification testing without reducing safety. For this purpose, the so-called “SHOL-X” test methodology has been established, which includes the
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The research on reactivity of alternative carbon reducers
Łabaj, J.; Słowikowski, M.; Żymła, W.; Lipart, J.
2013-01-01
The research involved measuring of the speed of zinc oxide with carbon reducers. Samples weighing between 60 and 100 mg were tested with the use of thermogravimetric analysis within the range of temperatures up to 1 100 °C in nitrogen atmosphere. The speed of heating was 20 deg min-1. The research involved also reducers normally used in reduction processes. The results obtained prove that some of the alternative reducers may be used for industrial purposes.
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Study on solitary word based on HMM model and Baum-Welch algorithm
Directory of Open Access Journals (Sweden)
Junxia CHEN
Full Text Available This paper introduces the principle of Hidden Markov Model, which is used to describe the Markov process with unknown parameters, is a probability model to describe the statistical properties of the random process. On this basis, designed a solitary word detection experiment based on HMM model, by optimizing the experimental model, Using Baum-Welch algorithm for training the problem of solving the HMM model, HMM model to estimate the parameters of the λ value is found, in this view of mathematics equivalent to other linear prediction coefficient. This experiment in reducing unnecessary HMM training at the same time, reduced the algorithm complexity. In order to test the effectiveness of the Baum-Welch algorithm, The simulation of experimental data, the results show that the algorithm is effective.
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Shafer, Teresa J; Schkade, David; Schkade, Lawrence; Geier, Steven S; Orlowski, Jeffrey P; Klintmalm, Goran
2011-09-01
Patients' deaths due to the organ donor shortage make it imperative that every suitable organ be transplanted. False-positive results of tests for infection with the human immunodeficiency virus (HIV) result in lost organs. A survey of US organ procurement organizations collected the numbers of donors and ruled-out potential donors who had a positive result on an HIV test from January 1,2006, to October 31, 2008. Sixty-two percent of US organ procurement organizations participated. Of the 12397 donor/nondonor cases, 56 (0.45%) had an initial positive result on an HIV antibody or HIV nucleic acid test, and only 8 (14.3%) of those were confirmed positive. Of the false-positive results, 50% were from HIV antibody tests and 50% were from HIV nucleic acid tests. Organs are a scarce, finite, and perishable resource. Use of HIV antibody testing has produced a remarkably safe track record of avoiding HIV transmission, with 22 years of nonoccurrence between transmissions. Because false positives occur with any test, including the HIV Ab test, adding nucleic acid testing to the standard donor testing panel doubles the number of false-positive HIV test results and thus the number of medically suitable donors lost. The required HIV antibody test is 99.99% effective in preventing transmission of the HIV virus. Adding the HIV nucleic acid test to routine organ donor screening could result in as many as 761 to 1551 unnecessary deaths of patients between HIV transmission events because medically suitable organs are wasted.
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Household methods to reduce {sup 137}Cs contents of mushrooms
Energy Technology Data Exchange (ETDEWEB)
Kostiainen, E. [Radiation and Nuclear Safety Authority - STUK, Helsinki (Finland)
2005-09-15
High radiocaesium contents in different species of mushrooms have been observed in areas contaminated by radiocaesium deposition after the Chernobyl accident in 1986. There has been no significant reduction in the {sup 137}Cs contents of mushrooms during the past ten years, besides via radioactive decay. The internal radiation dose received via mushrooms can be reduced by processing mushrooms before consumption. Various household methods were studied to find out their efficiency to reduce {sup 137}Cs contents of mushrooms. The methods tested were the same as normally used in cooking. The tests were made for the species of edible mushrooms widely consumed. The retention factors for the treatments tested were in most cases 0.2-0.3. The efficiency of treatments in reducing the {sup 137}Cs contents increased with larger water volumes and prolonged treatment times.
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[Alternatives to animal testing].
Fabre, Isabelle
2009-11-01
The use of alternative methods to animal testing are an integral part of the 3Rs concept (refine, reduce, replace) defined by Russel & Burch in 1959. These approaches include in silico methods (databases and computer models), in vitro physicochemical analysis, biological methods using bacteria or isolated cells, reconstructed enzyme systems, and reconstructed tissues. Emerging "omic" methods used in integrated approaches further help to reduce animal use, while stem cells offer promising approaches to toxicologic and pathophysiologic studies, along with organotypic cultures and bio-artificial organs. Only a few alternative methods can so far be used in stand-alone tests as substitutes for animal testing. The best way to use these methods is to integrate them in tiered testing strategies (ITS), in which animals are only used as a last resort.
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Raab, Stephen S; Andrew-Jaja, Carey; Condel, Jennifer L; Dabbs, David J
2006-01-01
The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.
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Goodman, Kenneth; Grad, Roland; Pluye, Pierre; Nowacki, Amy; Hickner, John
2012-01-01
Introduction: Electronic knowledge resources have the potential to rapidly provide answers to clinicians' questions. We sought to determine clinicians' reasons for searching these resources, the rate of finding relevant information, and the perceived clinical impact of the information they retrieved. Methods: We asked general internists, family…
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DEFF Research Database (Denmark)
Jensen, Christian F S; Ohl, Dana A; Parker, Walter R
2015-01-01
OBJECTIVE: To investigate optimal test vial (TV) volume, utility and reliability of TVs, intermediate temperature exposure (-88°C to -93°C) before cryostorage, cryostorage in nitrogen vapor (VN2) and liquid nitrogen (LN2), and long-term stability of VN2 cryostorage of human semen. DESIGN......: Prospective clinical laboratory study. SETTING: University assisted reproductive technology (ART) laboratory. PATIENT(S): A total of 594 patients undergoing semen analysis and cryopreservation. INTERVENTION(S): Semen analysis, cryopreservation with different intermediate steps and in different volumes (50......-1,000 μL), and long-term storage in LN2 or VN2. MAIN OUTCOME MEASURE(S): Optimal TV volume, prediction of cryosurvival (CS) in ART procedure vials (ARTVs) with pre-freeze semen parameters and TV CS, post-thaw motility after two- or three-step semen cryopreservation and cryostorage in VN2 and LN2. RESULT...
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3G - An Unnecessary Step Forward?
DEFF Research Database (Denmark)
Tan, Su-En
2004-01-01
Today’s mobile telecommunication world is a fast changing one with many changes happening daily. What has been happening in this field is one that is both exciting and surprising. Leading the introduction of 3rd Generation mobile communication services are countries such as Japan and South Korea ...
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Reducing health impacts of biomass burning for cooking. The need for cookstove performance testing
Energy Technology Data Exchange (ETDEWEB)
Abeliotis, K. [Department of Home Economics and Ecology, Harokopio University, Athens (Greece); Pakula, C. [Institute of Agricultural Engineering, Section Household and Appliance Technology, Rheinische Friedrich-Wilhelms University, Bonn (Germany)
2013-08-15
Biomass is a renewable energy source that is routinely used for cooking in the developing world, especially in rural areas. The World Health Organization estimates that about 2.5 billion people globally rely on biomass, such as wood, agricultural waste and animal dung to meet their energy needs for cooking utilising traditional low-efficiency cookstoves. However, certain human health risks are associated with the inhalation of off-gases resulting from the indoor use of biomass for cooking, especially for women and children who spend more of their time at home. On the other hand, use of energy-efficient cookstoves is considered to reduce those risks. Thus, qualitative and quantitative measurements of cookstove performance are necessary in order to make different stoves and different cooking processes comparable. The aim of this paper is the presentation of the current situation regarding biomass use for cooking with emphasis placed on the developing world, the brief of the adverse health impacts of biomass burning based on the review of literature, the presentation of the merits of improved efficiency cookstoves and to highlight the need for stove performance tests. The demand of different types of biomass is not likely to change in the near future in the developing world since biomass is readily available and cheap. Thus, the efforts to improve household air quality must concentrate on improving cookstoves efficiency and ventilation of the flue gases outdoors. Programmes for the improvement of the cookstoves efficiency in the developing world should be part of the development agenda.
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Effects of Data Passing Semantics and Operating System Structure on Network I/O Performance
National Research Council Canada - National Science Library
Brustoloni, Jose
1997-01-01
.... Researchers have often proposed changing the semantics of I/O data passing, so as to make copying unnecessary, or the structure of the operating system, so as to reduce or eliminate data and control passing...
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LENUS (Irish Health Repository)
Neff, Karl J
2013-06-24
To construct a clinical management matrix using serial fetal abdominal circumference measurements (ACMs) that will predict normal birth weight in pregnancies complicated by gestational diabetes (GDM) and reduce unnecessary ultrasound examination in women with GDM.
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H-Seda: Partial Packet Recovery with Heterogeneous Block Sizes for Wireless Sensor Networks
Meer, Ammar M.
2012-01-01
. Maximizing bandwidth utilization while maintaining low frame error rate has been an interesting problem. Frame fragmentation into small blocks with dedicated error detection codes per block can reduce the unnecessary retransmission of the correctly received
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Energy Technology Data Exchange (ETDEWEB)
Cheney, M.C. [PS Enterprises, Inc., Glastonbury, CT (United States)
1997-12-31
The cost of energy for renewables has gained greater significance in recent years due to the drop in price in some competing energy sources, particularly natural gas. In pursuit of lower manufacturing costs for wind turbine systems, work was conducted to explore an innovative rotor designed to reduce weight and cost over conventional rotor systems. Trade-off studies were conducted to measure the influence of number of blades, stiffness, and manufacturing method on COE. The study showed that increasing number of blades at constant solidity significantly reduced rotor weight and that manufacturing the blades using pultrusion technology produced the lowest cost per pound. Under contracts with the National Renewable Energy Laboratory and the California Energy Commission, a 400 kW (33m diameter) turbine was designed employing this technology. The project included tests of an 80 kW (15.5m diameter) dynamically scaled rotor which demonstrated the viability of the design.
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The research on reactivity of alternative carbon reducers
Directory of Open Access Journals (Sweden)
J. Lipart
2013-01-01
Full Text Available The research involved measuring of the speed of zinc oxide with carbon reducers. Samples weighing between 60 and 100 mg were tested with the use of thermogravimetric analysis within the range of temperatures up to 1 100 °C in nitrogen atmosphere. The speed of heating was 20 deg min-1. The research involved also reducers normally used in reduction processes. The results obtained prove that some of the alternative reducers may be used for industrial purposes.
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Technical specification optimization program - engineered safety features
International Nuclear Information System (INIS)
Andre, G.R.; Jansen, R.L.
1986-01-01
The Westinghouse Technical Specification Program (TOP) was designed to evaluate on a quantitative basis revisions to Nuclear Power Plant Technical Specifications. The revisions are directed at simplifying plant operation, and reducing unnecessary transients, shutdowns, and manpower requirements. In conjunction with the Westinghouse Owners Group, Westinghouse initiated a program to develop a methodology to justify Technical Specification revisions; particularly revisions related to testing and maintenance requirements on plant operation for instrumentation systems. The methodology was originally developed and applied to the reactor trip features of the reactor protection system (RPS). The current study further refined the methodology and applied it to the engineered safety features of the RPS
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International Nuclear Information System (INIS)
Leon, D.M.; White, M.D.; Moore, P.A.; Hedrick, R.A.
1978-01-01
Reduced instrument responses are presented for Thermal-Hydraulic Test Facility (THTF) test 104, which is part of the ORNL Pressurized-Water Reactor (PWR) Blowdown Heat Transfer Separate-Effects Program. The objective of the program is to investigate the thermal-hydraulic phenomenon governing the energy transfer and transport processes that occur during a loss-of-coolant accident in the PWR system. Test 104 was conducted to obtain CHF in bundle 1 under blowdown conditions. The primary purpose of this report is to make the reduced instrument responses during test 104 available
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Methods for reducing pollutant emissions from jet aircraft
Butze, H. F.
1971-01-01
Pollutant emissions from jet aircraft and combustion research aimed at reducing these emissions are defined. The problem of smoke formation and results achieved in smoke reduction from commercial combustors are discussed. Expermental results of parametric tests performed on both conventional and experimental combustors over a range of combustor-inlet conditions are presented. Combustor design techniques for reducing pollutant emissions are discussed. Improved fuel atomization resulting from the use of air-assist fuel nozzles has brought about significant reductions in hydrocarbon and carbon monoxide emissions at idle. Diffuser tests have shown that the combustor-inlet airflow profile can be controlled through the use of diffuser-wall bleed and that it may thus be possible to reduce emissions by controlling combustor airflow distribution. Emissions of nitric oxide from a shortlength annular swirl-can combustor were significantly lower than those from a conventional combustor operating at similar conditions.
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Lange, C; DeMeo, D; Silverman, EK; Weiss, ST; Laird, NM
2003-01-01
For genetic association studies with multiple phenotypes, we propose a new strategy for multiple testing with family-based association tests (FBATs). The strategy increases the power by both using all available family data and reducing the number of hypotheses tested while being robust against
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Reduce, Reuse, Recycle: The Longitudinal Value of Local Cut Scores Using State Test Data
Nelson, Peter M.; Van Norman, Ethan R.; VanDerHeyden, Amanda
2017-01-01
We used existing reading (n = 1,498) and math (n = 2,260) data to evaluate state test scores for screening middle school students. In Phase 1, state test data were used to create a research-derived cut score that was optimal for predicting state test performance the following year. In Phase 2, those cut scores were applied with future cohorts.…