Validation of the Andon KD-5917 automatic upper arm blood pressure monitor, for clinic use and self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Guo, Wan-Gang; Li, Bing-Ling; He, Yong; Xue, Yu-Sheng; Wang, Hai-Yan; Zheng, Qiang-Sun; Xiang, Ding-Cheng

2014-08-01

To validate the Andon KD-5917 automatic upper arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Sequential same-left-arm measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained in 33 participants using the mercury sphygmomanometer and the test device. According to the validation protocol, 99 pairs of test device and reference blood pressure measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 73, 98, and 99 measurements within 5, 10, and 15 mmHg for SBP and 86, 98, and 99 for DBP, respectively. The mean ± SD device-observer difference was 3.07 ± 3.68 mmHg for SBP and -0.89 ± 3.72 mmHg for DBP. The number of patients with two or three of the device-observer difference within 5 mmHg was 26 for SBP and 29 for DBP, and no patient had a device-observer difference within 5 mmHg. The Andon KD-5917 automatic upper arm blood pressure monitor can be recommended for clinical use and self-measurement in an adult population on the basis of the European Society of Hypertension International Protocol revision 2010.

Validation of the blood pressure measurement device Erkameter 125 PRO according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Beime, Beate; Deutsch, Cornelia; Krüger, Ralf; Zimmermann, Erik; Bramlage, Peter

2016-12-01

The aim of the present study was to validate the blood pressure (BP) measurement device Erkameter 125 PRO according to the International Protocol revision 2010 of the European Society of Hypertension (ESH-IP2). In 33 patients aged 32-79 years, BP measurements were performed alternately using the Erkameter 125 PRO and the reference mercury sphygmomanometer according to ESH-IP revision 2010. For the analysis, a total of 99 comparisons were included. All absolute differences between the test device and the reference were within 10 mmHg for systolic blood pressure (SBP), and all except one for diastolic blood pressure (DBP). A total of 93 out of 99 comparisons for SBP showed an absolute difference within 5 mmHg and 92 out of 99 for DBP. The mean±SD difference between the Erkameter 125 PRO and the standard reference was -0.5±3.5 mmHg for SBP and 0.5±3.5 mmHg for DBP. As to part 2 of ESH-IP 2010, all patients had a minimum of two out of three measurements within 5 mmHg difference for SBP and 31 out of 33 patients for DBP. The Erkameter 125 PRO fulfilled the requirements of parts 1 and 2 of the ESH-IP revision 2010 and can be recommended for office BP measurements in adults.

Nuclear Security Recommendations on Physical Protection of Nuclear Material and Nuclear Facilities (INFCIRC/225/Revision 5): Recommendations

International Nuclear Information System (INIS)

2011-01-01

This publication, Revision 5 of Physical Protection of Nuclear Material and Nuclear Facilities (INFCIRC/225), is intended to provide guidance to States and their competent authorities on how to develop or enhance, implement and maintain a physical protection regime for nuclear material and nuclear facilities, through the establishment or improvement of their capabilities to implement legislative and regulatory programmes. The recommendations presented in this publication reflect a broad consensus among IAEA Member States on the requirements which should be met for the physical protection of nuclear materials and nuclear facilities.

Revision of the recommended international general standard for irradiated foods and of the recommended international code of practice for the operation of radiation facilities used for the treatment of foods

International Nuclear Information System (INIS)

1981-11-01

In view of the findings and statements of the Joint FAO/IAEA/WHO Expert Committee on the Wholesomeness of Irradiated Food, convened in Geneva from 27 October to 3 November 1980, a Consultation Group, convened in Geneva from 1 to 3 July 1981 suggested the revision of the Recommended International General Standard for Irradiated Foods and of the Recommended International Code of Practice for the Operation of Radiation Facilities. The proposed changes are given and justified and the revised wording of the documents presented

Validation of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Bilo, Grzegorz; Zorzi, Cristina; Ochoa Munera, Juan E; Torlasco, Camilla; Giuli, Valentina; Parati, Gianfranco

2015-10-01

The present study aimed to evaluate the accuracy of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults (11 women, mean age 63.5±11.9 years) using a mercury sphygmomanometer (two observers) and the Somnotouch-NIBP device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the validation requirements were fulfilled. The Somnotouch-NIBP device fulfilled the requirements of the part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 75/99, 90/99, and 96/99, respectively, for systolic blood pressure and 90/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-seven and 31 participants had at least two of the three device-observers differences less than or equal to 5 mmHg for systolic and diastolic blood pressure, respectively. All three device-observer differences were greater than 5 mmHg in two participants for systolic and in one participant for diastolic blood pressure. The Somnotouch-NIBP noninvasive continuous blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure monitoring in adults, at least under conditions corresponding to those investigated in our study.

Summary of remarks and recommendations concerning the 2nd draft revision of the IAEA transport regulations

International Nuclear Information System (INIS)

The report contains a summary of all the remarks and recommendations that had been received by the International Atomic Energy Agency from Member States and International Organizations on the second draft revision of the IAEA transport regulations

Radionuclide transfer to animal products: revised recommended transfer coefficient values

International Nuclear Information System (INIS)

Howard, B.J.; Beresford, N.A.; Barnett, C.L.; Fesenko, S.

2009-01-01

A compilation has been undertaken of data which can be used to derive animal product transfer coefficients for radionuclides, including an extensive review of Russian language information. The resultant database has been used to provide recommended transfer coefficient values for a range of radionuclides to (i) cow, sheep and goat milk, (ii) meat (muscle) of cattle, sheep, goats, pigs and poultry and (iii) eggs. The values are used in a new IAEA handbook on transfer parameters which replaces that referred to as 'TRS 364'. The paper outlines the approaches and procedures used to identify and collate data, and assumptions used. There are notable differences between the TRS 364 'expected' values and the recommended values in the revised Handbook from the new database. Of the recommended values, three milk values are at least an order of magnitude higher than the TRS 364 values (Cr, Pu (cow) Pu (sheep)) and one milk value is lower (Ni (cow)). For meat, four values (Am, Cd, Sb (beef) I (pork)) are at least an order of magnitude higher than the TRS 364 values and eight values are at least an order of magnitude lower (Ru, Pu (beef), Ru, Sr, Zn (sheep), Ru, Sr (pork), Mn (poultry)). Many data gaps remain

Radionuclide transfer to animal products: revised recommended transfer coefficient values

Energy Technology Data Exchange (ETDEWEB)

Howard, B.J. [Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster LAI 4AP (United Kingdom)], E-mail: bjho@ceh.ac.uk; Beresford, N.A.; Barnett, C.L. [Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster LAI 4AP (United Kingdom); Fesenko, S. [International Atomic Energy Agency, 1400 Vienna (Austria)

2009-03-15

A compilation has been undertaken of data which can be used to derive animal product transfer coefficients for radionuclides, including an extensive review of Russian language information. The resultant database has been used to provide recommended transfer coefficient values for a range of radionuclides to (i) cow, sheep and goat milk, (ii) meat (muscle) of cattle, sheep, goats, pigs and poultry and (iii) eggs. The values are used in a new IAEA handbook on transfer parameters which replaces that referred to as 'TRS 364'. The paper outlines the approaches and procedures used to identify and collate data, and assumptions used. There are notable differences between the TRS 364 'expected' values and the recommended values in the revised Handbook from the new database. Of the recommended values, three milk values are at least an order of magnitude higher than the TRS 364 values (Cr, Pu (cow) Pu (sheep)) and one milk value is lower (Ni (cow)). For meat, four values (Am, Cd, Sb (beef) I (pork)) are at least an order of magnitude higher than the TRS 364 values and eight values are at least an order of magnitude lower (Ru, Pu (beef), Ru, Sr, Zn (sheep), Ru, Sr (pork), Mn (poultry)). Many data gaps remain.

Validation of the Pangao PG-800B5 for clinical use and self-measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Chen, Wan; Zeng, Zhaolin; Li, Lizhi; Wan, Xiaofen; Wan, Yi

2014-10-01

This study aimed to validate the Pangao PG-800B5 upper arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. A total of 33 participants, 16 men and 17 women, were included in the device evaluation. The protocol requirements were followed precisely. The mean age of the participants was 56.4±21.0 years (range 22-84 years). The mean systolic blood pressure was 143.6±25.5 mmHg (range 98-188 mmHg), the mean diastolic blood pressure was 85.7±17.2 mmHg (range 49-125 mmHg), and the mean arm circumference was 26.1±2.2 cm (range 23-32 cm). On average, the device overestimated the systolic blood pressure by 0.9±4.2 mmHg and diastolic blood pressure by 0.7±4.5 mmHg. The device passed all requirements, fulfilling the standards of the protocol. Therefore, the Pangao PG-800B5 upper arm blood pressure monitor can be recommended for clinical use and self-measurement in an adult population.

Treating rheumatoid arthritis to target: Revision of the 2014 International Expert Group Recommendations

Directory of Open Access Journals (Sweden)

N. T. Vatutin

2016-01-01

Full Text Available The paper presents a new edition (2014 of basic approaches to therapy of rheumatoid arthritis (RA based on the principle of «Treat to target », which has been elaborated by the experts of the European League Against Rheumatism (EULAR and the American College of Rheumatology (ACR. The revised recommendations consider the results of numerous randomized controlled and cohort studies, as well as the data of an extensive systematic review of the literature. The new 2014 version contains 4 basic principles and 10 recommendations for the management of patients with RA. When making the updated recommendations, the experts took into account particularly issues, such as criteria for defining a remission, the need to minimize comorbidities in patients with RA and to individualize its therapy, as well as their working ability. The basic principles in the management of patients with RA, by using a treat-to-target strategy, are discussed in detail and the rewording of the main points of the 2010 recommendations and their new edition are substantiated.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. First Revision

NARCIS (Netherlands)

Mantas, John; Ammenwerth, Elske; Demiris, George; Hasman, Arie; Haux, Reinhold; Hersh, William; Hovenga, Evelyn; Lun, K. C.; Marin, Heimar; Martin-Sanchez, Fernando; Wright, Graham

2010-01-01

Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop

Validation of the SCIAN LD-735 wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Chen, Qi; Li, Yan; Wang, Ji-Guang

2016-08-01

This study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor SCIAN LD-735 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were measured sequentially in 33 adult Chinese participants (10 women, mean age 44.8 years) using a mercury sphygmomanometer (two observers) and the SCIAN LD-735 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The SCIAN LD-735 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 86/99, 97/99, and 98/99, respectively, for systolic blood pressure and 85/99, 98/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. In total, 30 and 33 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The SCIAN wrist blood pressure monitor LD-735 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Validation of the AVITA BPM17 wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang

2017-08-01

The aim of the present study was to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM17 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (19 men, 45.7 years of mean age) using a mercury sphygmomanometer (two observers) and the AVITA BPM17 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM17 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 94/99, 98/99, and 98/99, respectively, for systolic blood pressure and 92/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Overall, 32 participants for both systolic and diastolic blood pressure, respectively, had at least two of the three device-observerss differences within 5 mmHg (required ≥24). None had all the three device-observers comparisons greater than 5 mmHg for systolic and diastolic blood pressure. The AVITA wrist blood pressure monitor BPM17 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Philadelphia chromosome-negative classical myeloproliferative neoplasms: revised management recommendations from European LeukemiaNet.

Science.gov (United States)

Barbui, Tiziano; Tefferi, Ayalew; Vannucchi, Alessandro M; Passamonti, Francesco; Silver, Richard T; Hoffman, Ronald; Verstovsek, Srdan; Mesa, Ruben; Kiladjian, Jean-Jacques; Hehlmann, Rȕdiger; Reiter, Andreas; Cervantes, Francisco; Harrison, Claire; Mc Mullin, Mary Frances; Hasselbalch, Hans Carl; Koschmieder, Steffen; Marchetti, Monia; Bacigalupo, Andrea; Finazzi, Guido; Kroeger, Nicolaus; Griesshammer, Martin; Birgegard, Gunnar; Barosi, Giovanni

2018-05-01

This document updates the recommendations on the management of Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-neg MPNs) published in 2011 by the European LeukemiaNet (ELN) consortium. Recommendations were produced by multiple-step formalized procedures of group discussion. A critical appraisal of evidence by using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was performed in the areas where at least one randomized clinical trial was published. Seven randomized controlled trials provided the evidence base; earlier phase trials also informed recommendation development. Key differences from the 2011 diagnostic recommendations included: lower threshold values for hemoglobin and hematocrit and bone marrow examination for diagnosis of polycythemia vera (PV), according to the revised WHO criteria; the search for complementary clonal markers, such as ASXL1, EZH2, IDH1/IDH2, and SRSF2 for the diagnosis of myelofibrosis (MF) in patients who test negative for JAK2V617, CALR or MPL driver mutations. Regarding key differences of therapy recommendations, both recombinant interferon alpha and the JAK1/JAK2 inhibitor ruxolitinib are recommended as second-line therapies for PV patients who are intolerant or have inadequate response to hydroxyurea. Ruxolitinib is recommended as first-line approach for MF-associated splenomegaly in patients with intermediate-2 or high-risk disease; in case of intermediate-1 disease, ruxolitinib is recommended in highly symptomatic splenomegaly. Allogeneic stem cell transplantation is recommended for transplant-eligible MF patients with high or intermediate-2 risk score. Allogeneic stem cell transplantation is also recommended for transplant-eligible MF patients with intermediate-1 risk score who present with either refractory, transfusion-dependent anemia, blasts in peripheral blood > 2%, adverse cytogenetics, or high-risk mutations. In these situations, the transplant procedure should be

Validation of the custo screen 400 ambulatory blood pressure-monitoring device according to the European Society of Hypertension International Protocol revision 2010

Directory of Open Access Journals (Sweden)

Bramlage P

2014-05-01

Full Text Available Peter Bramlage,1 Cornelia Deutsch,1 Ralf Krüger,1 Andreas Wolf,2 Peter Müller,2 Thomas Zwingers,1,4 Beate Beime,1 Thomas Mengden31Institut für Pharmakologie und Präventive Medizin, Cloppenburg, 2Müller and Sebastiani, Ottobrunn, 3Kerckhoff-Klinik, Bad Nauheim, 4Estimate, Augsburg, GermanyObjective: The aim of the present study was to validate the custo screen 400 ambulatory blood pressure-monitoring (ABPM device according to the 2010 International Protocol revision of the European Society of Hypertension (ESH-IP. The device can be used for ABPM for up to 72 hours.Materials and methods: Systolic and diastolic blood pressure (SBP and DBP, respectively were sequentially measured in 33 adult subjects (13 males and 20 females and compared with a standard mercury sphygmomanometer (two observers. A total of 99 comparison pairs were obtained.Results: The custo screen 400 met the requirements of parts 1 and 2 of the ESH-IP revision 2010. The mean difference between the device and reference sphygmomanometer readings was −0.5±4.5 mmHg for SBP and −0.1±3.3 mmHg for DBP. All but one measurement were within the absolute difference of 10 mmHg between the device and the observers for SBP and DBP. The number of absolute differences between the device and the observers within a range of 5 mmHg was 84 of 99 readings for SBP, and 93 of 99 readings for DBP.Conclusion: The custo screen 400 ABPM device met the requirements of the 2010 ESH-IP revision, and hence can be recommended for ABPM in adults. To our knowledge, the custo screen 400 is the first device to pass the revised ESH-IP 2010.Keywords: validation, ambulatory blood pressure monitoring, ESH

Validation of the iHealth BP3 upper-arm blood pressure monitor, for clinic use and self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Chen, Can; Shang, Fujun; Wang, Jiepin; Chen, Jianghong; Ji, Na; Wan, Yi

2012-12-01

This study aimed to evaluate the performance of the iHealth BP3 upper-arm blood pressure monitor, which is designed for clinic use and self-measurement of blood pressure using Apple touch devices as an interface. The European Society of Hypertension International Protocol (ESH-IP) revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. Ninty-nine couples of test device and reference blood pressure measurements were obtained during the study (three pairs for each of the 33 participants). The 33 participants, age 47.1±12.3 years (age range 27-69 years) and arm circumference 30.0±4.4 cm, had a mean systolic blood pressure (SBP) of 143.9±27.4 mmHg and a mean diastolic blood pressure (DBP) of 90.1±18.3 mmHg. The device passed all of the requirements fulfilling the standards of the protocol, and the mean±SD device-observer difference was 2.8±4.2 mmHg for SBP and -0.4±3.5 mmHg for DBP. According to the results of the validation study on the basis of the ESH-IP revision 2010, the iHealth BP3 can be recommended for clinic use and self-measurement in an adult population. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Validation of the AVITA BPM64 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang

2018-02-01

The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure (BP) monitor AVITA BPM64 for home BP monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic BPs were measured sequentially in 33 adult Chinese (14 women, mean age 47.0 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM64 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM64 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 91/99, 98/99, and 98/99, respectively, for systolic BP and 92/99, 99/99, and 99/99, respectively, for diastolic BP. The device also fulfilled the criteria in part 2 of the validation study. Thirty-two participants for both systolic and diastolic BP had at least two of the three device-observer differences within 5 mmHg (required ≥24). Only one participant for systolic BP had all three device-observer comparisons greater than 5 mmHg. The AVITA upper arm BP monitor BPM64 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.

Validation of the Rossmax CF175 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Zhang, Lu; Kang, Yuan-Yuan; Zeng, Wei-Fang; Li, Yan; Wang, Ji-Guang

2015-04-01

The present study aimed to evaluate the accuracy of the Rossmax CF175 upper-arm blood pressure monitor for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (17 women, mean age 46 years) using a mercury sphygmomanometer (two observers) and the Rossmax CF175 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The Rossmax CF175 device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg was 78/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 81/99, 96/99, and 97/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Twenty-nine participants, for both of systolic and diastolic blood pressure, had at least two of the three device-observers differences within 5 mmHg (required ≥24). Only one participant for diastolic blood pressure had all three device-observers comparisons greater than 5 mmHg. The Rossmax automated oscillometric upper-arm blood pressure monitor CF175 fulfilled the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure measurement in adults.

Validation of the AVITA BPM15S wrist blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Zeng, Wei-Fang; Zhang, Lu; Li, Yan; Wang, Ji-Guang

2014-06-01

The present study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM15S for home blood pressure monitoring according to the International Protocol revision 2010 of the European Society of Hypertension. Systolic and diastolic blood pressures were sequentially measured in 33 Chinese adults (15 women, mean age 51 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM15S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM15S device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg were 85/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 82/99, 96/99, and 98/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Thirty-two and 28 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥ 24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The AVITA wrist blood pressure monitor BPM15S fulfilled the requirements of the International Protocol revision 2010 and hence can be recommended for home use in an adult population.

Protocol recommendations for CT of the lungs. Konsensus der Arbeitsgemeinschaft Thoraxdiagnostik der DRG; Protokollempfehlungen fuer die Computertomografie der Lunge. Konsensus der Arbeitsgemeinschaft Thoraxdiagnostik der DRG

Energy Technology Data Exchange (ETDEWEB)

Biederer, J.; Bolte, H. [Universitaetsklinikum Schleswig-Holstein, Campus Kiel (Germany). Klinik fuer Diagnostische Radiologie; Wildberger, J.E.; Hieckel, H.G. [Helios Klinikum Berlin-Buch (Germany). Inst. fuer Roentgendiagnostik; Reuter, M. [Vivantes Klinikum Neukoelln, Berlin (Germany). Inst. fuer Radiologie und Interventionelle Therapie; Fink, C. [Universitaetsklinikum Mannheim (Germany). Inst. fuer Klinische Radiologie und Nuklearmedizin; Tuengerthal, S.; Heussel, C.P. [Thoraxklinik Heidelberg (Germany). Radiologie; Rehbock, B. [St. Hedwig Krankenhaus, Berlin-Mitte (Germany). Praxis fuer Diagnostische Radiologie; Wormanns, D. [Evangelische Lungenklinik Berlin (Germany); Diederich, S. [Marien-Hospital, Duesseldorf (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Nuklearmedizin; Hofmann-Preiss, K. [Radiologische Gemeinschaftspraxis Erlangen (Germany); Loercher, U. [Deutsche Klinik fuer Diagnostik, Wiesbaden (Germany). Fachbereich Bildgebende Verfahren

2008-05-15

An increasing variety of computed tomography scanners with different imaging geometry and diverse protocol recommendations of the vendors for chest imaging have raised the need for a consensus on basic imaging protocols. In addition to this, radiation exposure has become a relevant issue in computed tomography. With the recommendations of this article it was intended to provide a schematic set of protocols and recommendations for computed tomography of the lung, i.e. to facilitate follow-up reads of studies that were acquired with different scanners and at different sites. Four different types of protocols are suggested for different groups of indications. The basic protocol is a contrast-enhanced helical study with sufficient spatial resolution for tumour staging and workup of unclear situations. The second protocol is a refinement of this protocol with increased spatial resolution dedicated to vessel imaging and computeraided (CAD) applications. Depending on the z-coverage, this infers a higher radiation exposure and more data for post-processing and storage. A low dose protocol is recommended for short term follow up of known disease and imaging focused on the lung parenchyma only. For diffuse lung disease, an additional HRCT-mode inincremental technique can be applied. Adapted protocol recommendations are given for three scanner groups (single row detector and twin, 4-16 row detector and 32 and more row detectors). Nevertheless, individual adjustments for all patients are essential and some of the parameters will need to be adjusted for specific scanners and may thus differ from these general recommendations. Finally, we make suggestions for documentation, reporting and archiving (preferably digital). (orig.)

Validation of the iHealth BP5 wireless upper arm blood pressure monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Shang, Fujun; Zhu, Yizheng; Zhu, Zhenlai; Liu, Lei; Wan, Yi

2013-10-01

The aim of this study was to validate the iHealth BP5 wireless upper arm blood pressure (BP) monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for validation of BP measuring devices in adults was followed precisely. A total of 99 pairs of test device and reference BP measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 71, 89, and 97 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 73, 90, and 99 mmHg for diastolic blood pressure (DBP), respectively. The mean ± SD device-observer difference was -1.21 ± 5.87 mmHg for SBP and -1.04 ± 5.28 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 25 for SBP and 28 for DBP. In addition, three participants had no device-observer difference within 5 mmHg for SBP and none of the participants had the same for DBP. According to the validation results on the basis of the ESH-IP revision 2010, the iHealth BP5 wireless upper arm BP monitor can be recommended for self/home measurement in an adult population.

Validation of the Medipro MediCare 100f upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Yi, Jun; Wan, Yi; Pan, Feng; Yu, Xiaorong; Zhao, Huadong; Shang, Fujun; Xu, Yongyong

2011-08-01

The validation of sphygmomanometer is important in accurate blood pressure measurement. This study presents the validation results by the Medipro MediCare 100f upper arm blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. A total of 99 couples of test device and reference blood pressure measurements were obtained during the study (three pairs for each of the 33 participants). The device produced 73, 93, and 98 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 79, 93, and 96 for diastolic blood pressure (DBP), respectively. The mean standard deviation device-observer difference was 1.4 ± 5.2 mmHg for SBP and 0.02±5.8 mmHg for DBP. The number of participants with two or three of the device-observer differences within 5 mmHg was 24 for SBP and 30 for DBP, whereas there was no participant with none of the device-observer differences within 5 mmHg. According to the results of the validation study based on the ESH-IP revision 2010, the Medipro MediCare 100f can be recommended for self-measurement in an adult population.

No Child Left Behind in Art Education Policy: A Review of Key Recommendations for Arts Language Revisions

Science.gov (United States)

Grey, Anne C.

2010-01-01

From bipartisan origins and a laudable intent, the No Child Left Behind (Act) of 2001 has profoundly altered the condition of art education. A historical vantage point and review of literature reveals the current status of pending arts language revisions to the NCLB Act, as well as a pressing need to examine the key recommendations and to consider…

Validation of the Andon KD-5965 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Huang, Jinhua; Li, Zhijie; Li, Guimei; Liu, Zhaoying

2015-10-01

This study aimed to evaluate the accuracy of the Andon KD-5965 upper-arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults, with 20 women using a mercury sphygmomanometer (two observers) and the Andon KD-5965 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg was 70/99, 91/99, and 98/99, respectively, for systolic blood pressure and 81/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-five and 29 participants, for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required≥24). Two and one participants for systolic and diastolic blood pressure, respectively, had all three device-observers comparisons greater than 5 mmHg. According to the validation results, with better performance for diastolic blood pressure than that for systolic blood pressure, the Andon automated oscillometric upper-arm blood pressure monitor KD-5965 fulfilled the requirements of the European Society of Hypertension International Protocol revision 2010, and hence can be recommended for blood pressure measurement in adults.

Validation of the iHealth BP7 wrist blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Wang, Qing; Zhao, Huadong; Chen, Wan; Li, Ni; Wan, Yi

2014-02-01

The aim of this study was to validate the iHealth BP7 wireless wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. A total of 99 pairs of test device and reference blood pressure measurements (three pairs for each of the 33 participants) were obtained for validation. The ESH-IP revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. The device produced 66, 87, and 97 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 72, 93, and 99 mmHg for diastolic blood pressure (DBP), respectively. The mean±SD device-observer difference was -0.7±6.9 mmHg for SBP and -1.0±5.1 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 25 for SBP and 26 for DBP; furthermore, there were three participants for SBP and one participant for DBP, with none of the device-observer differences within 5 mmHg. On the basis of the validation results, the iHealth BP7 wireless wrist blood pressure monitor can be recommended for self-measurement in an adult population.

The nuclear liability conventions revised

International Nuclear Information System (INIS)

Reyners, P.

2004-01-01

The signature on 12 February 2004 of the Protocols amending respectively the 1960 Paris Convention and the 1963 Brussels Supplementary Convention was the second step of the process of modernisation of the international nuclear liability regime after the adoption in September 1997 of a Protocol revising the 1963 Vienna Convention and of a new Convention on Supplementary Compensation for Nuclear Damage. The common objective of the new instruments is to provide more funds to compensate a larger number of potential victims in respect of a broader range of damage. Another goal of the revision exercise was to maintain the compatibility between the Paris and Vienna based systems, a commitment enshrined in the 1988 Joint Protocol, as well as to ascertain that Paris/Brussels countries could also become a Party to the Convention on Supplementary Compensation. However, while generally consistent vis a vis the Joint Protocol, the provisions of the Paris and Vienna Conventions, as revised, differ on some significant aspects. Another remaining issue is whether the improved international nuclear liability regime will succeed in attracting in the future a larger number of countries, particularly outside Europe, and will so become truly universal. Therefore, the need for international co-operation to address these issues, to facilitate the adoption of new implementing legislation and to ensure that this special regime keeps abreast of economic and technological developments, is in no way diminished after the revision of the Conventions.(author)

Validation of the AVITA BPM63S upper arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Kang, Yuan-Yuan; Zeng, Wei-Fang; Liu, Ming; Li, Yan; Wang, Ji-Guang

2014-02-01

The present study aimed to evaluate the accuracy of the AVITA BPM63S upper arm blood pressure monitor for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (14 women, mean age of 47 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM63S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The AVITA BPM63S device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 68/99, 89/99, and 96/99, respectively, for systolic blood pressure, and 75/99, 95/99, and 97/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Twenty-four and 25 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required ≥24). One and two participants for systolic and diastolic blood pressure, respectively, had all three device-observers differences greater than 5 mmHg. The AVITA BPM63S automated oscillometric upper arm blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure measurement at home in adults.

The HPA photon protocol and proposed electron protocol

International Nuclear Information System (INIS)

Pitchford, W.G.

1985-01-01

The Hospital Physicists Association (HPA) photon dosimetry protocol has been produced and was published in 1983. Revised values of some components of Csub(lambda) and refinements introduced into the theory in the last few years have enabled new Csub(lambda) values to be produced. The proposed HPA electron protocol is at present in draft form and will be published shortly. Both protocels are discussed. (Auth.)

Impact of applying the more stringent validation criteria of the revised European Society of Hypertension International Protocol 2010 on earlier validation studies.

Science.gov (United States)

Stergiou, George S; Karpettas, Nikos; Atkins, Neil; O'Brien, Eoin

2011-04-01

Since 2002 when the European Society of Hypertension International Protocol (ESH-IP) was published it has become the preferred protocol for validating blood pressure monitors worldwide. In 2010, a revised version of the ESH-IP with more stringent criteria was published. This study assesses the impact of applying the revised ESH-IP criteria. A systematic literature review of ESH-IP studies reported between 2002 and 2010 was conducted. The impact of applying the ESH-IP 2010 criteria retrospectively on the data reported in these studies was investigated. The performance of the oscillometric devices in the last decade was also investigated on the basis of the ESH-IP criteria. Among 119 published studies, 112 with sufficient data were analyzed. According to ESH-IP 2002, the test device failed in 19 studies, whereas by applying the ESH-IP 2010 criteria in 28 additional studies increased the failure rate from 17 to 42%. Of these 28 studies, in 20 (71%) the test device failed at part 1 (accuracy per measurement) and in 22 (79%) at part 2 (accuracy per subject). Most of the failures involved the '5 mmHg or less' criterion. In the last decade there has been a consistent trend toward improved performance of oscillometric devices assessed on the basis of the ESH-IP criteria. This retrospective analysis shows that the stricter revised ESH-IP 2010 criteria will noticeably increase the failure rate of devices being validated. Oscillometric devices are becoming more accurate, and the revised ESH-IP by acknowledging this trend will allow more accurate devices to enter the market.

Components of an Anticancer Diet: Dietary Recommendations, Restrictions and Supplements of the Bill Henderson Protocol

Directory of Open Access Journals (Sweden)

Laurie Heilman Bell

2010-12-01

Full Text Available The use of complementary and alternative medicines including dietary supplements, herbals and special diets to prevent or treat disease continues to be popular. The following paper provides a description of an alternative dietary approach to the self-management and treatment of cancer, the Bill Henderson Protocol (BHP. This diet encourages daily intake of raw foods, a combination of cottage cheese and flaxseed oil and a number of supplements. Some foods and food groups are restricted (e.g., gluten, meat, dairy. Early background theory that contributed to the protocol’s development is presented as is a summary of relevant evidence concerning the anti-cancer fighting properties of the individual components. Supplement intake is considered in relation to daily recommended intakes. Challenges and risks to protocol adherence are discussed. As with many complementary and alternative interventions, clear evidence of this dietary protocol’s safety and efficacy is lacking. Consumers of this protocol may require guidance on the ability of this protocol to meet their individual nutritional needs.

Validation of the YuWell YE690A upper-arm blood pressure monitor, for clinic use and self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Chen, Qi; Lei, Lei; Li, Yan; Wang, Ji-Guang

2017-10-01

The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure monitor YuWell YE690A for blood pressure measurement according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were measured sequentially in 33 adult Chinese (12 women, 44.2 years of mean age) using a mercury sphygmomanometer (two observers) and the YE690A device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The YuWell YE690A device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 79/99, 96/99, and 97/99, respectively, for systolic blood pressure and 72/99, 95/99, and 98/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Thirty-one and 25 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). No participant for systolic and two participants for diastolic blood pressure had all the three device-observer comparisons greater than 5 mmHg. The YuWell blood pressure monitor YE690A has passed the requirements of the International Protocol revision 2010 and hence can be recommended for blood pressure measurement in adults.

Fundamental ICRP recommendations at the start of the 21st century: status of the revision of ICRP publication 60

International Nuclear Information System (INIS)

Valentin, J.

2002-01-01

The basic recommendations of the International Commission on Radiological Protection, ICRP, are either re-stated or revised at intervals of about 15 years, most recently in ICRP Publication 60, adopted in 1990. ICRP plan to issue its next recommendations around 2005. Through extensive consultation, the active participation of the radiological protection community was recruited already at the conceptual stage. Based on the vast input received, ICRP is currently preparing draft recommendations. These are likely to emphasise egalitarian values more than utilitarian ones, to be holistic rather than anthropocentric, and to be formatted as a relatively concise set of actual recommendations underpinned by separate publications with more detail. The draft will again be circulated worldwide and comments will be discussed in 2004 with a view to approval of the recommendations in 2005 and publication in 2005 or 2006. Thus, integration into legislation would be possible sometime between 2006 and 2010, say. (orig.) [de

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence Based Recommendations

Directory of Open Access Journals (Sweden)

Eric C. Silverman

2017-04-01

administered. Conclusion: Protocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols. [West J Emerg Med. 2017;18(3419-436.

Maximum surgical blood ordering schedules for revision lower limb arthroplasty.

Science.gov (United States)

Mahadevan, Devendra; Challand, Christopher; Clarke, Andrew; Keenan, Jonathan

2011-05-01

Effective utilisation of blood products is fundamental. The introduction of maximum surgical blood ordering schedules (MSBOS) for operations has been shown to improve transfusion services. A retrospective analysis was undertaken to establish an evidence-based MSBOS for revision total hip replacement (THR) and total knee revision (TKR). The impact of this schedule on blood conservation was analysed. A retrospective analysis was undertaken on 397 patients who underwent revision THR and TKR over a 4-year period. The cross-match-to-transfusion ratio (CTR) and transfusion index (TI) were calculated. A MSBOS protocol was created based on the TIs and its' impact on transfusion services was assessed prospectively on 125 patients by comparing CTRs. In revision THR, TI was 1.19 for elective cases, 1.55 for emergency cases and 2.35 for infected cases. There was no difference in TI for revisions of cemented and uncemented components. Single component THR revision required less transfusion. In revision TKR, TI was 0.31 for elective cases, 2.0 for emergency cases and 1.23 for cases with infection. The introduction of the MSBOS protocol had resulted in a considerable improvement in blood ordering. Reductions in the CTR were seen for all types of revision surgery, but most evident in elective revision THR (3.24-2.18) and elective revision TKR (7.95-1.2). Analysis confirmed that excessive cross-matching occurred for revision lower limb arthroplasty. The introduction of our MSBOS protocol promoted blood conservation and compliance with established national guidelines.

MRI of the prostate. Recommendations on patient preparation and scanning protocol; MRT der Prostata. Empfehlungen zur Vorbereitung und Durchfuehrung

Energy Technology Data Exchange (ETDEWEB)

Franiel, Tobias [University Hospital Jena (Germany). Dept. of Diagnostic and Interventional Radiology; Quentin, Michael; Schimmoeller, Lars [University Hospital Duesseldorf (Germany). Dept. of Diagnostic and Interventional Radiology; Mueller-Lisse, Ullrich Gerd [Munich Univ. (Germany). Dept. of Radiology; Asbach, Patrick [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Roedel, Stefan [Staedtisches Klinikum Dresden Friedrichstadt (Germany). Radiology; Willinek, Winfried [Bonn Univ. (Germany). Radiology; Hueper, Katja [Hannover Medical School (Germany). Inst. for Diagnostic and Interventional Radiology; Beyersdorff, Dirk [University Hospital Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Roethke, Matthias [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Radiology

2017-01-15

The Working Group Uroradiology and Urogenital Diagnosis of the German Roentgen Society has developed uniform recommendations for the preparation and implementation of prostate MRI. In the first part detailed recommendations are given in tabular form regarding 1. anamnestic data before prostate MRI, 2. termination of examinations and preparation of examinations, 3. examination protocol and 4. MRI-guided in-bore biopsy. In the second part, the recommendations are discussed in detail and relevant background information is provided.

Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems

Energy Technology Data Exchange (ETDEWEB)

Conover, David R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Crawford, Aladsair J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fuller, Jason C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gourisetti, Sri Nikhil Gup [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Viswanathan, Vilayanur V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Ferreira, Summer [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schoenwald, David [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rosewater, David [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2016-04-01

The Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems (PNNL-22010) was first issued in November 2012 as a first step toward providing a foundational basis for developing an initial standard for the uniform measurement and expression of energy storage system (ESS) performance. Based on experiences with the application and use of that document, and to include additional ESS applications and associated duty cycles, test procedures and performance metrics, a first revision of the November 2012 Protocol was issued in June 2014 (PNNL 22010 Rev. 1). As an update of the 2014 revision 1 to the Protocol, this document (the March 2016 revision 2 to the Protocol) is intended to supersede the June 2014 revision 1 to the Protocol and provide a more user-friendly yet more robust and comprehensive basis for measuring and expressing ESS performance.

Safe bunker designing for the 18 MV Varian 2100 Clinac: a comparison between Monte Carlo simulation based upon data and new protocol recommendations.

Science.gov (United States)

Beigi, Manije; Afarande, Fatemeh; Ghiasi, Hosein

2016-01-01

The aim of this study was to compare two bunkers designed by only protocols recommendations and Monte Carlo (MC) based upon data derived for an 18 MV Varian 2100Clinac accelerator. High energy radiation therapy is associated with fast and thermal photoneutrons. Adequate shielding against the contaminant neutron has been recommended by IAEA and NCRP new protocols. The latest protocols released by the IAEA (safety report No. 47) and NCRP report No. 151 were used for the bunker designing calculations. MC method based upon data was also derived. Two bunkers using protocols and MC upon data were designed and discussed. From designed door's thickness, the door designed by the MC simulation and Wu-McGinley analytical method was closer in both BPE and lead thickness. In the case of the primary and secondary barriers, MC simulation resulted in 440.11 mm for the ordinary concrete, total concrete thickness of 1709 mm was required. Calculating the same parameters value with the recommended analytical methods resulted in 1762 mm for the required thickness using 445 mm as recommended by TVL for the concrete. Additionally, for the secondary barrier the thickness of 752.05 mm was obtained. Our results showed MC simulation and the followed protocols recommendations in dose calculation are in good agreement in the radiation contamination dose calculation. Difference between the two analytical and MC simulation methods revealed that the application of only one method for the bunker design may lead to underestimation or overestimation in dose and shielding calculations.

Ultrasonography diagnosis and imaging-based management of thyroid nodules: Revised Korean society of thyroid radiology consensus statement and recommendations

Energy Technology Data Exchange (ETDEWEB)

Shin, Jung Hee [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Baek, Jung Hwan [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Chung, Jin [Dept. of Radiology, Ewha Womans University School of Medicine, Seoul (Korea, Republic of); and others

2016-06-15

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These recommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and imaging-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature and the consensus of experts.

The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision.

Science.gov (United States)

Magerl, M; Altrichter, S; Borzova, E; Giménez-Arnau, A; Grattan, C E H; Lawlor, F; Mathelier-Fusade, P; Meshkova, R Y; Zuberbier, T; Metz, M; Maurer, M

2016-06-01

These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC)].

Science.gov (United States)

Emoli, Alessandro; Cappuccio, Serena; Marche, Bruno; Musarò, Andrea; Scoppettuolo, Giancarlo; Pittiruti, Mauro

2014-01-01

The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). The insertion of a peripherally inserted central venous catheter (PICC) is not without risks. The Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) has developed a protocol (SIP: Safe Implantation of PICCs) with the aim of minimizing the risks which may be associated with the placement of PICCs. The protocol is based on recommendations available in the literature and on the main clinical practice guidelines. The SIP protocol, a bundle of evidence-based recommendations, it is is easy to use, inexpensive, and cost-effective. If routinely used and carefully inplemented, it greatly reduces complications such as failure of venipuncture, accidental arterial puncture, damage of median nerve, infection and catheter related venous thrombosis.

Methods for culturing retinal pigment epithelial cells: a review of current protocols and future recommendations

Directory of Open Access Journals (Sweden)

Aaron H Fronk

2016-07-01

Full Text Available The retinal pigment epithelium is an important part of the vertebrate eye, particularly in studying the causes and possible treatment of age-related macular degeneration. The retinal pigment epithelium is difficult to access in vivo due to its location at the back of the eye, making experimentation with age-related macular degeneration treatments problematic. An alternative to in vivo experimentation is cultivating the retinal pigment epithelium in vitro, a practice that has been going on since the 1970s, providing a wide range of retinal pigment epithelial culture protocols, each producing cells and tissue of varying degrees of similarity to natural retinal pigment epithelium. The purpose of this review is to provide researchers with a ready list of retinal pigment epithelial protocols, their effects on cultured tissue, and their specific possible applications. Protocols using human and animal retinal pigment epithelium cells, derived from tissue or cell lines, are discussed, and recommendations for future researchers included.

Quality and Dose Optimized CT Trauma Protocol - Recommendation from a University Level-I Trauma Center.

Science.gov (United States)

Kahn, Johannes; Kaul, David; Böning, Georg; Rotzinger, Roman; Freyhardt, Patrick; Schwabe, Philipp; Maurer, Martin H; Renz, Diane Miriam; Streitparth, Florian

2017-09-01

Purpose  As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods  61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50 %). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85 s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. Results  The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40 % (DLP 1087 vs. 647 mGyxcm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. Conclusion  A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR

Validation of the G.LAB MD2200 wrist blood pressure monitor according to the European Society of Hypertension, the British Hypertension Society, and the International Organization for Standardization Protocols.

Science.gov (United States)

Liu, Ze-Yu; Zhang, Qing-Han; Ye, Xiao-Lei; Liu, Da-Peng; Cheng, Kang; Zhang, Chun-Hai; Wan, Yi

2017-04-01

To validate the G.LAB MD2200 automated wrist blood pressure (BP) monitors according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010, the British Hypertension Society (BHS), and the International Organization for Standardization (ISO) 81060-2:2013 protocols. The device was assessed on 33 participants according to the ESH requirements and was then tested on 85 participants according to the BHS and ISO 81060-2:2013 criteria. The validation procedures and data analysis followed the protocols precisely. The G.LAB MD2200 devices passed all parts of ESH-IP revision 2010 for both systolic and diastolic BP, with a device-observer difference of 2.15±5.51 and 1.51±5.16 mmHg, respectively. The device achieved A/A grading for the BHS protocol and it also fulfilled the criteria of ISO 81060-2:2013, with mean differences of systolic and diastolic BP between the device and the observer of 2.19±5.21 and 2.11±4.70 mmHg, respectively. The G.LAB MD2200 automated wrist BP monitor passed the ESH-IP revision 2010 and the ISO 81060-2:2013 protocol, and achieved the A/A grade of the BHS protocol, which can be recommended for self-measurement in the general population.

Recommended Protocol for Round Robin Studies in Additive Manufacturing

Science.gov (United States)

Moylan, Shawn; Brown, Christopher U.; Slotwinski, John

2016-01-01

One way to improve confidence and encourage proliferation of additive manufacturing (AM) technologies and parts is by generating more high quality data describing the performance of AM processes and parts. Many in the AM community see round robin studies as a way to generate large data sets while distributing the cost among the participants, thereby reducing the cost to individual users. The National Institute of Standards and Technology (NIST) has conducted and participated in several of these AM round robin studies. While the results of these studies are interesting and informative, many of the lessons learned in conducting these studies concern the logistics and methods of the study and unique issues presented by AM. Existing standards for conducting interlaboratory studies of measurement methods, along with NIST’s experience, form the basis for recommended protocols for conducting AM round robin studies. The role of round robin studies in AM qualification, some of the limitations of round robin studies, and the potential benefit of less formal collaborative experiments where multiple factors, AM machine being only one, are varied simultaneously are also discussed. PMID:27274602

Validation of the A&D UM-211 device for office blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Fania, Claudio; Albertini, Federica; Palatini, Paolo

2017-10-01

The aim of this study was to define the accuracy of UM-211, an automated oscillometric device for office use coupled to several cuffs for different arm sizes, according to the International Protocol of the European Society of Hypertension. The validation was performed in 33 individuals. Their mean age was 59.6±12.9 years, systolic blood pressure (BP) was 144.3±21.5 mmHg (range: 96-184 mmHg), diastolic BP was 86.8±18.5 mmHg (range: 48-124 mmHg), and arm circumference was 30.2±4.3 cm (range: 23-39 cm). Four sequential readings were taken by observers 1 and 2 using a double-headed stethoscope and a mercury sphygmomanometer, whereas three BP readings were taken by the supervisor using the test instrument. The differences between the readings provided by the device and the mean observer measurements were calculated. Therefore, each device measurement was compared with the previous and the next mean observer measurement. The validation results fulfilled all the 2010 European Society of Hypertension revision Protocol criteria for the general population and passed all validation grades. On average, the device overestimated systolic BP by 1.7±2.4 mmHg and diastolic BP by 1.7±2.5 mmHg. These data show that the UM-211 device coupled to several cuffs for different ranges of arm circumference met the requirements for validation according to the International Protocol and can be recommended for clinical use in the adult population. However, these results mainly apply to the use of the 22-32 and the 31-45 cm cuffs.

EULAR revised recommendations for the management of fibromyalgia

DEFF Research Database (Denmark)

Macfarlane, G J; Kronisch, C; Dean, L E

2017-01-01

and Evaluation system was used for making recommendations. RESULTS: 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines......OBJECTIVE: The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'. METHODS: A multidisciplinary group from 12 countries assessed evidence with a focus...... on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development...

The protocol amending the 1963 Vienna Convention

International Nuclear Information System (INIS)

Lamm, V.

2006-01-01

Technically the Vienna Convention was revised by the adoption of the protocol to amend the instrument. and according to Article 19 of the protocol 'A State which is Party to this Protocol but not to the 1963 Vienna Convention shall be bound by the provisions of that Convention as amended by this Protocol in relation to other States Parties hereto, and failing an expression of a different intention by that State at the time of deposit of an instrument referred to in Article 20 shall be bound by the provisions of the 1963 Vienna Convention in relation to States which are only Parties thereto'. This solution has created a special situation, because after the entry into force of the protocol there will be living together or operating in practice 'two' Vienna Conventions, notably the convention's original text of 1963 and its new version as amended by the protocol. After the protocol has come into force, a state may only accede to the amended version, but in the inter se relations of the States Party to the 'old' Vienna Convention the provisions of that convention will remain in force until such time as they have acceded to the new protocol. This rather complicated situation is nevertheless understandable and is fully in accord with Article 40 of the 1969 Vienna Convention on the Law of Treaties, which provides for the amendment of multilateral treaties. In 1989 the negotiations on the revision of the Vienna Convention had begun with the aim of strengthening the existing nuclear liability regime and of improving the situation of potential victims of nuclear accidents. The Protocol to Amend the Vienna Convention serves those purposes; it also reflects a good compromise, since it is the outcome of a negotiation process in which experts from both nuclear and non-nuclear states, from Contacting Parties and non-Contracting Parties were very active. That affords some assurance that the compromise solution reached is acceptable to all States participating in the adoption of

EORTC recommended protocol for melanoma sentinel lymph node sectioning misclassifies up to 50% of the patients compared with complete step sectioning. Danish Society for Pathological Anatomy and Clinical Cytology

DEFF Research Database (Denmark)

Riber-Hansen, Rikke; Hastrup, N; Clemmensen, O.

2010-01-01

EORTC recommended protocol for melanoma sentinel lymph node sectioning misclassifies up to 50% of the patients compared with complete step sectioning. Danish Society for Pathological Anatomy and Clinical Cytology......EORTC recommended protocol for melanoma sentinel lymph node sectioning misclassifies up to 50% of the patients compared with complete step sectioning. Danish Society for Pathological Anatomy and Clinical Cytology...

Building America House Simulation Protocols (Revised)

Energy Technology Data Exchange (ETDEWEB)

Hendron, R.; Engebrecht, C.

2010-10-01

The House Simulation Protocol document was developed to track and manage progress toward Building America's multi-year, average whole-building energy reduction research goals for new construction and existing homes, using a consistent analytical reference point. This report summarizes the guidelines for developing and reporting these analytical results in a consistent and meaningful manner for all home energy uses using standard operating conditions.

Validation of the Omron HEM-7201 upper arm blood pressure monitor, for self-measurement in a high-altitude environment, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Cho, K; Tian, M; Lan, Y; Zhao, X; Yan, L L

2013-08-01

Few studies have been conducted on blood pressure monitors and their use at high altitude. This study is the first to evaluate the accuracy of an automatic blood pressure monitor in a high-altitude environment following a standard validation protocol. The Omron HEM-7201 upper arm blood pressure monitor was tested for accuracy in Lhasa, Tibet, China (3650 m above sea level) according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2). Thirty-three participants received 9-10 sequential blood pressure measurements alternating between a mercury sphygmomanometer and the device. The mean device-observer measurement difference was 1.0±5.9 mm Hg for systolic blood pressure (SBP) and -3.1±4.6 mm Hg for diastolic blood pressure (DBP). Of the 99 measurement pairs analyzed, 72, 90 and 97 device readings were within 5, 10 and 15 mm Hg, respectively, of the observer measurements for SBP, and 68, 92 and 99 readings for DBP. The number of participants with at least two out of three measurements within 5 mm Hg was 27 for SBP and 25 for DBP. Three participants had no measurements within 5 mm Hg for either SBP or DBP. As a result, the Omron HEM-7201 passes the ESH-IP2 validation criteria and can therefore be recommended for use in adults in this setting.

Utilisation de l'assistant grammatical Antidote dans le cadre d'activités de révision - Analyse exploratoire de protocoles d'observation Using Antidote in Revision Tasks: An Exploratory Study of Grammar Checker Usage Through Verbal Protocol Analysis

Directory of Open Access Journals (Sweden)

Patrick Durel

2006-06-01

Full Text Available Cette étude examine les opérations mentales d'apprenants utilisant l'assistant grammatical Antidote en phase de révision de leurs productions écrites. Analysant des données obtenues à partir de la méthode des protocoles verbaux, ce travail montre comment ce type d'activité de révision assistée par ordinateur conduit l'apprenant à manipuler, construire, renforcer ou élargir le champ d'application de ses connaissances, qu'elles soient déclaratives ou procédurales. Les éléments dégagés indiquent que l'utilisation d'Antidote peut être vecteur d'apprentissage et offrent quelques pistes permettant de concevoir des activités de révision assistée par ordinateur qui s'inscrivent dans le cadre d'une didactique de la production scripturale.This study explores learners' cognitive processes when using the grammar assistant software Antidote during the revision phase of their composition. Analysing data obtained using a hybrid form of verbal protocols, it shows how computer-assisted revision activity can lead learners to manipulate, build or reinforce declarative and procedural knowledge. We argue that using grammar assistant software can be conducive to learning. The results of the analysis provide an insight into how such a tool can be integrated into classroom activities, contributing to writing quality and the acquisition of revision strategies.

Recommendations on the transport of dangerous goods. Model regulations. 11. revised ed.

International Nuclear Information System (INIS)

1999-01-01

The Recommendations on the Transport of Dangerous Goods are addressed to governments and to the international organizations concerned with the regulation of the transport of dangerous goods. They have been prepared by the United Nations Economic and Social Council's Committee of Experts on the Transport of Dangerous Goods, and they were first published in 1956 (ST/ECA/43-E/CN.2/170). Pursuant to Resolution 645 G (XXIII) of 26 April 1957 of the Economic and Social Council and subsequent resolutions, they have been regularly amended and updated at succeeding sessions of the Committee of Experts. At its eighteenth session (28 November-7 December 1994), the Committee of Experts considered that reformatting the Recommendations on the Transport of Dangerous Goods into Model Regulations that could be directly integrated into all modal national and international regulations would enhance harmonization, facilitate regular up-dating of all legal instruments concerned, and result in overall considerable resource savings for the Governments of the Member States, the United Nations, the specialized agencies and other international organizations. At its nineteenth session (2-10 December 1996), the Committee adopted a first version of the Model Regulations on the Transport of Dangerous Goods, which was annexed to the tenth revised edition of the Recommendations on the Transport of Dangerous Goods. At its twentieth session (7-16 December 1998), the Committee adopted various amendments to the Model Regulations and new provisions including, in particular, packing instructions for individual substances and articles and additional provisions for the transport of radioactive material. The additional provisions concerning the transport of radioactive material were developed in close cooperation with the International Atomic Energy Agency (IAEA) and are based on the 1996 Edition of the IAEA Regulations for the Safe Transport of Radioactive Material which have been reformatted so as to be

Cost-benefit analysis of stricter emission ceilings for air pollutants. National evaluation for the revision of the Gothenburg Protocol; Kosten en baten van strengere emissieplafonds voor luchtverontreinigende stoffen. Nationale evaluatie voor de herziening van het Gothenburg Protocol

Energy Technology Data Exchange (ETDEWEB)

Smeets, W.

2012-06-15

The Netherlands experiences high benefits of strict European emission targets for air pollutants. The Dutch live longer and are healthier because of extra emission reductions. In addition, damage to nature decreases. This emerges from a cost-benefit analysis of a number of possible variants for tightening emission targets by 2020 in the context of the revision of the Gothenburg Protocol [Dutch] Nederland ondervindt hoge baten van strenge Europese emissiedoelen voor luchtverontreinigende stoffen. Nederlanders leven langer en gezonder door extra emissiereducties. Daarnaast neemt de schade aan de natuur af. Dit blijkt uit een kosten-batenanalyse van een aantal mogelijke varianten voor aanscherping van emissiedoelen per 2020 in het kader van de herziening van het Gothenburg protocol.

Validation of the Pangao PG-800A36 automatic wrist blood pressure monitor according to the European Society of Hypertension and the British Hypertension Society protocols.

Science.gov (United States)

Zhao, Hairong; Qiao, Weichang; Zhang, Rui; Cui, Peng; Hou, Fanglin; Zhang, Wenli

2018-02-01

The aim of this study was to validate the PG-800A36 automatic wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocols. A total of 33 participants were initially included on the basis of the ESH-IP, followed by examination of 85 participants according to the BHS protocol. The procedures and analysis methods of the protocols were followed precisely with left arm/wrist sequential measurements by two trained observers using a mercury sphygmomanometer and one supervisor using the device. The device passed the ESH-IP with an average difference of 1.45±6.46 mmHg for systolic blood pressure and 1.25±5.10 mmHg for diastolic blood pressure. Furthermore, the A/A grade of the BHS protocol was achieved with an average difference of 1.84±6.94 mmHg for systolic blood pressure and 1.15±6.49 mmHg for diastolic blood pressure, and thus, the device also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The Pangao PG-800A36 passed the requirements of the ESH-IP revision 2010 and achieved the A/A grade of the BHS protocol, which can be recommended for self-measurement in the general population.

Recommendations for a head and neck IMRT quality assurance protocol; Recommandations pour un protocole d'assurance de qualite de la radiotherapie conformationnelle avec modulation d'intensite des cancers de la tete et du cou

Energy Technology Data Exchange (ETDEWEB)

Zefkili, S. [Institut Curie, Service de Physique Medicale, 75 - Paris (France); Tomsej, M. [Cliniques Univ. Saint Luc, Service de Radiotherapie, Bruxelles (Belgium); Aletti, P.; Marchesi, V. [Centre Alexis-Vautrin, Unite de Radiophysique, 54 - Vandoeuvre-les-Nancy (France); Bidault, F. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Unite de Radiophysique, 21 - Dijon (France); Bridier, A. [Institut Gustave Roussy, 94 - Villejuif (France). Service de Radio-Physique; Marcie, S. [Centre Antoine-Lacassagne, Unite de Radiophysique, 06 - Nice (France)

2004-12-01

Head and neck tumors represent very interesting targets for IMRT techniques because of the complex shape of the structures and the organs at risk close by. The use of this kind of techniques requires a quality assurance protocol. The physicists of the GORTEC group shared their experience to define some recommendations in order to draw up a QA protocol. The dosimetric verification of the treatment plans (in terms of absolute and relative dose), the control of the reproducibility of the patient positioning and the use of a record and verify system to control the different parameters form the main parts of these recommendations. Each chapter comprises a description of the different methods, recommendations concerning the equipment, the adopted tolerances, the frequency of controls. At the end of each chapter, a table summarizes the main actions to carry out. These recommendations will allow to harmonize our practices whatever the softwares and the accelerator that are being used. They will simplify the task of the teams that wish to implement IMRT for head and neck tumors. (author)

Physical Therapy Protocols for Arthroscopic Bankart Repair.

Science.gov (United States)

DeFroda, Steven F; Mehta, Nabil; Owens, Brett D

Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols. The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols. Descriptive epidemiology study. Level 3. Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport. Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 ± 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 ± 2.8 weeks) and full active range of motion (mean, 12.2 ± 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists' (ASSET) consensus protocol. Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients. This study highlights the importance of attending surgeons being very clear and specific with

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

Science.gov (United States)

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

The new recommendations of the ICRP

International Nuclear Information System (INIS)

Sugier, A.; Metivier, H.

1991-01-01

One of the outstanding events that recently occurred in the field of radioprotection is the revision of the recommendations of the International Commission on Radiological Protection. In fact, the latest studies on the survivors from Hiroshima and Nagasaki have led the experts to revise downwards the individual dose limits. What are the new elements in this document

Validation of Transtek LS808-B for self/home measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Liu, Zhong Hua; Liu, Xian Yue; Wu, Wen Jun

2016-12-01

This study aimed to evaluate the accuracy of Transtek LS808-B according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2010). A total of 33 adult individuals (19 men and 14 women, mean age 46.8±15.8 years) were recruited; their systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using the mercury sphygmomanometer and Transtek LS808-B. A total of 99 pairs of measurements were obtained from these 33 participants for comparison in two parts with three grading phases. All the validation requirements were fulfilled. The number of absolute difference between the tested device and the observers within 5, 10, and 15 mmHg was 73, 94, and 98 for SBP and 78, 94, and 99 for DBP, respectively. The mean±SD of the device-observer difference was 0.5±4.4 mmHg for SBP and 0.2±4.1 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 24 for SBP and 27 for DBP. In addition, two of the participants had no device-observer difference within 5 mmHg for SBP and one of the participants had the same for DBP. Transtek LS808-B has passed all phases of ESH-IP 2010, and hence can be recommended for self/home measurement in adult populations.

Validation of the Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors in a general adult population according to the European Society of Hypertension and the ANSI/AAMI/ISO 81060-2: 2013 protocols.

Science.gov (United States)

Bing, Sen; Chen, Kang; Hou, Hong; Zhang, Weijuan; Li, Linyi; Wei, Jiao; Shu, Chang; Wan, Yi

2016-04-01

This study aimed to determine the accuracy of the Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors according to the European Society of Hypertension International Protocol revision 2010 and the ANSI/AAMI/ISO 81060-2:2013 protocols. The devices were assessed on 33 participants according to the European Society of Hypertension requirements and were then tested on 85 participants according to the ANSI/AAMI/ISO 81060-2:2013 criteria. Procedures and data analysis were carried out following protocol guidelines precisely. The Microlife BP A200 Comfort and W2 Slim devices passed the criteria of the European Society of Hypertension International Protocol revision 2010 for both systolic blood pressure and diastolic blood pressure. The devices also fulfilled the ANSI/AAMI/ISO 81060-2:2013 criteria, with mean differences of SBP and DPB between the devices and observers of 0.38±5.12 and 0.28±4.29 mmHg for the BP A200 Comfort and 1.01±6.80 and 0.34±5.62 mmHg for the W2 Slim, respectively. The Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors fulfilled the European Society of Hypertension revision 2010 and the ANSI/AAMI/ISO 81060-2:2013 protocols, and can be recommended for self-measurement in the general population.

It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North-South collaborative trials.

Science.gov (United States)

Ravinetto, Raffaella; Tinto, Halidou; Diro, Ermias; Okebe, Joseph; Mahendradhata, Yodi; Rijal, Suman; Gotuzzo, Eduardo; Lutumba, Pascal; Nahum, Alain; De Nys, Katelijne; Casteels, Minne; Boelaert, Marleen

2016-01-01

The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global

Quality and dose optimized CT trauma protocol. Recommendation from a university level-I trauma center

Energy Technology Data Exchange (ETDEWEB)

Kahn, Johannes; Boening, Georg; Rotzinger, Roman; Freyhardt, Patrick; Streitparth, Florian [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiology; Kaul, David [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiation Oncology; Schwabe, Philipp [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Trauma Surgery; Maurer, Martin H. [Inselspital Bern (Switzerland). Dept. of Diagnostic, Interventional and Pediatric Radiology; Renz, Diane Miriam [Univ. Hospital Jena (Germany). Inst. of Diagnostic and Interventional Radiology

2017-09-15

As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50%). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40% (DLP 1087 vs. 647 mGy x cm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a

Quality and dose optimized CT trauma protocol. Recommendation from a university level-I trauma center

International Nuclear Information System (INIS)

Kahn, Johannes; Boening, Georg; Rotzinger, Roman; Freyhardt, Patrick; Streitparth, Florian; Kaul, David; Schwabe, Philipp; Maurer, Martin H.; Renz, Diane Miriam

2017-01-01

As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50%). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40% (DLP 1087 vs. 647 mGy x cm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a

Empirical Validation of Indices for Consideration in the Revision of Recommended Senior School Financial Accounting Textbooks in Southwestern Nigeria

Directory of Open Access Journals (Sweden)

Oyebode Stephen Oyetoro

2017-12-01

Full Text Available The study determined a significant difference in teachers’ overall evaluations of six recommended Financial Accounting Textbooks in Southwestern Nigeria. It also assessed the specific evaluation parameters that account for the difference. It adopted the survey research design. The multistage sampling technique was used to select a total of 80 teachers from 64 schools from the six states in Southwestern Nigeria. Results of data collected which were analysed using the Kruskal-Wallis (H test depicted a significant difference in teachers’ overall evaluations of the textbooks. Also, results revealed that the textbooks differ significantly on the parameters of mechanics, assessment, lesson design and instructional strategy and incorporation of technology into students’ learning. The implications of these findings were discussed and the study concluded that financial accounting textbook writers and ministry of education officials at both national and state levels should give adequate consideration for these parameters in the revision of recommended financial accounting textbooks for improved effectiveness in the realization of curricular objectives in the subject.

Ocean Optics Protocols for Satellite Ocean Color Sensor Validation. Revised

Science.gov (United States)

Fargion, Giulietta S.; Mueller, James L.

2000-01-01

The document stipulates protocols for measuring bio-optical and radiometric data for the Sensor Intercomparison and Merger for Biological and Interdisciplinary Oceanic Studies (SIMBIOS) Project activities and algorithm development. This document supersedes the earlier version (Mueller and Austin 1995) published as Volume 25 in the SeaWiFS Technical Report Series. This document marks a significant departure from, and improvement on, theformat and content of Mueller and Austin (1995). The authorship of the protocols has been greatly broadened to include experts specializing in some key areas. New chapters have been added to provide detailed and comprehensive protocols for stability monitoring of radiometers using portable sources, abovewater measurements of remote-sensing reflectance, spectral absorption measurements for discrete water samples, HPLC pigment analysis and fluorometric pigment analysis. Protocols were included in Mueller and Austin (1995) for each of these areas, but the new treatment makes significant advances in each topic area. There are also new chapters prescribing protocols for calibration of sun photometers and sky radiance sensors, sun photometer and sky radiance measurements and analysis, and data archival. These topic areas were barely mentioned in Mueller and Austin (1995).

[Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document].

Science.gov (United States)

Alós Cortés, Juan Ignacio; Andreu Domingo, Antonia; Arribas Mir, Lorenzo; Cabero Roura, Luis; de Cueto López, Marina; López Sastre, José; Melchor Marcos, Juan Carlos; Puertas Prieto, Alberto; de la Rosa Fraile, Manuel; Salcedo Abizanda, Salvador; Sánchez Luna, Manuel; Sanchez Pérez, María José; Torrejon Cardoso, Rafael

2013-03-01

Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol

Science.gov (United States)

Garber, Andrea K.; Michihata, Nobuaki; Hetnal, Katherine; Shafer, Mary-Ann; Moscicki, Anna-Barbara

2015-01-01

Purpose Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol. Methods Adolescents aged 13.1–20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day. Results Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission. Conclusions Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome. PMID:22188830

Present situation and influence of new ICRP recommendations on radioactive material transport regulations

International Nuclear Information System (INIS)

Hamard, J.; Ringot, C.

1991-01-01

The publication of new ICRP recommendations will involve the revision of IAEA standards and consequently the revision of transport regulations for radioactive materials. Transport regulations are briefly reviewed and application for radiation protection of workers and public is examined. Influence of new recommendations on transport regulations and eventual modifications on classification and transport of materials, packaging design and permissible exposure for workers and public in the prospect of regulation revision forecasted for 1995

Revising REACH guidance on information requirements and chemical safety assessment for engineered nanomaterials for aquatic ecotoxicity endpoints: recommendations from the EnvNano project

DEFF Research Database (Denmark)

Hansen, Steffen Foss; Sørensen, Sara Nørgaard; Skjolding, Lars Michael

2017-01-01

be made applicable to nanomaterials. European Research Council project EnvNano—Environmental Effects and Risk Evaluation of Engineered, which ran from 2011 to 2016, took another outset by assuming that: “The behaviour of nanoparticles in suspension is fundamentally different from that of chemicals......The European Chemical Agency (ECHA) is in the process of revising its guidance documents on how to address the challenges of ecotoxicological testing of nanomaterials. In these revisions, outset is taken in the hypothesis that ecotoxicological test methods, developed for soluble chemicals, can...... in solution”. The aim of this paper is to present the findings of the EnvNano project and through these provide the scientific background for specific recommendations on how ECHA guidance could be further improved. Key EnvNano findings such as the need to characterize dispersion and dissolution rates in stock...

Implementation to spanish protocol of quality control of accelerators to daily control of electron beams

International Nuclear Information System (INIS)

Adaimi Hernandez, P.; Ramirez Ros, J. C.; Casa de Julian, M. A. de la; Clemente Gutierrez, F.; Cabello Murillo, E.; Diaz Fuente, R.; Ferrando Sanchez, A.

2011-01-01

A revised procedure for daily control of the electron beams to make measurements more meaningful physically, having a better reproducibility and more in line with the recommendations of the Spanish Protocol for Quality Control in Electron Linear Accelerators Clinical Use. The daily quality control beams of high energy electrons that had been done so far was the finding that the record of a series of measures (symmetry, uniformity, stability, energy, beam central dose) were within tolerance values established. The amendment is to check the beam quality by directly measuring changes in absorption depth at which the dose is reduced to half its maximum value, R50.

Social assessment methods recommendation report: Draft: Revision 1

International Nuclear Information System (INIS)

1986-05-01

This report recommends an approach to the Salt Repository Project Office (SRPO) for assessing the social impacts of a high-level nuclear waste repository. The report establishes several criteria for selecting an approach and then describes and evaluates existing social assessment approaches against the selection criteria. Based upon these evaluations a recommendation is made. The proposed modifications include suggestions to strengthen the approach by including elements of other methods. Suggestions for the development of community surveys and local leader interviews are also made. 64 refs., 4 figs., 14 tabs

Planned revision to DOE Order 5820.2A, Radioactive Waste Management

Energy Technology Data Exchange (ETDEWEB)

Duggan, G.J. [Dept. of Energy, Washington, DC (United States); Williams, R.E.; Kudera, D.E. [EG and G Idaho, Inc., Idaho Falls, ID (United States). Idaho National Engineering Lab.; Bailey, D.E. [NJG, Inc. (United States)

1993-03-01

US Department of Energy Headquarters initiated efforts to revise DOE Order 5820.2A, ``Radioactive Waste Management``. The purpose of the revision is to enhance DOE waste management requirements, reflect new DOE organizational responsibilities, and consolidate requirements for management of all waste, under the responsibility of Environmental Restoration and Waste Management, into a single order. This paper discusses the revision philosophy, objectives of the revision, and strategy for the revision. Issues being considered for inclusion in the revision and recommended methods of resolving each issue are also discussed.

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.

Science.gov (United States)

Schiffman, Eric; Ohrbach, Richard; Truelove, Edmond; Look, John; Anderson, Gary; Goulet, Jean-Paul; List, Thomas; Svensson, Peter; Gonzalez, Yoly; Lobbezoo, Frank; Michelotti, Ambra; Brooks, Sharon L; Ceusters, Werner; Drangsholt, Mark; Ettlin, Dominik; Gaul, Charly; Goldberg, Louis J; Haythornthwaite, Jennifer A; Hollender, Lars; Jensen, Rigmor; John, Mike T; De Laat, Antoon; de Leeuw, Reny; Maixner, William; van der Meulen, Marylee; Murray, Greg M; Nixdorf, Donald R; Palla, Sandro; Petersson, Arne; Pionchon, Paul; Smith, Barry; Visscher, Corine M; Zakrzewska, Joanna; Dworkin, Samuel F

2014-01-01

The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra

[Management of chronic heart failure - a systematic review of guidelines in the context of the DMP revision].

Science.gov (United States)

Kötter, Thomas; Bartel, Carmen; Schramm, Susanne; Lange, Petra; Höfer, Eva; Hänsel, Michaela; Waffenschmidt, Siw; Waldt, Susanne Ein; Hoffmann-Eßer, Wiebke; Rüther, Alric; Lühmann, Dagmar; Scherer, Martin

2013-01-01

Disease Management Programmes (DMPs) are structured treatment programmes for chronic diseases. The DMP requirements are primarily derived from evidence-based guidelines. DMPs are regularly revised to ensure that they reflect current best practice and medical knowledge. The aim of this study was to assess the need for updating the German DMP module on heart failure by comparing it to relevant guidelines and identifying recommendations that should be revised. We systematically searched for clinical guidelines on heart failure published in German, English or French, and extracted relevant guideline recommendations. All included guidelines were assessed for methodological quality. To identify revision needs in the DMP, we performed a synoptic analysis of the extracted guideline recommendations and DMP requirements. 27 guidelines were included. The extracted recommendations covered all aspects of the management of heart failure. The comparison of guideline recommendations with DMP requirements showed that, overall, guideline recommendations were more detailed than DMP requirements, and that the guidelines covered topics not included in the DMP module. The DMP module is largely consistent with current guidelines on heart failure. We did not identify any need for significant revision of the DMP requirements. However, some specific recommendations of the DMP module could benefit from revision. Copyright © 2013. Published by Elsevier GmbH.

Conducting Clinically Based Intimate Partner Violence Research: Safety Protocol Recommendations.

Science.gov (United States)

Anderson, Jocelyn C; Glass, Nancy E; Campbell, Jacquelyn C

Maintaining safety is of utmost importance during research involving participants who have experienced intimate partner violence (IPV). Limited guidance on safety protocols to protect participants is available, particularly information related to technology-based approaches to informed consent, data collection, and contacting participants during the course of a study. The purpose of the article is to provide details on the safety protocol developed and utilized with women receiving care at an urban HIV clinic and who were taking part in an observational study of IPV, mental health symptoms, and substance abuse and their relationship to HIV treatment adherence. The protocol presents the technological strategies to promote safety and allow autonomy in participant decision-making throughout the research process, including Voice over Internet Protocol telephone numbers, and tablet-based eligibility screening and data collection. Protocols for management of participants at risk for suicide and/or intimate partner homicide that included automated high-risk messaging to participants and research staff and facilitated disclosure of risk to clinical staff based on participant preferences are discussed. Use of technology and partnership with clinic staff helped to provide an environment where research regarding IPV could be conducted without undue burden or risk to participants. Utilizing tablet-based survey administration provided multiple practical and safety benefits for participants. Most women who screened into high-risk categories for suicide or intimate partner homicide did not choose to have their results shared with their healthcare providers, indicating the importance of allowing participants control over information sharing whenever possible.

Validation of the TONOPORT VI ambulatory blood pressure monitor in adults according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Abou-Dakn, M; Döhmen, C; Wenzel, S

2017-02-01

The present study aims to examine the performance of the TONOPORT VI ambulatory blood pressure (BP) monitor in the inflation and deflation measurement methods, according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP 2010). Systolic and diastolic blood pressures (SBP and DBP, respectively) of 33 subjects (23 female, 10 male) were sequentially measured and compared with reference measurements obtained by two observers using a standard mercury sphygmomanometer. The subjects were selected according to the recruitment instructions of the ESH-IP 2010. Three comparative readings were performed per subject. Among the 99 readings in the inflation measurement method were 92/94 (SBP/DBP) with differences ⩽5, 97/99 ⩽10 and 98/99 ⩽15 mm Hg. All of the 33 subjects had at least 2 out of 3 comparative readings with differences ⩽5 mm Hg and 0/0 of the subjects had no reading ⩽15 mm Hg. The validation of the deflation measurement method resulted in differences where 93/91 were ⩽5, 98/98 were ⩽10, and 99/99 were ⩽15 mm Hg. Thirty-two of the 33 subjects had at least 2 out of 3 comparative readings ⩽5 mm Hg and 0/0 of the subjects had no reading ⩽15 mm Hg. In conclusion, the TONOPORT VI, respectively, in the inflation and deflation measurement methods met all requirements of Part 1 and 2 of the ESH-IP 2010. Based on the study results, the TONOPORT VI can be recommended for BP measurements in adults.

75 FR 53273 - Federal Aquatic Nuisance Species Research Risk Analysis Protocol

Science.gov (United States)

2010-08-31

... Aquatic Nuisance Species Task Force (ANSTF). The Protocol is available for public review and comment... the draft revised Protocol are available on the ANSTF website, http://anstaskforce.gov/documents.php... nonindigenous species (ANS) and is designed to reduce the risk that research activities may cause introduction...

Validation of the Grandway MD2301 digital automatic blood pressure monitor according to the European Society of Hypertension International Protocol.

Science.gov (United States)

Chen, Wan; Zeng, Zhao-Lin; Bing, Sen; Li, Lin-Yi; Wang, Rui; Wan, Yi

2016-08-01

The aim of the present study was to validate the Grandway MD2301 digital automatic blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for the validation of blood pressure-measuring devices in adults was followed precisely. Systolic and diastolic blood pressure (SBP and DBP, respectively) were measured sequentially in 33 adult patients and compared with a standard mercury sphygmomanometer (two observers). A total of 99 comparison pairs were obtained. The device produced 78, 95 and 99 measurements within 5, 10, and 15 mmHg for SBP and 83, 96, and 99 for DBP, respectively. The average device-observer difference was -1.81±4.22 mmHg for SBP and -0.15±3.93 mmHg for DBP. All of the data were within the standards requirements to pass the testing. The Grandway MD2301 digital automatic blood pressure monitor meets the standards of the ESH-IP revision 2010 and can be recommended for self/home measurement in the general population.

SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials.

Science.gov (United States)

Chan, An-Wen; Tetzlaff, Jennifer M; Gøtzsche, Peter C; Altman, Douglas G; Mann, Howard; Berlin, Jesse A; Dickersin, Kay; Hróbjartsson, Asbjørn; Schulz, Kenneth F; Parulekar, Wendy R; Krleza-Jeric, Karmela; Laupacis, Andreas; Moher, David

2013-01-08

High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.

Private personalized social recommendations in an IPTV system

Science.gov (United States)

Elmisery, Ahmed M.

2014-04-01

In our connected world, recommender systems have become widely known for their ability to provide expert and personalize referrals to end-users in different domains. The rapid growth of social networks and new kinds of systems so called "social recommender systems" are rising, where recommender systems can be utilized to find a suitable content according to end-users' personal preferences. However, preserving end-users' privacy in social recommender systems is a very challenging problem that might prevent end-users from releasing their own data, which detains the accuracy of extracted referrals. In order to gain accurate referrals, social recommender systems should have the ability to preserve the privacy of end-users registered in this system. In this paper, we present a middleware that runs on end-users' Set-top boxes to conceal their profile data when released for generating referrals, such that computation of recommendation proceeds over the concealed data. The proposed middleware is equipped with two concealment protocols to give users a complete control on the privacy level of their profiles. We present an IPTV network scenario and perform a number of different experiments to test the efficiency and accuracy of our protocols. As supported by the experiments, our protocols maintain the recommendations accuracy with acceptable privacy level.

SPIRIT 2013 Statement: defining standard protocol items for clinical trials.

Science.gov (United States)

Chan, An-Wen; Tetzlaff, Jennifer M; Altman, Douglas G; Laupacis, Andreas; Gøtzsche, Peter C; Krle A-Jerić, Karmela; Hrobjartsson, Asbjørn; Mann, Howard; Dickersin, Kay; Berlin, Jesse A; Dore, Caroline J; Parulekar, Wendy R; Summerskill, William S M; Groves, Trish; Schulz, Kenneth F; Sox, Harold C; Rockhold, Frank W; Rennie, Drummond; Moher, David

2015-12-01

The protocol of a clinical trial serves as the foundation for study planning, conduct, reporting, and appraisal. However, trial protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline for the minimum content of a clinical trial protocol. The 33-item SPIRIT checklist applies to protocols for all clinical trials and focuses on content rather than format. The checklist recommends a full description of what is planned; it does not prescribe how to design or conduct a trial. By providing guidance for key content, the SPIRIT recommendations aim to facilitate the drafting of high-quality protocols. Adherence to SPIRIT would also enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, sponsors, funders, research ethics committees or institutional review boards, peer reviewers, journals, trial registries, policymakers, regulators, and other key stakeholders.

Protocols on prenatal care for pregnant women with Zika infection and children with microcephaly: nutritional approach

Directory of Open Access Journals (Sweden)

Rachel de Sá Barreto Luna Callou Cruz

Full Text Available Abstract This summary aimed to synthesize the protocol guidelines of Pernambuco, the Ministry of Health and the Centers for Disease Control and Prevention which deal with health care related to Zika virus infection during pregnancy and the preliminary procedures for surveillance on microcephaly cases including nutritional care. With the increase of number of cases on this event since August, 2015, it was necessary to reorganize the prenatal care which is offered to pregnant women, including the protocols in order to reduce the chances of a possible contamination of the virus, to detect previously suspected cases as well as perform follow up on confirmed cases. The gaps in the knowledge of this morbidity, it should be noted that the information and recommendations are subject to revision due to possible incorporation of new knowledge and other evidence, as well as the need for adequacy of surveillance actions in new epidemiological scenarios. It is known that cases of nutritional deficiencies are capable of producing malformation of the Central Nervous System, including microcephaly. In the analysis of the protocols, there were no changes as to the nutritional recommendations already established for the low-risk pregnant women. The authors presented a hypothesis and conceptually, as a prevention measurement, the inclusion of prenatal care to prevent and control isolated or multiple deficiencies associated to microcephaly, such as protein, vitamin A, iodine, folate, B12, vitamin D, biotin, zinc and selenium.

Broadening and Simplifying the First SETI Protocol

Science.gov (United States)

Michaud, M. A. G.

The Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence, known informally as the First SETI Protocol, is the primary existing international guidance on this subject. During the fifteen years since the document was issued, several people have suggested revisions or additional protocols. This article proposes a broadened and simplified text that would apply to the detection of alien technology in our solar system as well as to electromagnetic signals from more remote sources.

76 FR 32321 - Approval and Promulgation of Air Quality Implementation Plans; Pennsylvania; Revision to the...

Science.gov (United States)

2011-06-06

...) Program--Quality Assurance Protocol for the Safety Inspection Program in Non-I/M Counties AGENCY... approve revisions to the Pennsylvania State Implementation Plan (SIP). The revision consists of a change... prior SIP-approved I/M program to change the duration of the timing of quality assurance audits...

A Privacy-Preserving Framework for Trust-Oriented Point-of-Interest Recommendation

KAUST Repository

Liu, An; Wang, Weiqi; Li, Zhixu; Liu, Guanfeng; Li, Qing; Zhou, Xiaofang; Zhang, Xiangliang

2017-01-01

Point-of-Interest (POI) recommendation has attracted many interests recently because of its significant potential for helping users to explore new places and helping LBS providers to carry out precision marketing. Compared with the user-item rating matrix in conventional recommender systems, the user-location check-in matrix in POI recommendation is usually much more sparse, which makes the notorious cold start problem more prominent in POI recommendation. Trust-oriented recommendation is an effective way to deal with this problem but it requires that the recommender has access to user check-in and trust data. In practice, however, these data are usually owned by different businesses who are not willing to share their data with the recommender mainly due to privacy and legal concerns. In this paper, we propose a privacy-preserving framework to boost data owners willingness to share their data with untrustworthy businesses. More specifically, we utilize partially homomorphic encryption to design two protocols for privacy-preserving trustoriented POI recommendation. By offline encryption and parallel computing, these protocols can efficiently protect the private data of every party involved in the recommendation. We prove that the proposed protocols are secure against semi-honest adversaries. Experiments on both synthetic data and real data show that our protocols can achieve privacy-preserving with acceptable computation and communication cost.

A Privacy-Preserving Framework for Trust-Oriented Point-of-Interest Recommendation

KAUST Repository

Liu, An

2017-10-23

Point-of-Interest (POI) recommendation has attracted many interests recently because of its significant potential for helping users to explore new places and helping LBS providers to carry out precision marketing. Compared with the user-item rating matrix in conventional recommender systems, the user-location check-in matrix in POI recommendation is usually much more sparse, which makes the notorious cold start problem more prominent in POI recommendation. Trust-oriented recommendation is an effective way to deal with this problem but it requires that the recommender has access to user check-in and trust data. In practice, however, these data are usually owned by different businesses who are not willing to share their data with the recommender mainly due to privacy and legal concerns. In this paper, we propose a privacy-preserving framework to boost data owners willingness to share their data with untrustworthy businesses. More specifically, we utilize partially homomorphic encryption to design two protocols for privacy-preserving trustoriented POI recommendation. By offline encryption and parallel computing, these protocols can efficiently protect the private data of every party involved in the recommendation. We prove that the proposed protocols are secure against semi-honest adversaries. Experiments on both synthetic data and real data show that our protocols can achieve privacy-preserving with acceptable computation and communication cost.

Validation of the Pangao PG-800A11 wrist device assessed according to the European Society of Hypertension and the British Hypertension Society protocols.

Science.gov (United States)

Xie, Peigen; Wang, Yanling; Xu, Xiaoying; Huang, Fei; Pan, Jingru

2015-04-01

The objective of this study was to determine the accuracy of the Pangao PG-800A11 wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the protocol of the British Hypertension Society (BHS). The device evaluations were performed in 85 participants, 33 of whom were included according to the ESH-IP revision 2010 and 52 of whom were included on the basis of the requirements of the BHS protocol. The validation procedure and data analysis followed the protocols precisely. The device achieved an A/A grading for the BHS protocol and passed all phases of the ESH-IP revision 2010 protocol. The mean difference ±SD for the ESH and BHS protocols, respectively, was -0.6±4.5 and -0.8±6.2 mmHg for systolic pressure and 1.2±4.6 and -0.5±5.1 mmHg for diastolic pressure. The device maintained its A/A grading throughout the low, medium, and high-pressure ranges. The Pangao PG-800A11 wrist blood pressure monitor passed all requirements of the ESH-IP revision 2010 and achieved A/A grade of the BHS protocol in an adult population.

Recommended revisions to nuclear regulatory commission seismic design criteria

International Nuclear Information System (INIS)

Coats, D.W.

1981-01-01

Task Action Plan (TAP) A-40 was developed by consolidating specific technical assistance studies initiated to identify and quantify the conservatism inherent in the seismic design sequence of current NRC criteria. Task 10 of TAP A-40 provided a technical review of the results of the other nine engineering and seismological tasks in TAP A-40 and recommended changes to the existing NRC criteria based on this review. We used the team approach to accomplish the objectives of Task 10 in an efficient manner and to provide the best technical product possible within the limited time available. The team consisted of a core group of Lawrence Livermore National Laboratory personnel and selected consultants. The recommendations summarized in this paper were not based solely on the results of the tasks in TAP A-40 but went far beyond that data base to encompass all available and appropriate literature. Some recommendations are based on the expertise of core members and consultants that stem from unpublished data, research, and experience. Copies of the pertinent sections of the Standard Review Plan (SRP) and Regulatory Guides as well as the reports developed under TAP A-40 were provided to the participants. These reports, other available engineering literature, and the experience of the consultants and core group provided technical basis for the recommendations. (orig./HP)

Overview of the revised 10 CFR Part 20, standards for protection against radiation

International Nuclear Information System (INIS)

Peterson, H.T.; Cool, D.A.; Buchanan, J.D.; Cool, W.S.

1991-01-01

The revised 10 CFR Part 20 is based upon the 1977 recommendations of the International Commission of Radiological Protection and is generally consistent with the 1987 recommendations of the National Council on Radiation Protection and Measurements. The revised Part 20 contains significant changes from past practice and procedures for estimating, measuring, combining, recording and reporting doses. These changes are associated with the introduction of new concepts and methods of assessing doses

Application in the Nordic Countries of international radioactive waste recommendations

International Nuclear Information System (INIS)

1986-01-01

In the publication ''Report on the Applicability of International Radiation Protection Recommendations in the Nordic Countries'' published in 1976 the radiation protection authorities in Denmark, Finland, Iceland, Norway and Sweden expressed their agreement on the main principles of radiation protection. All aspects of radiation protection are covered in the recommendations. Since the recommendations were released new information on radioactive protection has been published e.g. by ICRP, IAEA and OECD/NEA and the radiation protection authorities have felt it necessary to make a revision of Chapter 21, Radioactive Waste, in the Recommendations of the Nordic Countries. Since 1982, a working group from the radiation protection authorities has been working on that revision. In this work the experience from national and international work has been incorporated. The new recommendations are divided into two main parts, one dealing with waste originating from the nuclear fuel cycle (nuclear waste) and one with waste from other sources (non-nuclear waste). These recommendations have been approved by the Nordic radiation protection authorities at a meeting in Finland, September 1985 and replace the corresponding recommendations in Chapter 21 in The 1976 Nordic Recommendations. (author)

Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†

Science.gov (United States)

Schiffman, Eric; Ohrbach, Richard; Truelove, Edmond; Look, John; Anderson, Gary; Goulet, Jean-Paul; List, Thomas; Svensson, Peter; Gonzalez, Yoly; Lobbezoo, Frank; Michelotti, Ambra; Brooks, Sharon L.; Ceusters, Werner; Drangsholt, Mark; Ettlin, Dominik; Gaul, Charly; Goldberg, Louis J.; Haythornthwaite, Jennifer A.; Hollender, Lars; Jensen, Rigmor; John, Mike T.; De Laat, Antoon; de Leeuw, Reny; Maixner, William; van der Meulen, Marylee; Murray, Greg M.; Nixdorf, Donald R.; Palla, Sandro; Petersson, Arne; Pionchon, Paul; Smith, Barry; Visscher, Corine M.; Zakrzewska, Joanna; Dworkin, Samuel F.

2015-01-01

Aims The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0

Methods for implementing revisions to emergency operating procedures. Final report

International Nuclear Information System (INIS)

Myers, L.B.; Bell, A.J.

1984-05-01

In response to the Three Mile Island (TMI) accident, the US Nuclear Regulatory Commission (NRC) has published the TMI Action Plan. The TMI Action Plan Item I.C.1 called for the upgrading of Emergency Operating Procedures (EOPs) at nuclear power plants. The program developed from this Action Plan item has resulted in utility efforts to: (1) revise EOPs; (2) train personnel in the use of the EOPs; and (3) implement the revised EOPs. The NRC supported the study presented in this report to identify factors which influence the effectiveness of training and implementation of revised EOPs. The NRC's major concern was the possible effects of negative transfer of training. The report includes a summary of existing methods for implementing revisions to procedures based on interviews of plant personnel, a review of the training literature applicable to the effect of previously learned procedures on the learning of and performance with revised procedures (i.e., negative transfer) and recommendations of methods and schedules for implementing revised EOPs. While the study found that the concern over negative transfer of training was not as great as anticipated, several recommendations were made. These include: (1) overtraining of operators to reduce the effect of observed negative transfer; and (2) implementation of the revised EOPs as soon as possible after training to minimize the time operators must rely upon the old EOPs after having been trained on the revised EOPs. The results of the study should be useful both to the utilities and the NRC in the development and review of EOP implementation programs

The Operation of the Joint Protocol: Theoretical and Practical Implications Revisited

International Nuclear Information System (INIS)

Horbach, N.

2008-01-01

Convention and the 1963 Vienna Convention), is even more urgent in respect of its operation under the revised nuclear liability treaties. Any interpretation making the operation of the Joint Protocol ineffective, distorted or even obsolete as to its main object and purpose, would warrant critical analysis as to its benefits it in practice would provide for its Contracting Parties, considering to join any of the revised treaties. This paper aims to provide an analysis of the legal complications involved in respect of the operation of the Joint Protocol, especially in its interrelation with the revised nuclear liability treaties.(author)

ICRP-26, the recommendations on radiological protection

International Nuclear Information System (INIS)

Jun, J.S.

1983-01-01

Since the last ICRP recommendations on radiological protection was pubished in 1966 as it's publication 9, the revised edition of the recommendations had first been published in 1977, accommodating up-to-date knowledge of radiobiology and operational experiences of radiation protection built up for over a decade. In this article, the new version of the recommendations is reviewed in comparison with those of the publication 9, while the corrections and modifications made afterward are introduced together with the recent trends and responses of the experts in various countries for the pracical adoption or legislation of the recommendations. (Author)

75 FR 27647 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to the Emission...

Science.gov (United States)

2010-05-18

... severable portions of two revisions to the Texas State Implementation Plan (SIP) submitted by the State of... further clarify procedures for using emission protocols and to update the approved list of emission credit... to recently recodified 30 TAC Chapter 117 provisions. EPA has determined that these SIP revisions...

Blockchain protocols in clinical trials: Transparency and traceability of consent

Science.gov (United States)

Benchoufi, Mehdi; Porcher, Raphael; Ravaud, Philippe

2018-01-01

Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security, transparency and could be

Blockchain protocols in clinical trials: Transparency and traceability of consent.

Science.gov (United States)

Benchoufi, Mehdi; Porcher, Raphael; Ravaud, Philippe

2017-01-01

Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients' informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient's consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security, transparency and could be a

Current IUBMB recommendations on enzyme nomenclature and kinetics

Directory of Open Access Journals (Sweden)

Athel Cornish-Bowden

2014-05-01

Full Text Available The International Union of Biochemistry (IUB, now IUBMB prepared recommendations for describing the kinetic behaviour of enzymes in 1981. Despite the more than 30 years that have passed since these have not subsequently been revised, though in various respects they do not adequately cover current needs. The IUBMB is also responsible for recommendations on the naming and classification of enzymes. In contrast to the case of kinetics, these recommendations are kept continuously up to date.

75 FR 15645 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to the Emission...

Science.gov (United States)

2010-03-30

... clarify EPA's role in the approval of emission quantification protocols. While the previous SIP- approved... approve severable portions of two revisions to the Texas State Implementation Plan (SIP) submitted by the... to further clarify procedures for using emission protocols and to update the approved list of...

Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Directory of Open Access Journals (Sweden)

Ștefan Cristea

2016-05-01

Full Text Available Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8 total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4 of these cases. Two (2 cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views, CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6 units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

[Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer].

Science.gov (United States)

2018-04-01

Colorectal cancer is one of the most common malignant tumors in China. In 2012 one million thirty six thousand cases of colorectal cancer were diagnosed all over the world, two hundred fifty three thousand cases were diagnosed in China (accounted for 18.6%). China has the largest number of new cases of colorectal cancer in the world. Colorectal cancer has becoming a serious threat of Chinese residents' health. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2010edition), and publish it publicly. In recent years, the National Health and Family Planning Commission has organized experts to revised the protocol 2 times: the first time in 2015, the second time in 2017. The revised part of "Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer" (2017 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherpy and radiotherapy. The 2017 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2017 edition of the protocol would further promote the standardization of diagnosis and treatment of colorectal cancer in China, improve the survival and prognosis of patients, and benefit millions of patients with colorectal cancer and their families.

Thromboprophylaxis in Abdominoplasty: Efficacy and Safety of a Complete Perioperative Protocol

Directory of Open Access Journals (Sweden)

Giovanni Francesco Marangi

2016-07-01

Full Text Available BackgroundVenous thromboembolism, a spectrum of diseases ranging from deep venous thrombosis to pulmonary embolism, is a major source of morbidity and mortality. The majority of cases described in plastic surgery involve abdominoplasty. Risk assessment and prophylaxis are paramount in such patients. General recommendations were recently developed, but the evidence in the literature was insufficient to prepare exhaustive guidelines regarding the medication, dosage, timing, or length of the prophylaxis.MethodsA thromboprophylaxis protocol was developed for patients undergoing abdominoplasty. The protocol consisted of preoperative, intraoperative, and postoperative measures. Enoxaparin was administered as chemoprophylaxis in selected patients. The study involved 253 patients. The patients were analyzed for age, body mass index, enoxaparin dosage, risk factors, and complications.ResultsDeep venous thrombosis was documented in two cases (0.8%. No pulmonary embolism occurred. Three patients (1.2% presented mild subcutaneous abdominal hematoma within the first postoperative week that spontaneously resorbed with neither aesthetic nor functional complications. Two patients (0.8% presented severe hematoma requiring surgical re-intervention for drainage and hemostasis revision. Statistical analysis showed no significant correlation between enoxaparin dosage and hematoma (P=0.18 or deep venous thrombosis (P=0.61.ConclusionsThe described thromboprophylaxis protocol proved to be effective in the prevention of thrombotic events, with an acceptable risk of hemorrhagic complications. Furthermore, it provides new evidence regarding the currently debated variables of chemoprophylaxis, namely type, dosage, timing, and length.

Novel protocol for persister cells isolation.

Directory of Open Access Journals (Sweden)

Silvia J Cañas-Duarte

Full Text Available Bacterial persistence, where a fraction of a population presents a transient resistance to bactericidal substances, has great medical importance due to its relation with the appearance of antibiotic resistances and untreatable bacterial chronic infections. The mechanisms behind this phenomenon remain largely unknown in spite of recent advances, in great part because of the difficulty in isolating the very small fraction of the population that is in this state at any given time. Current protocols for persister isolation have resulted in possible biases because of the induction of this state by the protocol itself. Here we present a novel protocol that allows rapid isolation of persister cells both from exponential and stationary phase. Moreover, it is capable of differentiating between type I and type II persister cells, which should allow the field to move beyond its current state of studying only one type. While this protocol prompts a revision of many of the current results, it should greatly facilitate further advances in the field.

Effects on instruments of the World Health Organization--recommended protocols for decontamination after possible exposure to transmissible spongiform encephalopathy-contaminated tissue.

Science.gov (United States)

Brown, Stanley A; Merritt, Katharine; Woods, Terry O; Busick, Deanna N

2005-01-15

It has been recommended by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) that rigorous decontamination protocols be used on surgical instruments that have been exposed to tissue possibly contaminated with Creutzfeldt-Jakob disease (CJD). This study was designed to examine the effects of these protocols on various types of surgical instruments. The most important conclusions are: (1) autoclaving in 1N NaOH will cause darkening of some instruments; (2) soaking in 1N NaOH at room temperature damages carbon steel but not stainless steel or titanium; (3) soaking in chlorine bleach will badly corrode gold-plated instruments and will damage some, but not all, stainless-steel instruments, especially welded and soldered joints. Damage became apparent after the first exposure and therefore long tests are not necessary to establish which instruments will be damaged. Copyright 2004 Wiley Periodicals, Inc.

Validation of the BPUMP BF1112 upper-arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Chen, Qi; Kang, Yuan-Yuan; Li, Yan; Wang, Ji-Guang

2017-04-01

The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure (BP) monitor BPUMP BF1112 for home BP monitoring according to the International Protocol of the European Society of Hypertension revision 2010 (ESH-IP2010). Systolic and diastolic BPs were sequentially measured in 33 adult Chinese (13 women, mean age 46.7 years) using a mercury sphygmomanometer (two observers) and the BF1112 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The BPUMP BF1112 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 85/99, 96/99, and 97/99, respectively, for systolic BP, and 83/99, 97/99, and 99/99, respectively, for diastolic BP. The device also fulfilled the criteria in part 2 of the validation study. A total of 31 and 30 participants for systolic and diastolic BP, respectively, had at least two of the three device-observer differences within 5 mmHg (required≥24mmHg). No participant for systolic or diastolic BP had all the three device-observer comparisons greater than 5 mmHg. The BPUMP BP monitor BF1112 has passed the requirements of the ESH-IP2010, and hence can be recommended for home use in adults.

Validation of the A&D UM-201 device for office blood pressure measurement according to the European Society of Hypertension International Protocol Revision 2010.

Science.gov (United States)

Fania, Claudio; Albertini, Federica; Palatini, Paolo

2017-08-01

The aim of this study was to determine the accuracy of the A&D UM-201 device coupled to several cuffs for different arm sizes for office blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. Evaluation was carried out in 33 individuals. The mean age of the individuals was 59.3±13.2 years, systolic BP was 145.4±20.6 mmHg (range: 109-186 mmHg), diastolic BP was 87.3±18.0 mmHg (range: 50-124 mmHg), and arm circumference was 30.4±4.2 cm (range: 23-39 cm). The protocol requirements were followed precisely. The UM-201 monitor passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated systolic BP by 3.0±2.1 mmHg and diastolic BP by 2.6±2.0 mmHg. These data show that the A&D UM-201 device coupled to several cuffs for different ranges of arm circumference fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

A Top-N Recommender System Evaluation Protocol Inspired by Deployed Systems

NARCIS (Netherlands)

A. Said (Alan); A. Bellogín Kouki (Alejandro); A.P. de Vries (Arjen)

2013-01-01

htmlabstractThe evaluation of recommender systems is crucial for their development. In today's recommendation landscape there are many standardized recommendation algorithms and approaches, however, there exists no standardized method for experimental setup of evaluation -- not even for widely used

Recommended revisions to Nuclear Regulatory Commission seismic design criteria. Technical report

International Nuclear Information System (INIS)

Coats, D.W.

1980-05-01

This report recommends changes in the Nuclear Regulatory Commission's (NRC's) criteria now used in the seismic design of nuclear power plants. Areas covered include ground motion, soil-structure interaction, structures, and equipment and components. Members of the Engineering Mechanics Section of the Nuclear Test Engineering Division at Lawrence Livermore Laboratory (LLL) generally agreed upon the recommendations, which are based on (1) reports developed under the NRC's Task Action Plan A-40, (2) other available engineering literature, and (3) recommendations of nationally recognized experts retained by LLL specifically for this task

Revision of the DELFIC Particle Activity Module

Energy Technology Data Exchange (ETDEWEB)

Hooper, David A [ORNL; Jodoin, Vincent J [ORNL

2010-09-01

The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.

Naturally occurring radioactivity in the Nordic countries. Recommendations

International Nuclear Information System (INIS)

2000-01-01

In the publication 'Naturally Occurring Radiation in the Nordic Countries - Recommendations' published in 1986 the radiation protection authorities in Denmark, Finland, Iceland, Norway and Sweden gave radiation protection recommendations for natural radiation in the Nordic countries. The exposure of the populations in the Nordic countries to natural radiation sources is among the highest in the world and much effort has been devoted during the last 10 to 20 years to characterising, assessing and, where feasible, to reduce these exposures. The exposure of workers to natural radiation sources has also been an important area of work in the same period. During this period the international recommendations on radiation protection policy have been further developed with ICRP Publication 60: '1990 Recommendations of the International Commission on Radiological Protection', and ICRP Publication 65: 'Protection Against Radon-222 at Home and at Work'. The European Basic Safety Standards Directive from 1996 (96/29/EURATOM), which is based on the ICRP recommendations, differs from the earlier versions in that special provisions have been laid down concerning exposure to natural radiation sources. As Denmark, Finland and Sweden are members of European Union and the EFTA-countries (Iceland and Norway) have close co-operation with the EU, the practical implementation of the EU-BSS will play an important role in all the Nordic countries. In November 1998, a new Drinking Water Directive, 98/83/EC, was adopted. The directive also includes radioactivity in drinking water, excluding potassium-40, radon, and radon decay products. Altogether this means that the Nordic recommendations from 1986 for natural radiation needed to be updated. The Nordic Radiation Protection Authorities therefore decided to set up a working group with the aim of revising the recommendations from 1986. The new revised recommendations will, as before, only deal with the components of the exposure to natural

Evaluation of revised trauma score in poly- traumatized patients

International Nuclear Information System (INIS)

Ahmad, H.N.

2004-01-01

Objective: To determine the prognostic value and reliability of revised trauma score (RTS) in polytraumatized patients. Subjects and Methods: Thirty adult patients of road traffic accidents sustaining multisystem injuries due to high energy blunt trauma were managed according to the protocols of advanced trauma life support (ATLS) and from their first set of data RTS was calculated. Score of each patient was compared with his final outcome at the time of discharge from the hospital. Results: The revised trauma score was found to be a reliable predictor of prognosis of polytraumatized patients but a potentially weak predictor for those patients having severe injury involving a single anatomical region. The higher the RTS the better the prognosis of polytrauma patient and vice versa. Revised trauma score <8 turned out to be an indicator of severe injury with high mortality and morbidity and overall mortality in polytraumatized patients was 26.66%. However, RTS-6 was associated with 50% mortality. Conclusion: The revised trauma score is a reliable indicator of prognosis of polytraumatized patients. Therefore, it can be used for field and emergency room triage. (author)

Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction.

Science.gov (United States)

Makhni, Eric C; Crump, Erica K; Steinhaus, Michael E; Verma, Nikhil N; Ahmad, Christopher S; Cole, Brian J; Bach, Bernard R

2016-08-01

To assess the quality and variability found across anterior cruciate ligament (ACL) rehabilitation protocols published online by academic orthopaedic programs. Web-based ACL physical therapy protocols from United States academic orthopaedic programs available online were included for review. Main exclusion criteria included concomitant meniscus repair, protocols aimed at pediatric patients, and failure to provide time points for the commencement or recommended completion of any protocol components. A comprehensive, custom scoring rubric was created that was used to assess each protocol for the presence or absence of various rehabilitation components, as well as when those activities were allowed to be initiated in each protocol. Forty-two protocols were included for review from 155 U.S. academic orthopaedic programs. Only 13 protocols (31%) recommended a prehabilitation program. Five protocols (12%) recommended continuous passive motion postoperatively. Eleven protocols (26%) recommended routine partial or non-weight bearing immediately postoperatively. Ten protocols (24%) mentioned utilization of a secondary/functional brace. There was considerable variation in range of desired full-weight-bearing initiation (9 weeks), as well as in the types of strength and proprioception exercises specifically recommended. Only 8 different protocols (19%) recommended return to sport after achieving certain strength and activity criteria. Many ACL rehabilitation protocols recommend treatment modalities not supported by current reports. Moreover, high variability in the composition and time ranges of rehabilitation components may lead to confusion among patients and therapists. Level II. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Whole Building Cost and Performance Measurement: Data Collection Protocol Revision 2

Energy Technology Data Exchange (ETDEWEB)

Fowler, Kimberly M.; Spees, Kathleen L.; Kora, Angela R.; Rauch, Emily M.; Hathaway, John E.; Solana, Amy E.

2009-03-27

This protocol was written for the Department of Energy’s Federal Energy Management Program (FEMP) to be used by the public as a tool for assessing building cost and performance measurement. The primary audiences are sustainable design professionals, asset owners, building managers, and research professionals within the Federal sector. The protocol was developed based on the need for measured performance and cost data on sustainable design projects. Historically there has not been a significant driver in the public or private sector to quantify whole building performance in comparable terms. The deployment of sustainable design into the building sector has initiated many questions on the performance and operational cost of these buildings.

District heating service connections. Technical recommendations. 4. ed. Hausanschluesse an Fernwaermenetze. Technische Richtlinien

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

The fourth edition of the 'Technical regulations - district heating service connections' constitutes a completely revised version answering to the considerable developments and changes the house service sector experienced between 1975 and 1985. Analyses and practical experiences have proved to show that precision thermostats which, depending on the mode of lines and layout of the service system allow to spare central temperature control systems, still have a decisive influence on the design of district heating service stations. The revised chapter on steam line service connections focuses on problems concerning the metering of condensates and the connection of secondary water heating networks to steam lines. The reader finds an updated selection of diagrams as well as a revised appendix listing the AGFW codes of practice and recommendations, relevant DIN standards and relevant VDE/VDI recommendations.

Protocol Fuel Mix reporting

International Nuclear Information System (INIS)

2002-07-01

The protocol in this document describes a method for an Electricity Distribution Company (EDC) to account for the fuel mix of electricity that it delivers to its customers, based on the best available information. Own production, purchase and sale of electricity, and certificates trading are taken into account. In chapter 2 the actual protocol is outlined. In the appendixes additional (supporting) information is given: (A) Dutch Standard Fuel Mix, 2000; (B) Calculation of the Dutch Standard fuel mix; (C) Procedures to estimate and benchmark the fuel mix; (D) Quality management; (E) External verification; (F) Recommendation for further development of the protocol; (G) Reporting examples

Nuclear Security Recommendations on Physical Protection of Nuclear Material and Nuclear Facilities (INFCIRC/225/Revision 5). Recommendations (Spanish Edition); Recomendaciones de Seguridad Fisica Nuclear sobre la Proteccion Fisica de los Materiales y las Instalaciones Nucleares (INFCIRC/225/Rev.5). Recomendaciones

Energy Technology Data Exchange (ETDEWEB)

NONE

2012-06-15

This publication, Revision 5 of Physical Protection of Nuclear Material and Nuclear Facilities (INFCIRC/225), is intended to provide guidance to States and their competent authorities on how to develop or enhance, implement and maintain a physical protection regime for nuclear material and nuclear facilities, through the establishment or improvement of their capabilities to implement legislative and regulatory programmes. The recommendations presented in this publication reflect a broad consensus among IAEA Member States on the requirements which should be met for the physical protection of nuclear materials and nuclear facilities.

Modelling and Initial Validation of the DYMO Routing Protocol for Mobile Ad-Hoc Networks

DEFF Research Database (Denmark)

Espensen, Kristian Asbjørn Leth; Kjeldsen, Mads Keblov; Kristensen, Lars Michael

2008-01-01

A mobile ad-hoc network (MANET) is an infrastructureless network established by a set of mobile devices using wireless communication. The Dynamic MANET On-demand (DYMO) protocol is a routing protocol for multi-hop communication in MANETs currently under development by the Internet Engineering Task...... Force (IETF). This paper presents a Coloured Petri Net (CPN) model of the mandatory parts of the DYMO protocol, and shows how scenario-based state space exploration has been used to validate key properties of the protocol. Our CPN modelling and verification work has spanned two revisions of the DYMO...... protocol specification and have had direct impact on the most recent version of the protocol specification....

Validation of the A&D BP UA-651 device for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo

2014-02-01

The objective of this study was to determine the accuracy of the A&D BP UA-651 device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. Device evaluation was carried out in 33 patients. The mean age of the patients was 48.3±15.5 years, the mean systolic BP was 138.3±24.9 mmHg (range 90-180), the mean diastolic BP was 88.3±13.8 mmHg (range 60-108), and the mean arm circumference was 28.6±3.4 cm (range 23-36). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device underestimated the systolic BP by 0.4±4.4 mmHg and diastolic BP by 1.3±3.5 mmHg. The device-observer discrepancies were unrelated to patients' clinical characteristics. These data show that the A&D BP UA-651 device fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Field Triage Decision Scheme: The National Trauma Triage Protocol

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.

Implementation plan for the Defense Nuclear Facilities Safety Board Recommendation 90-7

International Nuclear Information System (INIS)

Borsheim, G.L.; Cash, R.J.; Dukelow, G.T.

1992-12-01

This document revises the original plan submitted in March 1991 for implementing the recommendations made by the Defense Nuclear Facilities Safety Board in their Recommendation 90-7 to the US Department of Energy. Recommendation 90-7 addresses safety issues of concern for 24 single-shell, high-level radioactive waste tanks containing ferrocyanide compounds at the Hanford Site. The waste in these tanks is a potential safety concern because, under certain conditions involving elevated temperatures and low concentrations of nonparticipating diluents, ferrocyanide compounds in the presence of oxidizing materials can undergo a runaway (propagating) chemical reaction. This document describes those activities underway by the Hanford Site contractor responsible for waste tank safety that address each of the six parts of Defense Nuclear Facilities Safety Board Recommendation 90-7. This document also identifies the progress made on these activities since the beginning of the ferrocyanide safety program in September 1990. Revised schedules for planned activities are also included

ASSET guidelines. Revised 1991 Edition

International Nuclear Information System (INIS)

1991-12-01

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

A Proposal to Revise the Secondary School Curriculum in Economics

Science.gov (United States)

Marcus, Stuart Paul; Richman, Paul Jeffrey

1978-01-01

Two high school students recommend revision of the economics component of the social studies curriculum to include study of income tax preparation, consumer fraud, investment practices, labor economics, and urban problems. (Author/DB)

PWR secondary water chemistry guidelines: Revision 3

International Nuclear Information System (INIS)

Lurie, S.; Bucci, G.; Johnson, L.; King, M.; Lamanna, L.; Morgan, E.; Bates, J.; Burns, R.; Eaker, R.; Ward, G.; Linnenbom, V.; Millet, P.; Paine, J.P.; Wood, C.J.; Gatten, T.; Meatheany, D.; Seager, J.; Thompson, R.; Brobst, G.; Connor, W.; Lewis, G.; Shirmer, R.; Gillen, J.; Kerns, M.; Jones, V.; Lappegaard, S.; Sawochka, S.; Smith, F.; Spires, D.; Pagan, S.; Gardner, J.; Polidoroff, T.; Lambert, S.; Dahl, B.; Hundley, F.; Miller, B.; Andersson, P.; Briden, D.; Fellers, B.; Harvey, S.; Polchow, J.; Rootham, M.; Fredrichs, T.; Flint, W.

1993-05-01

An effective, state-of-the art secondary water chemistry control program is essential to maximize the availability and operating life of major PWR components. Furthermore, the costs related to maintaining secondary water chemistry will likely be less than the repair or replacement of steam generators or large turbine rotors, with resulting outages taken into account. The revised PWR secondary water chemistry guidelines in this report represent the latest field and laboratory data on steam generator corrosion phenomena. This document supersedes Interim PWR Secondary Water Chemistry Recommendations for IGA/SCC Control (EPRI report TR-101230) as well as PWR Secondary Water Chemistry Guidelines--Revision 2 (NP-6239)

WISE recommendations to ensure the safety of injections in diabetes.

Science.gov (United States)

Strauss, K

2012-01-01

Injections and fingersticks administered to patients with diabetes in health care settings present a risk of blood exposure to the injector as well as other workers in potential contact with sharps. Such exposures could lead to transmission of bloodborne pathogens such as hepatitis and HIV. A recent EU Directive requires that where such risks have been identified, processes and devices must be put in place to reduce or eliminate the risk. The aim of this paper is to provide formal guidelines on the application of this Directive to diabetes care settings. These evidence-based recommendations were written and vetted by a large group of international safety experts. A systematic literature search was conducted for all peer-reviewed studies and publications which bear on sharps safety in diabetes. Initially a group of experts reviewed this literature and drafted the recommendations. These were then presented for review, debate and revision to 57 experts from 14 countries at the WISE workshop in October, 2011. After the WISE meeting, the revised Recommendations were circulated electronically to attendees on three occasions, each time in a new iteration with revisions. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include Risks of Sharps Injury and Muco-cutaneous Exposure, The EU Directive, Device Implications, Injection Technique Implications, Education and Training (Creating a "Safety Culture"), Value, Awareness and Responsibility. These safety recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure safe, effective and largely injury-free injections and fingersticks. They will serve as the roadmap for applying the new EU Directive to diabetes care. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Implementation of the ICRP 2007 recommendations in Korea

International Nuclear Information System (INIS)

Cho, Kun-Woo

2008-01-01

Full text: International Commission on Radiological Protection (ICRP) is about to publish new recommendations on radiation protection. International Atomic Energy Agency (IAEA) is also under process in revising its International Basic Safety Standards (BSS) to take into account of the changes of the ICRP recommendations. As soon as the revision of the BSS is completed, Korean government is considering to implement those changes in the BSS and the ICRP recommendations into its national radiation protection laws and regulations. This paper introduces the current activities and future prospects in this matter. In the 2007 ICRP recommendations, there are some new concepts, principles and quantities such as the changes in the nominal risk coefficient for cancer and hereditary effects, new definitions on the tissue weighting factors and radiation weighting factors for neutron and proton, extended application of the dose constraints in all exposure situations in source-related radiation protection, and the introduction of new system of protection for non-human species. Based on the study carried out by KINS so far, the following points are identified as major areas that need for further in-depth review and consideration for the implementation of the ICRP 2007 recommendations into Korean radiation protection laws and regulations; changes in the radiation risk factors, radiation weighting factors and tissue weighting factors, maintenance of the ICRP 60 dose limits, practical application of the dose constraints and determination of the reference levels in many source to individual exposure relationships, change from process-based system to exposure situation-based system, strengthening of the principle of optimization in all exposure situations, system of radiation protection for the environment, practical application of the exclusion and exemption principles, active participation of the stake holders, changes in glossary etc. The study for the implementation of the ICRP

Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.

Science.gov (United States)

Wilson, Alexander T; Pidgeon, Tyler S; Morrell, Nathan T; DaSilva, Manuel F

2015-11-01

To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers. Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction. Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified. The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by

Validation of the A&D BP UB-542 wrist device for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Saladini, Francesca; Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo

2013-08-01

The objective of this study was to determine the accuracy of the A&D BP UB-542 wrist device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension (ESH). Device evaluation was carried out in 33 patients. The mean age was 50.9±10.1 years, the mean systolic BP was 141.6±22.8 mmHg (range 92 : 189), the mean diastolic BP was 89.2±11.4 mmHg (range 62 : 120), the mean arm circumference was 28.8±3.2 cm (range 23-35), and the mean wrist circumference was 17.1±1.4 cm (range 14-19.5). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated the systolic BP by 1.8±7.2 mmHg and diastolic BP by 1.6±5.7 mmHg. These data show that the A&D BP UB-542 wrist device met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

The revision of the safety standards for protection against ionizing radiation

International Nuclear Information System (INIS)

Wei Li Chen; Hsiao Ping Wang; Chia Chun Liao; Chin Shiun Yeh

1994-01-01

The Chinese Safety Standards for Protection Against Ionizing Radiation was issued on July 29, 1970, and has been used for more than thirteen years. In 1983, the Atomic Energy Council (AEC) decided to revise it accordingly to the recommendations of the International Commission on Radiological Protection and the experiences of regulation enforcement in Taiwan and other countries. The AEC assembled a task group of eight members from academic institutions, licensees, government agency, and senior health physics to be in charge of the revision. In this presentation the major changes of the Safety Standards are summarized. They refer to the adoption of the system of dose limitation recommended by ICRP publication 26 and 30, the use of the units of the International System as the primary units with the old units being noted in parentheses, the adoption of the minimums levels recommended by the International Atomic Energy Agency and the setting up of an executive regulatory system for the implementation of the ALARA concept. 6 refs

Revision of the Euratom basic safety standards directive-current status

International Nuclear Information System (INIS)

Mundig, S.

2011-01-01

The European Commission is currently developing a revised Euratom Basic Safety Standards (BSS) Directive covering two major objectives: the consolidation of existing Euratom Radiation Protection legislation and the revision of the Euratom BSS. The consolidation will merge the following five Directives into one single Directive: the BSS Directive, the Medical Exposures Directive, the Public Information Directive, the Outside Workers Directive and the Directive on the Control of high-activity sealed radioactive sources and orphan sources. The revision of the Euratom BSS will take account of the latest recommendations by the International Commission on Radiological Protection and shall improve clarity of the requirements where appropriate. It is planned to introduce more binding requirements on natural radiation sources, on criteria for exemption and clearance, and on the cooperation between Member States for emergency planning and response. The provisions for regulatory control of planned exposure situations foresee a graded approach commensurate to the magnitude and likelihood of exposures from a practice. Finally, the new BSS shall take account of recent scientific developments. One additional goal is to achieve greater harmonisation between the Euratom BSS and the international BSS. While the requirements on the protection of workers, apprentices and students remain nearly unchanged, the revised BSS will clarify the roles and responsibilities of services and experts involved in technical and practical aspects of radiation protection, such as the occupational health services, the dosimetry services, the radiation protection expert and the medical physics expert. The requirements in the BSS on individual monitoring of category A workers remain unchanged, but the existing guidance on individual monitoring was revised and updated-the technical recommendations for monitoring individuals occupationally exposed to external radiation are published by the European

Blockchain protocols in clinical trials: Transparency and traceability of consent [version 3; referees: 1 approved, 2 approved with reservations, 1 not approved

OpenAIRE

Mehdi Benchoufi; Raphael Porcher; Philippe Ravaud

2017-01-01

Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing the collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we will built a consent workflow using a rising technology called Blockchain. This is a...

Overview of the Nuclear Regulatory Commission's revised 10 CFR Part 20

International Nuclear Information System (INIS)

Peterson, H.T. Jr.

1990-01-01

The principal Nuclear Regulatory Commission (NRC) regulations covering radiation protection are in Part 20 of Title 10 of the Code of Federal Regulations (10 CFR Part 20). These regulations apply to almost all NRC licensed activities including nuclear power and research reactors, nuclear medicine, industrial radiography and the use of most radioactive isotopes in research. The revised 10 CFR Part 20 is based on the 1977 recommendations of the International Commission on Radiological Protection (ICRP) in ICRP Publication No. 26, implements the 1987 Federal Radiation Guidance on Occupational Exposure and is generally consistent with the 1987 recommendations of the U.S. National Council on Radiation Protection and Measurements (NCRP) in NCRP Report No. 91. There are a number of areas where the Revised Part 20 employs new and more up-to-date scientific information and concepts. One major change is in the use of revised lung and GI tract models and more recent metabolic retention data to calculate Annual Limits on Intake (ALI's) and Derived Air Concentration limits (DAC's). The Appendix B in the Revised Part 20 employs new and more up-to-date scientific information and concepts. One major change is in the use of revised lung and GI tract models and more recent metabolic retention data to calculate Annual Limits on Intake (ALI's) and Derived Air Concentration limits (DAC's). The Appendix B in the Revised Part 20 contains data on occupational ALI's and DCA's and radionuclide concentration limits for releases to the general environment for over 750 radionuclides. The final rule is expected to be published early in September with an implementation data of January 1, 1992

Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems

Energy Technology Data Exchange (ETDEWEB)

Conover, David R.; Crawford, Aladsair J.; Viswanathan, Vilayanur V.; Ferreira, Summer; Schoenwald, David

2014-06-01

The Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems (PNNL-22010) was first issued in November 2012 as a first step toward providing a foundational basis for developing an initial standard for the uniform measurement and expression of energy storage system (ESS) performance. Its subsequent use in the field and review by the protocol working group and most importantly the users’ subgroup and the thermal subgroup has led to the fundamental modifications reflected in this update of the 2012 Protocol. As an update of the 2012 Protocol, this document (the June 2014 Protocol) is intended to supersede its predecessor and be used as the basis for measuring and expressing ESS performance. The foreword provides general and specific details about what additions, revisions, and enhancements have been made to the 2012 Protocol and the rationale for them in arriving at the June 2014 Protocol.

Optimizing Greenhouse Rice Production: Summary of Recommendations

OpenAIRE

Eddy, Robert; Acosta, Kevin; Liu, Yisi; Russell, Michael

2016-01-01

This publication provides a single-page chart summarizing our protocols for growing Rice (japonica). Split into three production goals, recommendations are given for photoperiod, temperature, lighting, container, root medium, planting density, irrigation, fertilization, algae control and fungus gnat control. This version updates our fertilization frequency, pot size, root medium and algae control recommendations. This document summarizes a series of questions and answers originally posted ...

Implications of ICRP recommendations on the management of radiation protection of workers

International Nuclear Information System (INIS)

Huyskens, C.J.

1992-01-01

The new ICRP recommendations [1] give a slightly revised definition of occupational exposure. Guidance is given with respect to the exposure at work related no natural radiation sources. Where ICRP recommends a source related definition of occupational exposure, the Basic Safety Standards of the European Communities [3] and consequently legislation in member states depart from an effect related definition of workers. Mutual divergence regarding this identification issue will be discussed in this paper. Operational radiation protection is commonly based on the principles of classification of workers, classification of working conditions and classification of places of work. From the management view point, the rationale for applying classification is to balancing the nature and the scale of control measures, monitoring and surveillance, using resources in the most appropriate way. In previous recommendations [2] ICRP has given criteria for classification, based on the projected level of individual annual dose, relative to the recommended dose limits for occupational exposure. This guidance is now regarded as crude and arbitrary and therefore withdrawn. This paper will address some consequences of the revised recommendations as well as options for implementation in the European Community basic safety standards. (author)

Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.

Science.gov (United States)

Alberts, Mark J; Latchaw, Richard E; Jagoda, Andy; Wechsler, Lawrence R; Crocco, Todd; George, Mary G; Connolly, E S; Mancini, Barbara; Prudhomme, Stephen; Gress, Daryl; Jensen, Mary E; Bass, Robert; Ruff, Robert; Foell, Kathy; Armonda, Rocco A; Emr, Marian; Warren, Margo; Baranski, Jim; Walker, Michael D

2011-09-01

The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.

A review of recommendations for sequencing receptive and expressive language instruction.

Science.gov (United States)

Petursdottir, Anna Ingeborg; Carr, James E

2011-01-01

We review recommendations for sequencing instruction in receptive and expressive language objectives in early and intensive behavioral intervention (EIBI) programs. Several books recommend completing receptive protocols before introducing corresponding expressive protocols. However, this recommendation has little empirical support, and some evidence exists that the reverse sequence may be more efficient. Alternative recommendations include teaching receptive and expressive skills simultaneously (M. L. Sundberg & Partington, 1998) and building learning histories that lead to acquisition of receptive and expressive skills without direct instruction (Greer & Ross, 2008). Empirical support for these recommendations also is limited. Future research should assess the relative efficiency of receptive-before-expressive, expressive-before-receptive, and simultaneous training with children who have diagnoses of autism spectrum disorders. In addition, further evaluation is needed of the potential benefits of multiple-exemplar training and other variables that may influence the efficiency of receptive and expressive instruction.

MRI technique for the preoperative evaluation of deep infiltrating endometriosis: current status and protocol recommendation

International Nuclear Information System (INIS)

Schneider, C.; Oehmke, F.; Tinneberg, H.-R.; Krombach, G.A.

2016-01-01

Endometriosis is a common cause of chronic pelvic pain and infertility. It is defined as the occurrence of endometrial tissue outside the uterine cavity and can manifest as a peritoneal, ovarian or infiltrating form, the latter being referred to as deep infiltrating endometriosis (DIE). Surgery is essential in the treatment of DIE and depending on the severity of the disease, surgery can be difficult and extensive. Beside clinical examination and ultrasound, magnetic resonance imaging (MRI) has proven its value to provide useful information for planning surgery in patients with suspected DIE. To optimise the quality of MRI examinations, radiologists have to be familiar with the capabilities and also the limitations of this technique with respect to the assessment of DIE. MRI yields morphological information by using mainly T1- and T2-weighted sequences, but can also provide functional information by means of intravenous gadolinium, diffusion-weighted imaging or cine-MRI. In this article, these techniques and also adequate measures of patient preparation, which are indispensable for successful MRI imaging for the preoperative evaluation of DIE, are reviewed and a comprehensive protocol recommendation is provided.

The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants

DEFF Research Database (Denmark)

Søballe, Kjeld; Mouzin, Olivier R G; Kidder, Louis A

2003-01-01

We used our established experimental model of revision joint replacement to examine the roles of hydroxyapatite coating and bone graft in improving the fixation of revision implants. The revision protocol uses the Søballe micromotion device in a preliminary 8-week period of implant instability...... a titanium alloy (Ti) or a hydroxyapatite (HA) 6.0 mm plasma-sprayed implant, in the presence or absence of allograft packed into the initial 0.75 mm peri-implant gap. The contralateral limb is subjected to primary surgery with the same implant configuration, and serves as control. 8 implants were included...

Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair.

Science.gov (United States)

Lightsey, Harry M; Kantrowitz, David E; Swindell, Hasani W; Trofa, David P; Ahmad, Christopher S; Lynch, T Sean

2018-02-01

The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Cross-sectional study. Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of

Comparison of Current Recommended Regimens of Atropinization in Organophosphate Poisoning

OpenAIRE

Connors, Nicholas J.; Harnett, Zachary H.; Hoffman, Robert S.

2013-01-01

Atropine is the mainstay of therapy in organophosphate (OP) toxicity, though research and consensus on dosing is lacking. In 2004, as reported by Eddleston et al. (J Toxicol Clin Toxicol 42(6):865-75, 2004), they noted variation in recommended regimens. We assessed revisions of original references, additional citations, and electronic sources to determine the current variability in atropine dosing recommendations. Updated editions of references from Eddleston et al.’s work, texts of Internal ...

Validation of the Pangao PG-800B11 blood pressure monitor according to the European Society of Hypertension and the British Hypertension Society protocols.

Science.gov (United States)

Bing, Sen; Zhang, Cunhai; Wang, Liping; Li, Linyi; Wan, Yi

2014-12-01

The study aimed to determine the accuracy of the fully automated oscillometric upper-arm blood pressure (BP) monitor Pangao PG-800B11 according to the European Society of Hypertension-International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocol 1993. Data from 33 participants were initially examined according to the ESH-IP revision 2010. Furthermore, 52 participants were then enrolled to fulfill the BHS protocol requirements. In all participants, sequential left arm measurements were performed by two trained observers using a mercury sphygmomanometer and one supervisor using the device. The protocols' requirements were followed precisely. The device passed all parts of the ESH protocol for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and was graded A according to the criteria of the BHS protocol for both SBP and DBP. The A/A grade was achieved in low (160/100 mmHg) BP categories. The mean BP difference between PG-800B11 and observers in the 85 participants was -0.6±5.0 mmHg for SBP and -0.6±4.5 mmHg for DBP; thus, the device also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation (AAMI). The Pangao PG-800B11 passed all requirements of the ESH-IP revision 2010 and achieved A/A grade of the BHS protocol across a wide range of BPs.

Revised Methods for Characterizing Stream Habitat in the National Water-Quality Assessment Program

Science.gov (United States)

Fitzpatrick, Faith A.; Waite, Ian R.; D'Arconte, Patricia J.; Meador, Michael R.; Maupin, Molly A.; Gurtz, Martin E.

1998-01-01

Stream habitat is characterized in the U.S. Geological Survey's National Water-Quality Assessment (NAWQA) Program as part of an integrated physical, chemical, and biological assessment of the Nation's water quality. The goal of stream habitat characterization is to relate habitat to other physical, chemical, and biological factors that describe water-quality conditions. To accomplish this goal, environmental settings are described at sites selected for water-quality assessment. In addition, spatial and temporal patterns in habitat are examined at local, regional, and national scales. This habitat protocol contains updated methods for evaluating habitat in NAWQA Study Units. Revisions are based on lessons learned after 6 years of applying the original NAWQA habitat protocol to NAWQA Study Unit ecological surveys. Similar to the original protocol, these revised methods for evaluating stream habitat are based on a spatially hierarchical framework that incorporates habitat data at basin, segment, reach, and microhabitat scales. This framework provides a basis for national consistency in collection techniques while allowing flexibility in habitat assessment within individual Study Units. Procedures are described for collecting habitat data at basin and segment scales; these procedures include use of geographic information system data bases, topographic maps, and aerial photographs. Data collected at the reach scale include channel, bank, and riparian characteristics.

Planning Facilities for Athletics, Physical Education and Recreation. Revised.

Science.gov (United States)

American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD).

This revised edition includes new material recommended by a panel of experts in the field of recreational planning. The following topics are covered: (1) the planning process; (2) indoor facilities; (3) outdoor facilities; (4) indoor and outdoor swimming pools; (5) encapsulated spaces and stadiums; (6) service areas; (7) recreation and park…

Validation of the Pangao PG-800B26 upper arm blood pressure monitor in the general population according to the European Society of Hypertension and the British Hypertension Society protocols.

Science.gov (United States)

Chen, Liang; Li, Jiyu; Wen, Jing; Guo, Changfeng; Zhang, Jingying; Yu, Zhen

2018-02-01

This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor Pangao PG-800B26 for home blood pressure monitoring according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocols. Systolic and diastolic blood pressures were measured sequentially in 33 and 85 adults, respectively, on the basis of the ESH-IP and BHS protocols using a mercury sphygmomanometer (two observers) and the device (one supervisor). The procedures and analysis methods of the protocols were followed precisely. The device fulfilled the criteria of the ESH-IP, with device-observer differences of 1.01±5.16 and -0.58±4.17 mmHg for systolic and diastolic blood pressure, respectively. Furthermore, the A/A grade of the BHS protocol was also achieved for overall grading and for the three pressure levels, with average differences of 0.85±6.35 and -0.15±5.65 mmHg for systolic and diastolic blood pressure, respectively, which also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The Pangao PG-800B26 fulfilled the criteria of the ESH-IP 2010 and achieved the A/A grade of the BHS protocol, and hence can be recommended for home use in adults.

The Kyoto protocol becomes effective - implications for french forests

International Nuclear Information System (INIS)

Chaudron, Alain; Morel, Michel-Paul; Merckx, Valerie; Gaborit, Guillaume

2005-01-01

The Kyoto Protocol came into force on February 16, 2005. The article takes stock of ongoing processes and their consequences for French forests. It first describes the Kyoto Protocol and the framework agreement on climate change from which it is derived, then the particular implementing regulations for forestry stakeholders and the detailed rules for applying it to French forests, and specifically the complex accounting rules that arose from negotiations, and finally the future outlook of these processes that have been regularly revised at annual meetings and will continue to be developed. Indeed, the international dialogue concerning the post-2012 era has already begun. (authors)

Revision of the Euratom Basic Standards

International Nuclear Information System (INIS)

Recht, P.; Eriskat, H.

1976-01-01

In the field of radiation protection, the Commission of the European Communities possesses certain powers which allowed it to develop a common health policy and to promote the harmonization of regulations on protecting the health of workers and the population from ionizing radiations. The Community directives constitute the legal instrument which enabled the policy to be achieved; the principles are based on the recommendations of the ICRP but are adapted to the requirements of the Euratom Treaty. The revision of the standards gave the experts and the Commission the opportunity to examine in detail a certain number of new concepts recently introduced in the international recommendations and to update and improve the standards laid down for the first time in 1959. (Auth) [fr

Directives and recommendations of the European Communities on health protection against ionizing radiations

International Nuclear Information System (INIS)

1977-11-01

The CNEN has published a third edition, with comments, of the Directives and Recommendations of the European Communities on health protection against ionizing radiations, following their revision in 1976. This revision takes account of recent developments in the ICRP recommendations which serve as guidelines in the legislation of many countries for establishing general radiation protection principles as well as basic criteria and technical standards. The new Directive, while keeping to the basic principles established in 1959, introduces new methods for improved medical surveillance of workers; also, the previous difference between occupationally exposed workers and those occasionally exposed is eliminated. Finally, a new concept of critical groups is introduced as regards protection of the population, as a basis for its protection. (NEA) [fr

Revision of the occupational health examination form for radiation workers

International Nuclear Information System (INIS)

Liu Chang'an; Chen Erdong

2005-01-01

Objective: To revise the Occupational Health Examination Form for Radiation Workers, which is served as annex 3 of Management Regulations for Occupational Health Surveillance (Decree No.23 of Ministry of Health, P.R. China), so as to further improve and standardize the occupational health management for radiation workers. Methods: Based on corresponding laws, standards and general principles of occupational medicine. Results: The new version of the Form was established and passed auditing. Conclusion: The theoretical foundation, intention and methods of the revision process are briefly introduced. Requirements and necessary recommendations for implement the new Form are also described. (authors)

Advanced dementia pain management protocols.

Science.gov (United States)

Montoro-Lorite, Mercedes; Canalias-Reverter, Montserrat

Pain management in advanced dementia is complex because of neurological deficits present in these patients, and nurses are directly responsible for providing interventions for the evaluation, management and relief of pain for people suffering from this health problem. In order to facilitate and help decision-makers, pain experts recommend the use of standardized protocols to guide pain management, but in Spain, comprehensive pain management protocols have not yet been developed for advanced dementia. This article reflects the need for an integrated management of pain in advanced dementia. From the review and analysis of the most current and relevant studies in the literature, we performed an approximation of the scales for the determination of pain in these patients, with the observational scale PAINAD being the most recommended for the hospital setting. In addition, we provide an overview for comprehensive management of pain in advanced dementia through the conceptual framework «a hierarchy of pain assessment techniques by McCaffery and Pasero» for the development and implementation of standardized protocols, including a four-phase cyclical process (evaluation, planning/performance, revaluation and recording), which can facilitate the correct management of pain in these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Field validation of protocols developed to evaluate in-line mastitis detection systems.

Science.gov (United States)

Kamphuis, C; Dela Rue, B T; Eastwood, C R

2016-02-01

This paper reports on a field validation of previously developed protocols for evaluating the performance of in-line mastitis-detection systems. The protocols outlined 2 requirements of these systems: (1) to detect cows with clinical mastitis (CM) promptly and accurately to enable timely and appropriate treatment and (2) to identify cows with high somatic cell count (SCC) to manage bulk milk SCC levels. Gold standard measures, evaluation tests, performance measures, and performance targets were proposed. The current study validated the protocols on commercial dairy farms with automated in-line mastitis-detection systems using both electrical conductivity (EC) and SCC sensor systems that both monitor at whole-udder level. The protocol for requirement 1 was applied on 3 commercial farms. For requirement 2, the protocol was applied on 6 farms; 3 of them had low bulk milk SCC (128×10(3) cells/mL) and were the same farms as used for field evaluation of requirement 1. Three farms with high bulk milk SCC (270×10(3) cells/mL) were additionally enrolled. The field evaluation methodology and results were presented at a workshop including representation from 7 international suppliers of in-line mastitis-detection systems. Feedback was sought on the acceptance of standardized performance evaluation protocols and recommended refinements to the protocols. Although the methodology for requirement 1 was relatively labor intensive and required organizational skills over an extended period, no major issues were encountered during the field validation of both protocols. The validation, thus, proved the protocols to be practical. Also, no changes to the data collection process were recommended by the technology supplier representatives. However, 4 recommendations were made to refine the protocols: inclusion of an additional analysis that ignores small (low-density) clot observations in the definition of CM, extension of the time window from 4 to 5 milkings for timely alerts for CM

Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

Science.gov (United States)

Lightsey, Harry M.; Kantrowitz, David E.; Swindell, Hasani W.; Trofa, David P.; Ahmad, Christopher S.; Lynch, T. Sean

2018-01-01

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises

OAI-PMH repositories : quality issues regarding metadata and protocol compliance, tutorial 1

CERN Multimedia

CERN. Geneva; Cole, Tim

2005-01-01

This tutorial will provide an overview of emerging guidelines and best practices for OAI data providers and how they relate to expectations and needs of service providers. The audience should already be familiar with OAI protocol basics and have at least some experience with either data provider or service provider implementations. The speakers will present both protocol compliance best practices and general recommendations for creating and disseminating high-quality "shareable metadata". Protocol best practices discussion will include coverage of OAI identifiers, date-stamps, deleted records, sets, resumption tokens, about containers, branding, errors conditions, HTTP server issues, and repository lifecycle issues. Discussion of what makes for good, shareable metadata will cover topics including character encoding, namespace and XML schema issues, metadata crosswalk issues, support of multiple metadata formats, general metadata authoring recommendations, specific recommendations for use of Dublin Core elemen...

Using critiquing for improving medical protocols : Harder than it seems

NARCIS (Netherlands)

Marcos, Mar; Berger, Geert; van Harmelen, Frank; ten Teije, Annette; Roomans, Hugo; Miksch, Silvia

2001-01-01

Medical protocols are widely recognised to provide clinicians with high-quality and up-to-date recommendations. A critical condition for this is of course that the protocols themselves are of high quality. In this paper we investigate the use of critiquing for improving the quality of medical

Implementation to spanish protocol of quality control of accelerators to daily control of electron beams; Implementacion del protocolo espanol de control de calidad de aceleradores al control diario de haces de electrones

Energy Technology Data Exchange (ETDEWEB)

Adaimi Hernandez, P.; Ramirez Ros, J. C.; Casa de Julian, M. A. de la; Clemente Gutierrez, F.; Cabello Murillo, E.; Diaz Fuente, R.; Ferrando Sanchez, A.

2011-07-01

A revised procedure for daily control of the electron beams to make measurements more meaningful physically, having a better reproducibility and more in line with the recommendations of the Spanish Protocol for Quality Control in Electron Linear Accelerators Clinical Use. The daily quality control beams of high energy electrons that had been done so far was the finding that the record of a series of measures (symmetry, uniformity, stability, energy, beam central dose) were within tolerance values established. The amendment is to check the beam quality by directly measuring changes in absorption depth at which the dose is reduced to half its maximum value, R50.

Prophylaxis and treatment of HIV-1 infection in pregnancy - Swedish Recommendations 2017.

Science.gov (United States)

Navér, Lars; Albert, Jan; Carlander, Christina; Flamholc, Leo; Gisslén, Magnus; Karlström, Olof; Svedhem-Johansson, Veronica; Sönnerborg, Anders; Westling, Katarina; Yilmaz, Aylin; Pettersson, Karin

2018-01-24

Prophylaxis and treatment with antiretroviral drugs have resulted in a very low rate of mother-to-child transmission (MTCT) of HIV during recent years. Registration of new antiretroviral drugs, modification of clinical praxis, updated general treatment guidelines and increasing knowledge about MTCT have necessitated regular revisions of the recommendations for 'Prophylaxis and treatment of HIV-1 infection in pregnancy'. The Swedish Reference Group for Antiviral Therapy (RAV) has updated the recommendations from 2013 at an expert meeting 19 September 2017. In the new text, current treatment guidelines for non-pregnant are considered. The most important revisions are that: (1) Caesarean section and infant prophylaxis with three drugs are recommended when maternal HIV RNA >150 copies/mL (previously >50 copies/mL). The treatment target of undetectable HIV RNA remains unchanged <50 copies/mL; (2) Obstetric management and mode of delivery at premature rupture of the membranes and rupture of the membranes at full term follow the same procedures as in HIV negative women; (3) Vaginal delivery is recommended to a well-treated woman with HIV RNA <150 copies/mL regardless of gestational age, if no obstetric contraindications are present; (4) Treatment during pregnancy should begin as soon as possible and should continue after delivery; (5) Ongoing well-functioning HIV treatment at pregnancy start should usually be retained; (6) Recommended drugs and drug combinations have been updated.

The effect of repeated laser stimuli to ink-marked skin on skin temperature—recommendations for a safe experimental protocol in humans

Directory of Open Access Journals (Sweden)

Victoria J. Madden

2016-01-01

Full Text Available Background. Nd:YAP laser is widely used to investigate the nociceptive and pain systems, generating perpetual and laser-evoked neurophysiological responses. A major procedural concern for the use of Nd:YAP laser stimuli in experimental research is the risk of skin damage. The absorption of Nd:YAP laser stimuli is greater in darker skin, or in pale skin that has been darkened with ink, prompting some ethics boards to refuse approval to experimenters wishing to track stimulus location by marking the skin with ink. Some research questions, however, require laser stimuli to be delivered at particular locations or within particular zones, a requirement that is very difficult to achieve if marking the skin is not possible. We thoroughly searched the literature for experimental evidence and protocol recommendations for safe delivery of Nd:YAP laser stimuli over marked skin, but found nothing.Methods. We designed an experimental protocol to define safe parameters for the use of Nd:YAP laser stimuli over skin that has been marked with black dots, and used thermal imaging to assess the safety of the procedure at the forearm and the back.Results. Using thermal imaging and repeated laser stimulation to ink-marked skin, we demonstrated that skin temperature did not increase progressively across the course of the experiment, and that the small change in temperature seen at the forearm was reversed during the rest periods between blocks. Furthermore, no participant experienced skin damage due to the procedure.Conclusion. This protocol offers parameters for safe, confident and effective experimentation using repeated Nd:YAP laser on skin marked with ink, thus paving the way for investigations that depend on it.

Recommendations for resolution of public comments on USI [Unresolved Safety Issues] A-40, ''Seismic Design Criteria''

International Nuclear Information System (INIS)

Philippacopoulos, A.J.

1989-06-01

In June 1988 the Nuclear Regulatory Commission (NRC) issued for public comment the proposed Revision 2 of the Standard Review Plan (SRP) Sections 2.5.2, 3.7.1, 3.7.2. and 3.7.3. Comments were received from six organizations. Brookhaven National Laboratory (BNL) was requested by NRC to provide expert consultation in the seismic and soil-structure interaction areas for the review and resolution of these comments. For this purpose, a panel of consultants was established to assist BNL with the review and evaluation of the public comments. This review was carried out during the period of October 1988 through January 1989. Many of the suggestions given in the public comments were found to be significant and a number of modifications to appropriate SRP sections are recommended. Other public comments were found to have no impact on the proposed Revision 2 of the SRP. Major changes are recommended to the SRP sections dealing with (a) Power Spectral Density (PSD) and ground motion requirements and (b) soil-structure interaction requirements. This report contains specific recommendations to NRC for resolution of the public comments made on the proposed Revision 2 of the SRP

Korean Medication Algorithm for Depressive Disorders 2017: Third Revision

Science.gov (United States)

Seo, Jeong Seok; Wang, Hee Ryung; Woo, Young Sup; Park, Young-Min; Jeong, Jong-Hyun; Kim, Won; Shim, Se-Hoon; Lee, Jung Goo; Jon, Duk-In

2018-01-01

Objective In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. Methods Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. Results AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. Conclusion The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased. PMID:29397669

76 FR 32333 - Approval and Promulgation of Air Quality Implementation Plans; Pennsylvania; Revision to the...

Science.gov (United States)

2011-06-06

...) Program--Quality Assurance Protocol for the Safety Inspection Program in Non-I/M Counties AGENCY... Implementation Plan (SIP) revision submitted by the Commonwealth of Pennsylvania for the purpose of changing the...). Specifically, the Commonwealth is amending a provision of its prior SIP-approved I/M program to amend the...

Implementation of a quality control protocol in a radiotherapy planning system

International Nuclear Information System (INIS)

Condori, P.; Paucar, R.

2004-01-01

Due to the impossibility of each particular case analysis and taking as example the spanish protocol (Under revision), necessary tests have been performed for the verification of the calculations for the Multidata planning system, including: calculation algorithms, reconstruction of the rectangular beams, light modulators, irregular fields, fields summation, weights, normalization, prescription and calculation of UM, for the teletherapy planning

The implications of the new ICRP recommendations on the legislation community radiation protection

International Nuclear Information System (INIS)

Eriskat, H.

1992-01-01

One of the fundamental tasks attributed to the European Community by the Euratom Treaty is to establish uniform safety standards for the health protection of the general public and workers against the dangers of ionising radiation. Ever since 1959, when for the first time, following a proposal by the Commission, the Council of Ministers issued the Basic Safety Standards under form of a Directive, they were reviewed and amended on a regular basis taking into account to a large extent the recommendations of the International Commission on Radiological Protection (ICRP). The aim of the ongoing revision of the Basic Safety Standards Directives (80/836 EURATOM and 84/466 EURATOM) is to reinforce radiation protection thoughout the Community to assure the best possible protection of the workers and public. This partial revision of the basic safety standards needs careful interpretation of the ICRP recommendations, taking into account existing legislation in Member States and an evaluation of the applicability of such a revision in both implementation in legislation and in the daily practice of radiation protection. At the same time, the actual revision's impact on other community Directives in the area of radiation protection has to be considered and, if necessary, these Directives have to be brought in line with the modified Basic Safety Standards. Finally, this revision has to take into account as well the possible repercussion on radiation protection of the future single European Market in order to continue to assure the high level of protection obtained until now. (author)

Energy conservation indicators cold and heat storage. Revision factsheet cold and heat storage 2009; Besparingskentallen koude- en warmteopslag. Herziening factsheet koude- en warmteopslag 2009

Energy Technology Data Exchange (ETDEWEB)

Bosselaar, L. [SenterNovem, Utrecht (Netherlands); Koenders, M.J.B.; Van Helden, M.J.C.; Kleinlugtenbelt, J.H. [IF Technology, Arnhem (Netherlands)

2009-08-15

The aim of the title revision is to update the existing indicators for cold and heat storage as given in the Protocol Monitoring Sustainable Energy [Dutch] Het doel van het onderzoek is om de bestaande set van kentallen voor koude- en warmteopslag uit het Protocol Monitoring Duurzame Energie te actualiseren.

Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group.

Science.gov (United States)

Turner, D; Levine, A; Weiss, B; Hirsh, A; Shamir, R; Shaoul, R; Berkowitz, D; Bujanover, Y; Cohen, S; Eshach-Adiv, O; Jamal, Gera; Kori, M; Lerner, A; On, A; Rachman, L; Rosenbach, Y; Shamaly, H; Shteyer, E; Silbermintz, A; Yerushalmi, B

2010-12-01

There are no current recommendations for bowel cleansing before colonoscopy in children. The Israeli Society of Pediatric Gastroenterology and Nutrition (ISPGAN) established an iterative working group to formulate evidence-based guidelines for bowel cleansing in children prior to colonoscopy. Data were collected by systematic review of the literature and via a national-based survey of all endoscopy units in Israel. Based on the strength of evidence, the Committee reached consensus on six recommended protocols in children. Guidelines were finalized after an open audit of ISPGAN members. Data on 900 colonoscopies per year were accrued, which represents all annual pediatric colonoscopies performed in Israel. Based on the literature review, the national survey, and the open audit, several age-stratified pediatric cleansing protocols were proposed: two PEG-ELS protocols (polyethylene-glycol with electrolyte solution); Picolax-based protocol (sodium picosulphate with magnesium citrate); sodium phosphate protocol (only in children over the age of 12 years who are at low risk for renal damage); stimulant laxative-based protocol (e. g. bisacodyl); and a PEG 3350-based protocol. A population-based analysis estimated that the acute toxicity rate of oral sodium phosphate is at most 3/7320 colonoscopies (0.041 %). Recommendations on diet and enema use are provided in relation to each proposed protocol. There is no ideal bowel cleansing regimen and, thus, various protocols are in use. We propose several evidence-based protocols to optimize bowel cleansing in children prior to colonoscopy and minimize adverse events. © Georg Thieme Verlag KG Stuttgart · New York.

Questionable accuracy of home blood pressure measurements in the obese population - Validation of the Microlife WatchBP O3® and Omron RS6® devices according to the European Society of Hypertension-International Protocol.

Science.gov (United States)

Azaki, Alaa; Diab, Reem; Harb, Aya; Asmar, Roland; Chahine, Mirna N

2017-01-01

Two oscillometric devices, the Microlife WatchBP O3 ® and the Omron RS6 ® , designed for self-blood pressure measurement were evaluated according to the European Society of Hypertension (ESH)-International Protocol (IP) Revision 2010 in the obese population. The Microlife WatchBP O3 measures blood pressure (BP) at the brachial level and the Omron RS6 measures BP at the wrist level. The ESH-IP revision 2010 includes a total of 33 subjects. The difference between observers' and device BP values was calculated for each measure. A total of 99 pairs of BP differences were classified into three categories (≤5, ≤10, and ≤15 mmHg). The protocol procedures were followed precisely in each of the two studies. Microlife WatchBP O3 and Omron RS6 failed to fulfill the criteria of the ESH-IP. The mean differences between the device and the mercury readings were: 0.3±7.8 mmHg and -1.9±6.4 mmHg for systolic BP and diastolic BP, respectively, for Microlife WatchBP O3, and 2.7±9.9 mmHg for SBP and 3.5±11.1 mmHg for diastolic BP for Omron RS6. Microlife WatchBP O3 and Omron RS6 readings differing from the mercury standard by more than 5, 10, and 15 mmHg failed to fulfill the ESH-IP revision 2010 requirements in obese subjects. Therefore, the two devices cannot be recommended for use in obese subjects.

Nuclear safety guide: TID--7016, Revision 2

International Nuclear Information System (INIS)

Thomas, J.T.

1978-01-01

The Nuclear Safety Guide was first issued in 1956 as classified AEC report LA-2063 and was reprinted the next year, unclassified, as TID-7016. Revision 1, published in 1961, extended the scope and refined the guiding information. Revision 2 of the Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams experienced in the field. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the former Guides by employing appropriate safety factors

Hot sample archiving. Revision 3

International Nuclear Information System (INIS)

McVey, C.B.

1995-01-01

This Engineering Study revision evaluated the alternatives to provide tank waste characterization analytical samples for a time period as recommended by the Tank Waste Remediation Systems Program. The recommendation of storing 40 ml segment samples for a period of approximately 18 months (6 months past the approval date of the Tank Characterization Report) and then composite the core segment material in 125 ml containers for a period of five years. The study considers storage at 222-S facility. It was determined that the critical storage problem was in the hot cell area. The 40 ml sample container has enough material for approximately 3 times the required amount for a complete laboratory re-analysis. The final result is that 222-S can meet the sample archive storage requirements. During the 100% capture rate the capacity is exceeded in the hot cell area, but quick, inexpensive options are available to meet the requirements

Field Triage Decision Scheme: The National Trauma Triage Protocol

Centers for Disease Control (CDC) Podcasts

2009-01-22

In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.  Created: 1/22/2009 by National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR).   Date Released: 1/22/2009.

Regulations for the Safe Transport of Radioactive Materials. 1964 Revised Edition

International Nuclear Information System (INIS)

1965-01-01

In 1961 the International Atomic Energy Agency, within the framework of its statutory functions and in accordance with recommendations made by its Preparatory Commission and by the Economic and Social Council of the United Nations, published safety regulations which could be applied to the national and international transport of radio active materials by all means of transport. At the same time, the Director General of the Agency indicated that these regulations would be revised at appropriate intervals in consultation with Member States and the organizations concerned and invited suggestions for their improvement in the light of experience and increased knowledge. In preparing the revised regulations presented in this document, the Agency has received considerable support from its Member States and the organizations concerned, which have made extensive studies and suggestions in order to assist in its work. The Agency also convened several meetings of experts from its Member States and of representatives of a number of international organizations, and has been represented in several meetings convened by those organizations. In publishing the revised transport regulations which result from that co-ordinated effort, the Agency aims at proposing a lasting framework of principles and rules, complemented by appropriate technical data, acceptable for the safe transport of radio active materials by air, land and water. In particular, the developments which have been introduced concerning the packaging requirements, the nuclear safety criteria for the transport of fissile materials and the methods for testing packages should facilitate the international acceptance of packages by the authorities concerned. The Board of Governors of the Agency approved the revised regulations in June and September 1964. It authorized the Director General to apply them, as appropriate, to Agency operations and Agency assisted operations and to recommend to Member States and to the

Validation of the Omron HEM-7320-LA, upper arm blood pressure monitor with Intelli Wrap Technology Cuff HEM-FL1 for self-measurement and clinic use according to the European Society of Hypertension International Protocol revision 2010 in the Mexican population.

Science.gov (United States)

Grover-Páez, Fernando; Cardona-Muñoz, Ernesto G; Cardona-Müller, David; Guzmán-Saldívar, Víctor H; Rodríguez-De la Cerda, Mariana; Jiménez-Cázarez, Mayra B; Totsuka-Sutto, Sylvia E; Alanis-Sánchez, Guillermo A; Ramos-Becerra, Carlos G

2017-12-01

The aim of this study was to determine the accuracy of the Omron HEM-7320-LA with Intelli Wrap technology cuff HEM-FL1 for self-measurement and clinic blood pressure (BP) measurement according to the European Society of Hypertension International Protocol revision 2010. The evaluation was performed in 39 individuals. The mean age of the participants was 47.9±14 years; systolic BP was 145.2±24.3 mmHg (range: 97-190), diastolic BP was 90.9±12.9 mmHg (range: 68-120), and arm circumference was 30.8±4 cm (range: 25-38.5). The device successfully fulfilled the established criteria of the validation protocol. The device overestimated systolic BP by 0.6±5.7 mmHg and diastolic BP by 2.2±5.1 mmHg. The specially designed cuff HEM-FL1 to cover a broad range of arm circumferences and self-placement fulfilled the requirements of the International Protocol.

Working Paper for the Revision of San Francisco's Cable Franchise.

Science.gov (United States)

San Francisco Public Library, CA. Video Task Force.

Ideas are presented for the revision of San Francisco's cable franchise. The recommendations in the report are based upon national research of library and urban use of cable communications and are designed to help the city's present and future cable franchises to comply with the regulations of the Federal Communications Commission by March 31,…

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

Science.gov (United States)

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

2015-12-01

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

Recommended Data on the Electron Impact Ionization of Atoms and Ions: Fluorine to Nickel

International Nuclear Information System (INIS)

Lennon, M.A.; Bell, K.L.; Gilbody, H.B.; Hughes, J.G.; Kingston, A.E.; Murray, M.J.; Smith, F.J.

1988-01-01

Experimental and theoretical cross-section data for electron impact ionization of atoms and ions from fluorine to nickel has been assessed and earlier recommendations for light atoms and ions have been revised. Based on this assessment and, in the absence of any data, on the classical scaling laws a recommended cross section has been produced for each species. This has been used to evaluate recommended Maxwellian rate coefficients over a wide range of temperatures. Convenient analytic expressions have been obtained for the recommended cross sections and rate coefficients. The data are presented in both graphical and tabular form and estimates of the reliability of the recommended data are given

Protocol compliance and time management in blunt trauma resuscitation.

Science.gov (United States)

Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

2009-01-01

To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

Revising Translations

DEFF Research Database (Denmark)

Rasmussen, Kirsten Wølch; Schjoldager, Anne

2011-01-01

The paper explains the theoretical background and findings of an empirical study of revision policies, using Denmark as a case in point. After an overview of important definitions, types and parameters, the paper explains the methods and data gathered from a questionnaire survey and an interview...... survey. Results clearly show that most translation companies regard both unilingual and comparative revisions as essential components of professional quality assurance. Data indicate that revision is rarely fully comparative, as the preferred procedure seems to be a unilingual revision followed by a more...... or less comparative rereading. Though questionnaire data seem to indicate that translation companies use linguistic correctness and presentation as the only revision parameters, interview data reveal that textual and communicative aspects are also considered. Generally speaking, revision is not carried...

Protecting multi-party privacy in location-aware social point-of-interest recommendation

KAUST Repository

Wang, Weiqi; Liu, An; Li, Zhixu; Zhang, Xiangliang; Li, Qing; Zhou, Xiaofang

2018-01-01

Point-of-interest (POI) recommendation has attracted much interest recently because of its significant business potential. Data used in POI recommendation (e.g., user-location check-in matrix) are much more sparse than that used in traditional item (e.g., book and movie) recommendation, which leads to more serious cold start problem. Social POI recommendation has proved to be an effective solution, but most existing works assume that recommenders have access to all required data. This is very rare in practice because these data are generally owned by different entities who are not willing to share their data with others due to privacy and legal concerns. In this paper, we first propose PLAS, a protocol which enables effective POI recommendation without disclosing the sensitive data of every party getting involved in the recommendation. We formally show PLAS is secure in the semi-honest adversary model. To improve its performance. We then adopt the technique of cloaking area by which expensive distance computation over encrypted data is replaced by cheap operation over plaintext. In addition, we utilize the sparsity of check-ins to selectively publish data, thus reducing encryption cost and avoiding unnecessary computation over ciphertext. Experiments on two real datasets show that our protocol is feasible and can scale to large POI recommendation problems in practice.

Protecting multi-party privacy in location-aware social point-of-interest recommendation

KAUST Repository

Wang, Weiqi

2018-04-04

Point-of-interest (POI) recommendation has attracted much interest recently because of its significant business potential. Data used in POI recommendation (e.g., user-location check-in matrix) are much more sparse than that used in traditional item (e.g., book and movie) recommendation, which leads to more serious cold start problem. Social POI recommendation has proved to be an effective solution, but most existing works assume that recommenders have access to all required data. This is very rare in practice because these data are generally owned by different entities who are not willing to share their data with others due to privacy and legal concerns. In this paper, we first propose PLAS, a protocol which enables effective POI recommendation without disclosing the sensitive data of every party getting involved in the recommendation. We formally show PLAS is secure in the semi-honest adversary model. To improve its performance. We then adopt the technique of cloaking area by which expensive distance computation over encrypted data is replaced by cheap operation over plaintext. In addition, we utilize the sparsity of check-ins to selectively publish data, thus reducing encryption cost and avoiding unnecessary computation over ciphertext. Experiments on two real datasets show that our protocol is feasible and can scale to large POI recommendation problems in practice.

Revision surgery due to magnet dislocation in cochlear implant patients: an emerging complication.

Science.gov (United States)

Hassepass, Frederike; Stabenau, Vanessa; Maier, Wolfgang; Arndt, Susan; Laszig, Roland; Beck, Rainer; Aschendorff, Antje

2014-01-01

To analyze the cause and effect of magnet dislocation in cochlear implant (CI) recipients requiring magnet revision surgery for treatment. Retrospective study. Tertiary referral center. Case reports from 1,706 CI recipients consecutively implanted from January 2000 to December 2011 were reviewed. The number of cases requiring magnet revision surgery was assessed. Revision surgery involving magnet removal or replacement was indicated in 1.23% (21/1,706), of all CI recipients. Magnet dislocation occurring during magnetic resonance tomography (MRI), at 1.5 Tesla (T), with the magnet in place and with the application of compression bandaging around the head, was the main cause for revision surgery in 47.62% (10/21) of the affected cases. All 10 cases were implanted with Cochlear Nucleus cochlear implants. These events occurred, despite adherence to current recommendations of the manufacturer. The present study underlines that MRI examination is the main cause of magnet dislocation. The use of compressive bandaging when using 1.5-T MRI does not eliminate the risk of magnet dislocation. Additional cautionary measures are for required for conditional MRI. We recommend X-ray examination after MRI to determine magnet dislocation and avoid major complications in all cases reporting pain during or after MRI. Additional research regarding silicon magnet pocket design for added retention is needed. Effective communication of guidelines for precautionary measures during MRI examination in CI patients is mandatory for all clinicians involved. MRI in CI recipients should be indicated with caution.

Reimmunization after bone marrow transplantation: Current recommendations and perspectives

Directory of Open Access Journals (Sweden)

Machado Clarisse M.

2002-01-01

Full Text Available Autologous and allogeneic BMT recipients lose immune memory of exposition to infectious agents and vaccines accumulated throughout lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children < 7 years old, Haemophilus influenza type B (Hib conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time of vaccination, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers suggesting that the lack of sufficient data has not permitted the establishment of solid recommendations. The use of other vaccines and the perspectives for different vaccination protocols are discussed in this review.

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P 2015 statement

Directory of Open Access Journals (Sweden)

Mireia Estarli

2016-02-01

Full Text Available Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015. PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium. Translation with permission of the authors. The original authors have not revised and verified the Spanish translation, and they do not necessarily endorse it.

Validation of the Medisana MTP Plus upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Erdem, Emre; Aydogdu, Türkan; Akpolat, Tekin

2011-02-01

Standard validation protocols are objective guides for healthcare providers, physicians, and patients. The purpose of this study was to test validation of the Medisana MTP Plus upper arm blood pressure (BP) measuring monitor for self-measurement according to the European Society of Hypertension International Protocol (ESH-IP2) in adults. The Medisana MTP Plus monitor is an automated and oscillometric upper arm device for home BP monitoring. Nine consecutive measurements were made according to the ESH-IP2. Overseen by an independent supervisor, measurements were recorded by two observers blinded from both each other's readings and from the device readings. The Medisana MTP Plus device fulfills the validation criteria of the ESH-IP2 for the general population. The mean (standard deviation) of the difference between the observers and the device measurements was 0.6 mmHg (5.1 mmHg) for systolic and 2.7 mmHg (3.4 mmHg) for diastolic pressures, respectively. As the Medisana MTP Plus device has achieved the required standards, it is recommended for home BP monitoring in an adult population.

Revision to ANSI/ANS 3.1 1978: resulting from TMI-2

International Nuclear Information System (INIS)

Palmer, F.A.

1981-01-01

The personnel errors which occurred at TMI-2 brought forth several areas of weaknesses in personnel selection, qualification and training that impacted ANS-3. As a result, the ANS-3 Committee started working on a revision to ANSI/ANS 3.1-1978 Standard in May 1979. In July 1979 the first set of official recommendations was issued in NUREG 0578. Due to the interim nature of these regulations some interpretation of the intent of these recommendations had to be made and a basis developed to justify changes to the standard

WHO Working Group discussion on revision of the WHO recommendations for the production and control of poliomyelitis vaccines (oral): TRS Nos. 904 and 910. Report of Meeting held on 20-22 July 2010, Geneva, Switzerland.

Science.gov (United States)

Martin, Javier; Milne, Catherine; Minor, Philip; Chumakov, Konstantin; Baca-Estrada, Maria; Caruana, Jacqueline Fournier; Zhou, Tiequn

2011-09-02

Oral poliomyelitis vaccine (OPV) is a critical part of the polio eradication programme. A high number of doses are administered each year with an impact on billions of citizens worldwide. It is therefore essential that written standards concerning OPV are up to date and widely available. The World Health Organization (WHO) publishes technical guidance on the quality, safety and efficacy of vaccines intended to assist national regulatory authorities (NRAs), national control laboratories (NCLs) and manufacturers. As part of its programme, on 20-22 July 2010 WHO convened a working group meeting to initiate the revision of the WHO recommendations on the production and control of OPV as presently outlined in the Technical Reports Series (TRS) issues Nos. 904 and 910 [1,2]. The attendees included experts from academia, NRAs/NCLs and industry involved in the study, manufacture, and authorization and testing/release of OPV from countries around the world including representatives from China, the European Union, Indonesia, Japan, Mexico, and the USA. The objective was to review the state of knowledge concerning production and control of OPV, with a focus on neurovirulence testing, to determine how the existing guidelines should be updated and what recommendations should be made for the future. The outcomes of this meeting will be taken into consideration in future revision of the WHO TRS. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.

Revision total hip arthoplasty: factors associated with re-revision surgery.

Science.gov (United States)

Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

2015-03-04

The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a

Annual limits on intake of radionuclides by workers based on the 1990 recommendations

International Nuclear Information System (INIS)

1991-01-01

The Commission's new radiation protection recommendations (ICRP, 1991) were developed to take into account new biological information related to the detriment associated with radiation exposures and supersede earlier recommendations in Publication 26 (ICRP, 1977). Adoption of the recommendations necessitates a revision in the Commission's secondary limits contained in Publication 30, Parts 1-4 (ICRP, 1979a, 1980, 1981b, 1988). In order to permit immediate application of these new recommendations, new values of the Annual Limits on Intake (ALIs) which incorporate the new dose limits, radiation weighting factors, and tissue weighting factors and the metabolic and biokinetic information from Publication 30 have been calculated. Presented here are secondary limits for the 1990 Recommendations based on the dosimetric data assembled during the preparation of Publication 30. (author)

Variability in donation after cardiac death protocols: a national survey.

Science.gov (United States)

Fugate, Jennifer E; Stadtler, Maria; Rabinstein, Alejandro A; Wijdicks, Eelco F M

2011-02-27

As donation after cardiac death practices expand, the number of institutional policies is increasing. We contacted organ procurement organizations throughout the United States and requested protocols in hospitals in their donor service areas. Sixty-four protocols were obtained with representation from 16 different states. The terminology and recommended practices varied substantially. The methods for death determination were not specified in 28 (44%) protocols. Most adhered to a 2- to 5-min observation time between circulatory arrest and organ procurement, but 10 (16%) provided no information. This variability reveals a need to define a uniform standard in donation after cardiac death protocols and death determination practices.

On the new recommendation of the International Commission on Radiological Protection. Publication 60

International Nuclear Information System (INIS)

Chukhin, S.G.

1994-01-01

The International Commission on Radioligical Protection (ICRP) published in 1990 new main recommendations (Publication 60), in which the recommendations of 1977 (Publication 26) were revised and noticeable changes were introduced. The main changes in ICRP recommendations important for practical personnel are discussed. These important changes include introduction of two protection systems, which are the protection system in practice and that during intervention, conception of potential irradiation, dose and risk limits, changes in dose limits and risk coefficients, determination of the effective dose and its numerical values by changing the weighting coefficients. The problems open to arguments are formulated

76 FR 44589 - Proposed Data Collections Submitted for Public Comment and Recommendations

Science.gov (United States)

2011-07-26

... understand a health message or that the message will move people to take recommended action. Communication... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [[60Day-11-0572..., (0920-0572, exp. 11/30/2011)-- Revision--Office of the Associate Director for Communication, Centers for...

Updated and revised neutron reaction data for 237Np

Directory of Open Access Journals (Sweden)

Chen Guochang

2017-01-01

Full Text Available Nuclear data with high accuracy for minor actinides play an important role in nuclear technology applications, including reactor design and operation, fuel cycle, estimation of the amount of minor actinides in high burn-up reactors and the minor actinides transmutation. Based on the evaluated experimental data, the updated and revised evaluation of a full set of n+237Np nuclear data from 10−5 eV ∼ 20 MeV are carried out and recommended. Mainly revised quantities are neutron multiplicities from fission reaction, inelastic, fission, (n, 2n and (n, γ reaction cross sections as well as angular distribution and so on. The promising results are obtained when the renewal evaluated data of 237Np will be used to instead of the evaluated data in CENDL-3.1 database.

Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension.

Science.gov (United States)

Calvert, Melanie; Kyte, Derek; Mercieca-Bebber, Rebecca; Slade, Anita; Chan, An-Wen; King, Madeleine T; Hunn, Amanda; Bottomley, Andrew; Regnault, Antoine; Chan, An-Wen; Ells, Carolyn; O'Connor, Daniel; Revicki, Dennis; Patrick, Donald; Altman, Doug; Basch, Ethan; Velikova, Galina; Price, Gary; Draper, Heather; Blazeby, Jane; Scott, Jane; Coast, Joanna; Norquist, Josephine; Brown, Julia; Haywood, Kirstie; Johnson, Laura Lee; Campbell, Lisa; Frank, Lori; von Hildebrand, Maria; Brundage, Michael; Palmer, Michael; Kluetz, Paul; Stephens, Richard; Golub, Robert M; Mitchell, Sandra; Groves, Trish

2018-02-06

Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n�

Outcomes of Patients With Revised Stage I Clear Cell Sarcoma of Kidney Treated in National Wilms Tumor Studies 1-5

International Nuclear Information System (INIS)

Kalapurakal, John A.; Perlman, Elizabeth J.; Seibel, Nita L.; Ritchey, Michael; Dome, Jeffrey S.; Grundy, Paul E.

2013-01-01

Purpose: To report the clinical outcomes of children with revised stage I clear cell sarcoma of the kidney (CCSK) using the National Wilms Tumor Study Group (NWTS)-5 staging criteria after multimodality treatment on NWTS 1-5 protocols. Methods and Materials: All CCSK patients enrolled in the National Wilms Tumor Study Group protocols had their pathology slides reviewed, and only those determined to have revised stage I tumors according to the NWTS-5 staging criteria were included in the present analysis. All patients were treated with multimodality therapy according to the NWTS 1-5 protocols. Results: A total of 53 children were identified as having stage I CCSK. All patients underwent primary surgery with radical nephrectomy. The chemotherapy regimens used were as follows: regimen A, C, F, or EE in 4 children (8%); regimen DD or DD4A in 33 children (62%); regimen J in 4 children (8%); and regimen I in 12 children (22%). Forty-six patients (87%) received flank radiation therapy (RT). Seven children (13%) did not receive flank RT. The median delay between surgery and the initiation of RT was 9 days (range, 3-61). The median RT dose was 10.8 Gy (range, 10-36). The flank RT doses were as follows: 10.5 or 10.8 Gy in 25 patients (47%), 11-19.9 Gy in 2 patients (4%), 20-29.9 Gy in 9 patients (17%), and 30-40 Gy in 10 patients (19%). The median follow-up for the entire group was 17 years (range, 2-36). The relapse-free and cancer-specific survival rate was 100% at the last follow-up examination. Conclusions: The present results have demonstrated that children with revised stage I CCSK using the NWTS-5 staging criteria have excellent survival rates despite the use of varying RT doses and chemotherapy regimens in the NWTS 1-5 protocols.

Protocol of specific health monitoring: ionizing radiation, 11 years later

International Nuclear Information System (INIS)

Castillejo Puertas, F. M.

2016-01-01

Since the approval on November 11 t h 2003 of the Protocol of Specific Health Monitoring for Workers Exposed to Ionizing Radiation a study has been carried out to discover its effectiveness. These areas were examined: the daily practice od accupational medicine and, in particular, its specific task in the application of the different clinical/labour criteria for workers exposed to ionizing radiation or at risk of radioactive contamination; the degree of its uses as well as the updates and improvements. For that purpose, a descriptive bibliographic revision has been used for the last 11 years. The results revealed the lack of updates of the Protocol as well as the few usable objective criteria, when the clinical/labour aptitudes are reflected upon. (Author)

Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up

DEFF Research Database (Denmark)

Lange, Jeppe; Troelsen, Anders; Solgaard, Søren

2018-01-01

was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure. RESULTS......BACKGROUND: Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. METHODS: The study was performed as a multicenter, proof-of-concept, observational study...

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol.

Science.gov (United States)

Furberg, Robert D; Ortiz, Alexa M; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-06-27

Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care-related infections were reviewed to develop the infection control protocol to support tablet maintenance. This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings.

Current Sterilization Protocols-An Orthodontic Perspective

Directory of Open Access Journals (Sweden)

Abraham Vinod Korath

2010-01-01

Part I of this article focuses on the working principles of various methods of sterilization with an appraisalof their effects on orthodontic instruments. Additionally,contributory factors of instrument damage is enumerated to emphasis the importance of adhering to precise protocols and manufacturer recommendations as well as in alleviating some misconceptions about sterilization induced instrument damage.

The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants.

Science.gov (United States)

Søballe, Kjeld; Mouzin, Olivier R G; Kidder, Louis A; Overgaard, Søren; Bechtold, Joan E

2003-06-01

We used our established experimental model of revision joint replacement to examine the roles of hydroxyapatite coating and bone graft in improving the fixation of revision implants. The revision protocol uses the Søballe micromotion device in a preliminary 8-week period of implant instability for the presence of particulate polyethylene. During this procedure, a sclerotic endosteal bone rim forms, and a dense fibrous membrane is engendered, having macrophages with ingested polyethylene and high levels of inflammatory cytokines. At the time of revision after 8 weeks, the cavity is revised with either a titanium alloy (Ti) or a hydroxyapatite (HA) 6.0 mm plasma-sprayed implant, in the presence or absence of allograft packed into the initial 0.75 mm peri-implant gap. The contralateral limb is subjected to primary surgery with the same implant configuration, and serves as control. 8 implants were included in each of the 8 treatment groups (total 64 implants in 32 dogs). The observation period was 4 weeks after revision. Outcome measures are based on histomorphometry and mechanical pushout properties. The revision setting was always inferior to its primary counterpart. Bone graft improved the revision fixation in all treatment groups, as also did the HA coating. The sole exception was revision-grafted HA implants, which reached the same fixation as primary Ti and HA grafted implants. The revision, which was less active in general, seems to need the dual stimulation of bone graft and HA implant surface, to obtain the same level of fixation associated with primary implants. Our findings suggest that the combination of HA implant and bone graft may be of benefit in the clinical revision implant setting.

Alcohol handrubbing and chlorhexidine handwashing protocols for routine hospital practice: A randomized clinical trial of protocol efficacy and time effectiveness

NARCIS (Netherlands)

Chow, Angela; Arah, Onyebuchi A.; Chan, Siew-Pang; Poh, Bee-Fong; Krishnan, Prabha; Ng, Woei-Kian; Choudhury, Saugata; Chan, Joey; Ang, Brenda

2012-01-01

Background: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend the use of alcohol handrubs to prevent health care-associated infections. However, the efficacy and time effectiveness of different alcohol handrubbing protocols have yet to be

Performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance. Performance evaluation examples

International Nuclear Information System (INIS)

2005-06-01

The Japan Society of Civil Engineers has updated performance evaluation recommendations of nuclear power plants outdoor significant civil structures earthquake resistance in June 2005. Based on experimental and analytical considerations, analytical seismic models of soils for underground structures, effects of vertical motions on time-history dynamic analysis and shear fracture of reinforced concretes by cyclic loadings have been incorporated in new recommendations. This document shows outdoor civil structures earthquake resistance and endurance performance evaluation examples based on revised recommendations. (T. Tanaka)

Replacing the CCSDS Telecommand Protocol with the Next Generation Uplink (NGU)

Science.gov (United States)

Kazz, Greg J.; Greenberg, Ed; Burleigh, Scott C.

2012-01-01

The current CCSDS Telecommand (TC) Recommendations 1-3 have essentially been in use since the early 1960s. The purpose of this paper is to propose a successor protocol to TC. The current CCSDS recommendations can only accommodate telecommand rates up to approximately 1 mbit/s. However today's spacecraft are storehouses for software including software for Field Programmable Gate Arrays (FPGA) which are rapidly replacing unique hardware systems. Changes to flight software occasionally require uplinks to deliver very large volumes of data. In the opposite direction, high rate downlink missions that use acknowledged CCSDS File Delivery Protocol (CFDP)4 will increase the uplink data rate requirements. It is calculated that a 5 mbits/s downlink could saturate a 4 kbits/s uplink with CFDP downlink responses: negative acknowledgements (NAKs), FINISHs, End-of-File (EOF), Acknowledgements (ACKs). Moreover, it is anticipated that uplink rates of 10 to 20 mbits/s will be required to support manned missions. The current TC recommendations cannot meet these new demands. Specifically, they are very tightly coupled to the Bose-Chaudhuri-Hocquenghem (BCH) code in Ref. 2. This protocol requires that an uncorrectable BCH codeword delimit the TC frame and terminate the randomization process. This method greatly limits telecom performance since only the BCH code can support the protocol. More modern techniques such as the CCSDS Low Density Parity Check (LDPC)5 codes can provide a minimum performance gain of up to 6 times higher command data rates as long as sufficient power is available in the data. This paper will describe the proposed protocol format, trade-offs, and advantages offered, along with a discussion of how reliable communications takes place at higher nominal rates.

An Improved Protocol for Controlled Deterministic Secure Quantum Communication Using Five-Qubit Entangled State

Science.gov (United States)

Kao, Shih-Hung; Lin, Jason; Tsai, Chia-Wei; Hwang, Tzonelih

2018-03-01

In early 2009, Xiu et al. (Opt. Commun. 282(2) 333-337 2009) presented a controlled deterministic secure quantum communication (CDSQC) protocol via a newly constructed five-qubit entangled quantum state. Later, Qin et al. (Opt. Commun. 282(13), 2656-2658 2009) pointed out two security loopholes in Xiu et al.'s protocol: (1) A correlation-elicitation (CE) attack can reveal the entire secret message; (2) A leakage of partial information for the receiver is noticed. Then, Xiu et al. (Opt. Commun. 283(2), 344-347 2010) presented a revised CDSQC protocol to remedy the CE attack problem. However, the information leakage problem still remains open. This work proposes a new CDSQC protocol using the same five-qubit entangled state which can work without the above mentioned security problems. Moreover, the Trojan Horse attacks can be automatically avoided without using detecting devices in the new CDSQC.

An Improved Protocol for Controlled Deterministic Secure Quantum Communication Using Five-Qubit Entangled State

Science.gov (United States)

Kao, Shih-Hung; Lin, Jason; Tsai, Chia-Wei; Hwang, Tzonelih

2018-06-01

In early 2009, Xiu et al. (Opt. Commun. 282(2) 333-337 2009) presented a controlled deterministic secure quantum communication (CDSQC) protocol via a newly constructed five-qubit entangled quantum state. Later, Qin et al. (Opt. Commun. 282(13), 2656-2658 2009) pointed out two security loopholes in Xiu et al.'s protocol: (1) A correlation-elicitation (CE) attack can reveal the entire secret message; (2) A leakage of partial information for the receiver is noticed. Then, Xiu et al. (Opt. Commun. 283(2), 344-347 2010) presented a revised CDSQC protocol to remedy the CE attack problem. However, the information leakage problem still remains open. This work proposes a new CDSQC protocol using the same five-qubit entangled state which can work without the above mentioned security problems. Moreover, the Trojan Horse attacks can be automatically avoided without using detecting devices in the new CDSQC.

Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery

OpenAIRE

Khatod, M; Cafri, G; Inacio, MCS; Schepps, AL; Paxton, EW; Bini, SA

2015-01-01

The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty.A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revi...

Newborn hearing screening protocol in tuscany region.

Science.gov (United States)

Berrettini, Stefano; Ghirri, Paolo; Lazzerini, Francesco; Lenzi, Giovanni; Forli, Francesca

2017-09-20

Newborn hearing screening has to be considered the first step of a program for the identification, diagnosis, treatment and habilitation/rehabilitation of children with hearing impairment. In Tuscany Region of Italy, the universal newborn hearing screening is mandatory since november 2007. The first guidelines for the execution of the screening have been released in June 2008; then many other Italian regions partially or totally adopted these guidelines. On the basis of the experience from 2008 and according to the recent evidences in the scientific literature, a new screening protocol was released in Tuscany region. The new protocol is an evolution of the previous one. Some issues reported in the previous protocol and in the Joint Committee on Infant Hearing statement published in 2007 were revised, such as the risk factors for auditory neuropathy and for late onset, progressive or acquired hearing loss. The new updated guidelines were submitted to the Sanitary Regional Council and then they have been approved in August 2016. The updated screening protocol is mainly aimed to identify newborns with a congenital moderate-to-profound hearing loss, but it also provides indications for the audiological follow-up of children with risk's factor for progressive or late onset hearing loss; further it provides indications for the audiological surveillance of children at risk for acquired hearing impairment. Then, in the new guidelines the role of the family paediatrician in the newborn hearing screening and audiological follow-up and surveillance is underscored. Finally the new guidelines provide indications for the treatment with hearing aids and cochlear implant, in accordance with the recent Italian Health Technology Assessment (HTA) guidelines. In the paper we report the modality of execution of the universal newborn hearing screening in the Tuscany Region, according to the recently updated protocol. The main features of the protocol and the critical issues are

Disinfection Contact Time study plan (100-N Area tracer protocol). Revision 1

International Nuclear Information System (INIS)

Kretzschmar, S.P.; Bedi, G.S.; Martinez, P.; Ervin, K.

1996-07-01

Bechtel Hanford, Inc. will prepare an Engineering Tracer Study Protocol for the determination of contact time for the disinfection process at Group A Non-transient Non-community water treatment plant for the 100-N Water Plant at the Hanford Site in Richland, Washington. Included in this report are the results of a study that determine the actual detention time within the plant clearwell, and thus the disinfection contact time at several clearwell effluent flow rates

Preliminary hazards analysis of thermal scrap stabilization system. Revision 1

International Nuclear Information System (INIS)

Lewis, W.S.

1994-01-01

This preliminary analysis examined the HA-21I glovebox and its supporting systems for potential process hazards. Upon further analysis, the thermal stabilization system has been installed in gloveboxes HC-21A and HC-21C. The use of HC-21C and HC-21A simplified the initial safety analysis. In addition, these gloveboxes were cleaner and required less modification for operation than glovebox HA-21I. While this document refers to glovebox HA-21I for the hazards analysis performed, glovebox HC-21C is sufficiently similar that the following analysis is also valid for HC-21C. This hazards analysis document is being re-released as revision 1 to include the updated flowsheet document (Appendix C) and the updated design basis (Appendix D). The revised Process Flow Schematic has also been included (Appendix E). This Current revision incorporates the recommendations provided from the original hazards analysis as well. The System Design Description (SDD) has also been appended (Appendix H) to document the bases for Safety Classification of thermal stabilization equipment

SPECT/CT workflow and imaging protocols

Energy Technology Data Exchange (ETDEWEB)

Beckers, Catherine [University Hospital of Liege, Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Liege (Belgium); Hustinx, Roland [University Hospital of Liege, Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Liege (Belgium); Domaine Universitaire du Sart Tilman, Service de Medecine Nucleaire et Imagerie Oncologique, CHU de Liege, Liege (Belgium)

2014-05-15

Introducing a hybrid imaging method such as single photon emission computed tomography (SPECT)/CT greatly alters the routine in the nuclear medicine department. It requires designing new workflow processes and the revision of original scheduling process and imaging protocols. In addition, the imaging protocol should be adapted for each individual patient, so that performing CT is fully justified and the CT procedure is fully tailored to address the clinical issue. Such refinements often occur before the procedure is started but may be required at some intermediate stage of the procedure. Furthermore, SPECT/CT leads in many instances to a new partnership with the radiology department. This article presents practical advice and highlights the key clinical elements which need to be considered to help understand the workflow process of SPECT/CT and optimise imaging protocols. The workflow process using SPECT/CT is complex in particular because of its bimodal character, the large spectrum of stakeholders, the multiplicity of their activities at various time points and the need for real-time decision-making. With help from analytical tools developed for quality assessment, the workflow process using SPECT/CT may be separated into related, but independent steps, each with its specific human and material resources to use as inputs or outputs. This helps identify factors that could contribute to failure in routine clinical practice. At each step of the process, practical aspects to optimise imaging procedure and protocols are developed. A decision-making algorithm for justifying each CT indication as well as the appropriateness of each CT protocol is the cornerstone of routine clinical practice using SPECT/CT. In conclusion, implementing hybrid SPECT/CT imaging requires new ways of working. It is highly rewarding from a clinical perspective, but it also proves to be a daily challenge in terms of management. (orig.)

SPECT/CT workflow and imaging protocols

International Nuclear Information System (INIS)

Beckers, Catherine; Hustinx, Roland

2014-01-01

Introducing a hybrid imaging method such as single photon emission computed tomography (SPECT)/CT greatly alters the routine in the nuclear medicine department. It requires designing new workflow processes and the revision of original scheduling process and imaging protocols. In addition, the imaging protocol should be adapted for each individual patient, so that performing CT is fully justified and the CT procedure is fully tailored to address the clinical issue. Such refinements often occur before the procedure is started but may be required at some intermediate stage of the procedure. Furthermore, SPECT/CT leads in many instances to a new partnership with the radiology department. This article presents practical advice and highlights the key clinical elements which need to be considered to help understand the workflow process of SPECT/CT and optimise imaging protocols. The workflow process using SPECT/CT is complex in particular because of its bimodal character, the large spectrum of stakeholders, the multiplicity of their activities at various time points and the need for real-time decision-making. With help from analytical tools developed for quality assessment, the workflow process using SPECT/CT may be separated into related, but independent steps, each with its specific human and material resources to use as inputs or outputs. This helps identify factors that could contribute to failure in routine clinical practice. At each step of the process, practical aspects to optimise imaging procedure and protocols are developed. A decision-making algorithm for justifying each CT indication as well as the appropriateness of each CT protocol is the cornerstone of routine clinical practice using SPECT/CT. In conclusion, implementing hybrid SPECT/CT imaging requires new ways of working. It is highly rewarding from a clinical perspective, but it also proves to be a daily challenge in terms of management. (orig.)

[Schools meals in French secondary state schools: compliance to national recommendations and schools catering patterns].

Science.gov (United States)

Bertin, M; Lafay, L; Calamassi-Tran, G; Volatier, J-L; Dubuisson, C

2011-02-01

Recent reports on the lack of nutritional quality of meals served in schools have led public authorities to draft, in 1999, recommendations for restoring a balanced food supply. Following the survey carried out by the French food safety Agency in 2005-2006, which highlighted gaps in the implementation of these recommendations, a law passed in July 2010 plans to make these recommendations mandatory, as their 2007 revised version. Thus, the objective of this study was to assess initial school compliance with regard to this last revised version of the recommendations and to identify school patterns through their catering management and implication in a dietary project. Seven hundred and seven secondary state schools were questioned (570 were administrated by the Ministry of Education and 137 by the Ministry of Agriculture) on their catering practices. Twenty consecutive menus from each school were also analyzed with a specific coding system to establish its nutritional composition for comparison with the 2007 recommendations. On average, schools complied with half of the recommendations. Good compliance was observed with the 2007 recommendations concerning fried products, starchy foods, fruits, and dairy products whereas very few schools were in compliance with recommendations concerning fish, cheeses and sweetened desserts containing less than 15 % fat and more than 20 g of sugar per portion. Furthermore, compliance with recommendations was significantly better for lunch meals, and even better for agricultural establishments. A 5-component meal was also associated with greater compliance with the recommendations. In addition, four school patterns were identified based on catering management practices. The first two categories of establishments had knowledge of the recommendations but exhibited different levels of application. The last two types of establishments had no knowledge of the recommendations and differed in their catering management practices. Compliance

P-02: Echocardiography Has Low Clinical Efficacy of Libyan Screening Protocol in Athletes

Directory of Open Access Journals (Sweden)

Salaheddin Sharif

2017-03-01

Full Text Available INTRODUCTIONPre-participation screening has been largely accepted as a means to identify those athletes at risk of cardiovascular diseases which are responsible for sudden cardiac death. The objectives of athlete screening are to reduce injuries and prevent sudden. However, there is no single commonly adopted protocol to screen athletes. Although the European Society of Cardiology and the American Heart Association recommend the routine screening of athletes to prevent sudden death, there is significant disagreement regarding use 12 lead ECG. FIFA has recommend the inclusion of an Echocardiography (ECHO in screening protocol.PURPOSEExplore the debate regarding differences between European and the USA pre-participation screening protocol for sudden death while also considering pre-competition medical assessment protocol used by the Libyan Football Federation. To provide evidence based recommendations on the best protocol to be used for pre-participation screening, and thus to standardize the screening method.MATERIALS and METHOD1236 male athletic received a medical history, general physical examination, cardiovascular and musculoskeletal examination, 12 lead ECG, blood laboratory test, and echocardiography.FINDINGS1235 athletics were found to be eligible to participate in sport and were given a full medical clearance. One athletic was diagnosed with second degree heart block by ECG while his medical history, physical examination, echocardiograph, and blood test were normal.DISCUSSIONEchocardiography alone do did not identify pathological condition and using echocardiography is still controversial and clinically not effective in young athletesCONCLUSIONThe Screening protocol should include a combination of medical history, physical examination and ECG due to the high sensitivity found, and thus it was able to identify all athletes at risk for the disease.

Blockchain protocols in clinical trials: Transparency and traceability of consent [version 5; referees: 1 approved, 2 approved with reservations, 2 not approved

Directory of Open Access Journals (Sweden)

Mehdi Benchoufi

2018-02-01

Full Text Available Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security

Blockchain protocols in clinical trials: Transparency and traceability of consent [version 4; referees: 1 approved, 2 approved with reservations, 2 not approved

Directory of Open Access Journals (Sweden)

Mehdi Benchoufi

2017-12-01

Full Text Available Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security

ICRP recommendations in the present and in the short term

International Nuclear Information System (INIS)

Valentin, Jack

2003-01-01

The recommendations of ICRP are either re-stated or revised at intervals of about 15 years, most recently in 1990. The protection philosophy in Publication 60 comprises justification of the practice or intervention considered; optimisation of protection; dose and risk limits and constraints to restrict the options in optimisation. For medical exposures, dose and risk limits and formal constraints are irrelevant, but Diagnostic Reference Levels serve a similar purpose. Building on this foundation, ICRP plans to issue its next recommendations around 2005. The 2005 Recommendations are likely to emphasise protection of the individual more than protection of society; to aim at protection of non-human species as well as man; to summarise and simplify advice given in various reports after Publication 60, and to be formatted as concise recommendations underpinned by separate publications with more detail. The draft will be circulated and comments will be discussed in 2004 with a view approval of the recommendations in 2005 and publication in 2005 or 2006. Thus, integration into legislation may be possible sometime between 2006 and 2010. (author)

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

Science.gov (United States)

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

2015-07-01

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

Bulletin 2005-12 : revised Alberta pipeline regulation issued

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-05-31

A revised Pipeline Regulation has been issued and is currently available on the Alberta Energy and Utilities Board (EUB) website. Changes to the regulation reflect bothchanges in EUB regulatory policy and processes and technological improvements. Goals of the revision include improvements in overall pipeline performance, and the implementation of recommendations derived from the Public Safety and Sour Gas Committee concerning sour gas pipeline safety. The regulation was re-organized for greater clarity, and structured into 11 parts. Issues concerning the transition to the revised regulation were presented. The summary of notable administrative changes included clarifications of when a pipeline application is not required; when ABSA approval is required for steam lines; situations for which low-pressure natural gas lines must be licensed; and emergency response requirements. Technical clarifications include requirements for pipeline operations and maintenance manuals; composite materials; limitations on amounts of H{sub 2}S in polymeric pipe; pressure mismatches; approval for testing with gaseous media; venting of small volumes of raw gas; right-of-way surveillance; inspection of surface construction activities; annual corrosion evaluations; registering of pipelines and excavators in controlled areas with Alberta One-Call; ground disturbance training; restoration and signage maintenance on abandoned pipelines; sour service steel pipelines; unused pipelines and abandoned pipelines; and remediation of stub ends in operating pipelines.

The Impact of use of Double Set-up on Infection Rates in Revision Total Knee Replacement and Limb Salvage Procedures

Directory of Open Access Journals (Sweden)

Jennifer Waterman

2015-03-01

Full Text Available A retrospective analysis was performed to determine the impact of utilizing a double set-up procedure on reducing infection rates revision total knee and limb salvage procedures in patients with known joint infection.  Eighteen cases fit selection criteria.  The recurrence rate of infection was 5.5% which is less than reported recent literature review.   This suggests the use of a double set-up in combination with other infection reducing protocols may help further reduce recurrent infection.  Keywords: double set-up, infection, revision total knee arthroplasty, limb-salvage

Revised

DEFF Research Database (Denmark)

Johannsen, Vivian Kvist; Nord-Larsen, Thomas; Riis-Nielsen, Torben

This report is a revised analysis of the Danish data on CO2 emissions from forest, afforestation and deforestation for the period 1990 - 2008 and a prognosis for the period until 2020. Revision have included measurements from 2009 in the estimations. The report is funded by the Ministry of Climate...

Comparison of mRNA splicing assay protocols across multiple laboratories: recommendations for best practice in standardized clinical testing.

Science.gov (United States)

Whiley, Phillip J; de la Hoya, Miguel; Thomassen, Mads; Becker, Alexandra; Brandão, Rita; Pedersen, Inge Sokilde; Montagna, Marco; Menéndez, Mireia; Quiles, Francisco; Gutiérrez-Enríquez, Sara; De Leeneer, Kim; Tenés, Anna; Montalban, Gemma; Tserpelis, Demis; Yoshimatsu, Toshio; Tirapo, Carole; Raponi, Michela; Caldes, Trinidad; Blanco, Ana; Santamariña, Marta; Guidugli, Lucia; de Garibay, Gorka Ruiz; Wong, Ming; Tancredi, Mariella; Fachal, Laura; Ding, Yuan Chun; Kruse, Torben; Lattimore, Vanessa; Kwong, Ava; Chan, Tsun Leung; Colombo, Mara; De Vecchi, Giovanni; Caligo, Maria; Baralle, Diana; Lázaro, Conxi; Couch, Fergus; Radice, Paolo; Southey, Melissa C; Neuhausen, Susan; Houdayer, Claude; Fackenthal, Jim; Hansen, Thomas Van Overeem; Vega, Ana; Diez, Orland; Blok, Rien; Claes, Kathleen; Wappenschmidt, Barbara; Walker, Logan; Spurdle, Amanda B; Brown, Melissa A

2014-02-01

Accurate evaluation of unclassified sequence variants in cancer predisposition genes is essential for clinical management and depends on a multifactorial analysis of clinical, genetic, pathologic, and bioinformatic variables and assays of transcript length and abundance. The integrity of assay data in turn relies on appropriate assay design, interpretation, and reporting. We conducted a multicenter investigation to compare mRNA splicing assay protocols used by members of the ENIGMA (Evidence-Based Network for the Interpretation of Germline Mutant Alleles) consortium. We compared similarities and differences in results derived from analysis of a panel of breast cancer 1, early onset (BRCA1) and breast cancer 2, early onset (BRCA2) gene variants known to alter splicing (BRCA1: c.135-1G>T, c.591C>T, c.594-2A>C, c.671-2A>G, and c.5467+5G>C and BRCA2: c.426-12_8delGTTTT, c.7988A>T, c.8632+1G>A, and c.9501+3A>T). Differences in protocols were then assessed to determine which elements were critical in reliable assay design. PCR primer design strategies, PCR conditions, and product detection methods, combined with a prior knowledge of expected alternative transcripts, were the key factors for accurate splicing assay results. For example, because of the position of primers and PCR extension times, several isoforms associated with BRCA1, c.594-2A>C and c.671-2A>G, were not detected by many sites. Variation was most evident for the detection of low-abundance transcripts (e.g., BRCA2 c.8632+1G>A Δ19,20 and BRCA1 c.135-1G>T Δ5q and Δ3). Detection of low-abundance transcripts was sometimes addressed by using more analytically sensitive detection methods (e.g., BRCA2 c.426-12_8delGTTTT ins18bp). We provide recommendations for best practice and raise key issues to consider when designing mRNA assays for evaluation of unclassified sequence variants.

[Results of revision after failed surgical treatment for traumatic anterior shoulder instability].

Science.gov (United States)

Lópiz-Morales, Y; Alcobe-Bonilla, J; García-Fernández, C; Francés-Borrego, A; Otero-Fernández, R; Marco-Martínez, F

2013-01-01

Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques). Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Quality control of nuclear medicine instruments

International Nuclear Information System (INIS)

1984-11-01

This document, which gives detailed guidance on the quality control of the various electronic instruments used for radiation detection and measurement in nuclear medicine, stems from the work of two Advisory Groups convened by the International Atomic Energy Agency (IAEA). A preliminary document, including recommended test schedules but lacking actual protocols for the tests, was drawn up by the first of these groups, meeting at the IAEA Headquarters in Vienna in 1979. A revised and extended version, incorporating recommended test protocols, was prepared by the second Group, meeting likewise in Vienna in 1982. This version is the model for the present text. The document should be of value to all nuclear medicine units, and especially to those in developing countries, in the initiation or revision of schemes for the quality control of their instruments. Its recommendations have provided the basis for instruction in two IAEA regional technical co-operation projects in the subject field, one initiated in 1981 for countries of Latin America and one initiated in 1982 for countries of Asia and the Pacific

Revised nonstochastic health effects models

International Nuclear Information System (INIS)

Yaniv, S.S.; Scott, B.R.

1991-01-01

In 1989, the U.S. Nuclear Regulatory Commission (NRC) published a revision of the 1985 report, Health Effects Models for Nuclear Power Plant Accident Consequence Analysis, NUREG/CR-4214, that included models for early occurring and continuing nonstochastic effects, cancers and thyroid nodules, and genetic effects. This paper discusses specific models for lethality from early occurring and continuing effects. For brevity, hematopoietic-syndrome lethality is called hematopoietic death; pulmonary-syndrome lethality is called pulmonary death; and gastrointestinal syndrome lethality is called gastrointestinal death. Two-parameter Weibull risk functions are recommended for estimating the risk of hematopoietic, pulmonary, or gastrointestinal death. The risks are obtained indirectly by using hazard functions; as a result, this type of approach has been called hazard-function modeling and the models generated are called hazard-function models. In the 1989 NUREG/CR-4214 report, changes were made in the parameter values for a number of effects, and the models used to estimate hematopoietic and pulmonary deaths were substantially revised. Upper and lower estimates of model parameters are provided for all early health effects models. In this paper, we discuss the 1989 models for hematopoietic and pulmonary deaths, highlighting the differences between the 1989 and 1985 models. In addition, we give the reasons for which the 1985 models were modified

Evaluation of a new system for chest tomosynthesis: aspects of image quality of different protocols determined using an anthropomorphic phantom

Science.gov (United States)

Sundin, A; Aspelin, P; Båth, M; Nyrén, S

2015-01-01

Objective: To compare the image quality obtained with the different protocols in a new chest digital tomosynthesis (DTS) system. Methods: A chest phantom was imaged with chest X-ray equipment with DTS. 10 protocols were used, and for each protocol, nine acquisitions were performed. Four observers visually rated the quality of the reconstructed section images according to pre-defined quality criteria in four different classes. The data were analysed with visual grading characteristics (VGC) analysis, using the vendor-recommended protocol [12-s acquisition time, source-to-image distance (SID) 180 cm] as reference, and the area under the VGC curve (AUCVGC) was determined for each protocol and class of criteria. Results: Protocols with a smaller swing angle resulted in a lower image quality for the classes of criteria “disturbance” and “homogeneity in nodule” but a higher image quality for the class “structure”. The class “demarcation” showed little dependency on the swing angle. All protocols but one (6.3 s, SID 130 cm) obtained an AUCVGC significantly <0.5 (indicating lower quality than reference) for at least one class of criteria. Conclusion: The study indicates that the DTS protocol with 6.3 s yields image quality similar to that obtained with the vendor-recommended protocol (12 s) but with the clinically important advantage for patients with respiratory impairment of a shorter acquisition time. Advances in knowledge: The study demonstrates that the image quality may be strongly affected by the choice of protocol and that the vendor-recommended protocol may not be optimal. PMID:26118300

Sincalide - the final protocol

International Nuclear Information System (INIS)

Clarke, E.A.; Notghi, A.; Hesslewood, S.R.; Harding, L.K.

2002-01-01

Full text: HIDA biliary studies examine the gallbladder (GB) to give a percentage ejection fraction (EF). Porcine CCK was an accepted agent for stimulating the GB prior to being withdrawn in the UK from 1998. Sincalide (a synthetic CCK) was the suggested replacement. We have tried many administration regimes in an attempt to get results comparable with our established CCK protocols. Dose concentration and length of infusion times have been studied. Initially a dose of 10 ngm/kg/min given over 2 minutes (manufacturer's recommended dose) was used. This gave falsely low ejection fractions. The dose was reduced to 3 ngm/kg/min over 3 minutes as it was felt the higher dose may be causing constriction of the sphincter of Oddi. This gave a slight improvement with 22 % of patients having normal EF (>35 %). The length of infusion was extended to 15 minutes and the dose concentration reduced again to 0.6 ngm/kg/min. 62 % of patients had a normal EF. However, on many of the curves the gallbladder was still contracting on completion of the 15 minute infusion and began to refill immediately after stopping Sincalide. A further change of protocol was indicated. The infusion time was extended to 30 minutes and the dose concentration per minute kept the same. Imaging began at 30 minutes post HIDA injection and continued for a total of 50 minutes. Sincalide infusion began at 35 minutes if a GB was visualized. This protocol has been performed on 17 patients. 53 % of these had a normal result (comparable with a normal rate of 40 % previously established with CCK) with a mean EF of 60 %. The mean EF of patients with abnormal studies was 15 %. Curves showed a plateau by 30 minutes in 94 % of patients indicating that gallbladder contraction was complete. No normal range is available so results were compared with ultrasound (US). All patients who had an abnormal US scan also had abnormal HIDA results. Three patients had a normal US scan and abnormal HIDA study. These are currently

A revised Thai Multi-Dimensional Scale of Perceived Social Support.

Science.gov (United States)

Wongpakaran, Nahathai; Wongpakaran, Tinakon

2012-11-01

In order to ensure the construct validity of the three-factor model of the Multi-dimensional Scale of Perceived Social Support (MSPSS), and based on the assumption that it helps users differentiate between sources of social support, in this study a revised version was created and tested. The aim was to compare the level of model fit of the original version of the MSPSS against the revised version--which contains a minor change from the original. The study was conducted on 486 medical students who completed the original and revised versions of the MSPSS, as well as the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and Beck Depression Inventory II (Beck, Steer, & Brown, 1996). Confirmatory factor analysis was performed to compare the results, showing that the revised version of MSPSS demonstrated a good internal consistency--with a Cronbach's alpha of .92 for the MSPSS questionnaire, and a significant correlation with the other scales, as predicted. The revised version provided better internal consistency, increasing the Cronbach's alpha for the Significant Others sub-scale from 0.86 to 0.92. Confirmatory factor analysis revealed an acceptable model fit: chi2 128.11, df 51, p < .001; TLI 0.94; CFI 0.95; GFI 0.90; PNFI 0.71; AGFI 0.85; RMSEA 0.093 (0.073-0.113) and SRMR 0.042, which is better than the original version. The tendency of the new version was to display a better level of fit with a larger sample size. The limitations of the study are discussed, as well as recommendations for further study.

Impact of revised 10 CFR 20 on existing performance assessment computer codes used for LLW disposal facilities

International Nuclear Information System (INIS)

Leonard, P.R.; Seitz, R.R.

1992-04-01

The US Nuclear Regulatory Commission (NRC) recently announced a revision to Chapter 10 of the Code of Federal Regulations, Part 20 (10 CFR 20) ''Standards for Protection Against Radiation,'' which incorporates recommendations contained in Publications 26 and 30 of the International Commission on Radiological Protection (ICRP), issued in 1977 and 1979, respectively. The revision to 10 CFR 20 was also developed in parallel with Presidential Guidance on occupational radiation protection published in the Federal Register. Thus, this study concludes that the issuance of the revised 10 CFR 20 will not affect calculations using the computer codes considered in this report. In general, the computer codes and EPA and DOE guidance on which computer codes are based were developed in a manner consistent with the guidance provided in ICRP 26/30, well before the revision of 10 CFR 20

Validation of four automatic devices for self-measurement of blood pressure according to the international protocol of the European Society of Hypertension

Directory of Open Access Journals (Sweden)

Asmar R

2011-11-01

Full Text Available Jirar Topouchian1, Davide Agnoletti1, Jacques Blacher1, Ahmed Youssef1, Isabel Ibanez2,3, Jose Khabouth2, Salwa Khawaja2, Layale Beaino2, Roland Asmar1–31Centre de Diagnostic, Hôpital Hôtel-Dieu, Paris, France; 2Hôpital Libanais and Faculté Libanaise de Médecine, Beirut, Lebanon; 3Foundation-Medical Research Institutes, Geneva, SwitzerlandBackground: Four oscillometric devices for self-measurement of blood pressure (SBPM were evaluated according to the European Society of Hypertension (ESH international protocol and its 2010 revision in four separate studies. The Omron® M2, Omron M3, and Omron M6 measure blood pressure (BP at the brachial level, while the Omron R2 measures BP at the wrist level.Methods: The international protocol requires a total number of 33 subjects in which the validation is performed. The Omron M2 and Omron R2 were validated in 2009 according to the ESH international protocol, while the Omron M3 and Omron M6 were validated in 2010–2011 according to the 2010 ESH international protocol revision. The protocol procedures were followed precisely.Results: All four tested devices passed the validation process. The mean differences between the device and mercury readings were 2.7 ± 5.0 and –1.4 ± 3.2 mmHg for systolic and diastolic BP, respectively, using the Omron M2 device, and 1.7 ± 3.2 and –0.9 ± 2.6 mmHg using the Omron M3, 1.6 ± 2.9 and -0.9 ± 2.5 mmHg using the Omron M6, and –1.1 ± 4.8 and –0.9 ± 4.3 mmHg using the Omron R2.Conclusion: Readings from the Omron M2, Omron M3, Omron M6, and Omron R2, differing by less than 5, 10, and 15 mmHg, fulfill the ESH international protocol and its 2010 revision requirements. Therefore, each of these four devices can be used by patients for SBPM.Keywords: Omron R2, M2, M3, M6, blood pressure measurement, validation, international protocol, European Society of Hypertension

Assessment of the Portuguese building thermal code: Newly revised requirements for cooling energy needs used to prevent the overheating of buildings in the summer

International Nuclear Information System (INIS)

Oliveira Panao, Marta J.N.; Camelo, Susana M.L.; Goncalves, Helder J.P.

2011-01-01

In this paper, cooling energy needs are calculated by the steady-state methodology of the Portuguese building thermal code. After the first period of building code implementation, re-evaluation according to EN ISO 13790 is recommended in order to compare results with the dynamic simulation results. From these analyses, a newly revised methodology arises including a few corrections in procedure. This iterative result is sufficiently accurate to calculate the building's cooling energy needs. Secondly, results show that the required conditions are insufficient to prevent overheating. The use of the gain utilization factor as an overheating risk index is suggested, according to an adaptive comfort protocol, and is integrated in the method used to calculate the maximum value for cooling energy needs. This proposed streamlined method depends on reference values: window-to-floor area ratio, window shading g-value, integrated solar radiation and gain utilization factor, which leads to threshold values significantly below the ones currently used. These revised requirements are more restrictive and, therefore, will act to improve a building's thermal performance during summer. As a rule of thumb applied for Portuguese climates, the reference gain utilization factor should assume a minimum value of 0.8 for a latitude angle range of 40-41 o N, 0.6 for 38-39 o N and 0.5 for 37 o N. -- Highlights: → A newly revised methodology for Portuguese building thermal code. → The use of the gain utilization factor as an overheating risk index is suggested. → The proposed streamlined method depends on reference values. → Threshold maximum values are significantly below the ones currently used.

76 FR 60503 - Guidance for Industry on Target Animal Safety and Effectiveness Protocol Development and...

Science.gov (United States)

2011-09-29

... Safety and Effectiveness Protocol Development and Submission.'' The purpose of this document is to provide sponsors guidance in preparation of study protocols for review by the Center for Veterinary Medicine, Office of New Animal Drug Evaluation. The recommendations included in this guidance are intended...

Quantitative assessment of inter-clinician variability of target volume delineation for medulloblastoma: quality assurance for the SIOP PNET 4 trial protocol

International Nuclear Information System (INIS)

Coles, Charlotte E.; Hoole, Andrew C.F.; Harden, Susan V; Burnet, Neil G.; Twyman, Nicola; Taylor, Roger E.; Kortmann, Rolf D.; Williams, Michael V.

2003-01-01

Background and purpose: To assess inter-clinician variability amongst specialist paediatric radiation oncologists in delineating clinical target volumes for treating medulloblastoma as a quality assurance exercise prior to the introduction of the SIOP PNET 4 trial protocol of conformal radiotherapy to the posterior fossa and tumour bed. Patients and methods: Participants from 17 UK centres attended an educational meeting and then completed a clinical planning exercise to outline: (1) the whole posterior fossa and (2) the tumour bed. Quantitative analysis of the volumes, lengths, spatial positioning and axial planes for each individual was carried out and variation between individuals analysed. Results: Outlining of the posterior fossa was reasonably consistent, although most variation was seen in defining the superior border of the tentorium. A major difference was the decision whether or not to include the post-surgical meningocoele in the clinical target volume (CTV). The CTV for the tumour bed was under treated by all participants due to lack of inclusion of pre-operative tumour extent. Conclusions: This exercise demonstrated several ambiguities in the draft protocol and highlighted particular areas of inter-clinician variation. Consequently the protocol was revised and improved to take account of these findings. We recommend that planning exercises, in conjunction with education and training, should be implemented before the start of any new radiotherapy trial. In the future, the use of image transfer will allow prospective peer review of target volumes before treatment commences. These measures are essential to ensure that alterations in clinical practice are achieved in a uniform way

Impact of the Revised 10 CFR 835 on the Neutron Dose Rates at LLNL

International Nuclear Information System (INIS)

Radev, R.

2009-01-01

In June 2007, 10 CFR 835 (1) was revised to include new radiation weighting factors for neutrons, updated dosimetric models, and dose terms consistent with the newer ICRP recommendations. A significant aspect of the revised 10 CFR 835 is the adoption of the recommendations outlined in ICRP-60 (2). The recommended new quantities demand a review of much of the basic data used in protection against exposure to sources of ionizing radiation. The International Commission on Radiation Units and Measurements has defined a number of quantities for use in personnel and area monitoring (3,4,5) including the ambient dose equivalent H*(d) to be used for area monitoring and instrument calibrations. These quantities are used in ICRP-60 and ICRP-74. This report deals only with the changes in the ambient dose equivalent and ambient dose rate equivalent for neutrons as a result of the implementation of the revised 10 CFR 835. In the report, the terms neutron dose and neutron dose rate will be used for convenience for ambient neutron dose and ambient neutron dose rate unless otherwise stated. This report provides a qualitative and quantitative estimate of how much the neutron dose rates at LLNL will change with the implementation of the revised 10 CFR 835. Neutron spectra and dose rates from selected locations at the LLNL were measured with a high resolution spectroscopic neutron dose rate system (ROSPEC) as well as with a standard neutron rem meter (a.k.a., a remball). The spectra obtained at these locations compare well with the spectra from the Radiation Calibration Laboratory's (RCL) bare californium source that is currently used to calibrate neutron dose rate instruments. The measurements obtained from the high resolution neutron spectrometer and dose meter ROSPEC and the NRD dose meter compare within the range of ±25%. When the new radiation weighting factors are adopted with the implementation of the revised 10 CFR 835, the measured dose rates will increase by up to 22%. The

Beyond protocols

DEFF Research Database (Denmark)

Vanderhoeven, Sonia; Branquart, Etienne; Casaer, Jim

2017-01-01

Risk assessment tools for listing invasive alien species need to incorporate all available evidence and expertise. Beyond the wealth of protocols developed to date, we argue that the current way of performing risk analysis has several shortcomings. In particular, lack of data on ecological impact...... information on risk and the exploration of improved methods for decision making on biodiversity management. This is crucial for efficient conservation resource allocation and uptake by stakeholders and the public......., transparency and repeatability of assessments as well as the incorporation of uncertainty should all be explicitly considered. We recommend improved quality control of risk assessments through formalized peer review with clear feedback between assessors and reviewers. Alternatively, a consensus building...

A Novel Recommendation To AES Limitation

Directory of Open Access Journals (Sweden)

Falguni Patel

2017-07-01

Full Text Available Among all available conventional encryption algorithms the AES Advanced Encryption Standard is the most secured and highly used algorithm. AES algorithm is widely used by variety of applications like Archive and Compression tools File Encryption Encryption File System Disk Partition Encryption Networking Signal Protocol among others. This paper highlights the Brute Force attack and Cryptanalysis attack on AES Algorithm. This paper also discusses about a novel recommendation of a combination model of AES Algorithm and Random-X Cipher.

Recommended documentation for computer users at ANL. Revision 3

Energy Technology Data Exchange (ETDEWEB)

Heiberger, A.A.

1992-04-01

Recommended Documentation for Computer Users at ANL is for all users of the services available from the Argonne National Laboratory (ANL) Computing and Telecommunications Division (CTD). This document will guide you in selecting available documentation that will best fill your particular needs. Chapter 1 explains how to use this document to select documents and how to obtain them from the CTD Document Distribution Counter. Chapter 2 contains a table that categorizes available publications. Chapter 3 gives descriptions of the online DOCUMENT command for CMS, and VAX, and the Sun workstation. DOCUMENT allows you to scan for and order documentation that interests you. Chapter 4 lists publications by subject. Categories I and IX cover publications of a general nature and publications on telecommunications and networks respectively. Categories II, III, IV, V, VI, VII, VIII, and X cover publications on specific computer systems. Category XI covers publications on advanced scientific computing at Argonne. Chapter 5 contains abstracts for each publication, all arranged alphabetically. Chapter 6 describes additional publications containing bibliographies and master indexes that the user may find useful. The appendix identifies available computer systems, applications, languages, and libraries.

Predictors of unsuccessful outcome in cemented femoral revisions using bone impaction grafting; Cox regression analysis of 208 cases.

Science.gov (United States)

Te Stroet, Martijn A J; Rijnen, Wim H C; Gardeniers, Jean W M; Schreurs, B Willem; Hannink, Gerjon

2016-09-29

Despite improvements in the technique of femoral impaction bone grafting, reconstruction failures still can occur. Therefore, the aim of our study was to determine risk factors for the endpoint re-revision for any reason. We used prospectively collected demographic, clinical and surgical data of all 202 patients who underwent 208 femoral revisions using the X-change Femoral Revision System (Stryker-Howmedica), fresh-frozen morcellised allograft and a cemented polished Exeter stem in our department from 1991 to 2007. Univariable and multivariable Cox regression analyses were performed to identify potential factors associated with re-revision. The mean follow-up was 10.6 (5-21) years. The cumulative re-revision rate was 6.3% (13/208). After univariable selection, sex, age, body mass index (BMI), American Association of Anesthesiologists (ASA) classification, type of removed femoral component, and mesh used for reconstruction were included in multivariable regression analysis.In the multivariable analysis, BMI was the only factor that was significantly associated with the risk of re-revision after bone impaction grafting (BMI ≥30 vs. BMI <30, HR = 6.54 [95% CI 1.89-22.65]; p = 0.003). BMI was the only factor associated with the risk of re-revision for any reason. Besides BMI also other factors, such as Endoklinik score and the type of removed femoral component, can provide guidance in the process of preclinical decision making. With the knowledge obtained from this study, preoperative patient selection, informed consent, and treatment protocols can be better adjusted to the individual patient who needs to undergo a femoral revision with impaction bone grafting.

Protocol: methodology for chromatin immunoprecipitation (ChIP in Chlamydomonas reinhardtii

Directory of Open Access Journals (Sweden)

Strenkert Daniela

2011-11-01

Full Text Available Abstract We report on a detailed chromatin immunoprecipitation (ChIP protocol for the unicellular green alga Chlamydomonas reinhardtii. The protocol is suitable for the analysis of nucleosome occupancy, histone modifications and transcription factor binding sites at the level of mononucleosomes for targeted and genome-wide studies. We describe the optimization of conditions for crosslinking, chromatin fragmentation and antibody titer determination and provide recommendations and an example for the normalization of ChIP results as determined by real-time PCR.

Definition and recommendations for the convention on the prevention of marine pollution by dumping of wastes and other matter, 1972. 1986 ed.

International Nuclear Information System (INIS)

1986-01-01

Under the terms of the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter, the IAEA is the organization with the responsibility for defining high level radioactive wastes or other high level radioactive matter which is unsuitable for dumping at sea, and for making recommendations to Contracting Parties about the issue of permits for dumping radioactive waste or other radioactive matter. The IAEA established a provisional Definition and Recommendations in 1974 and a revised version in 1978. This Safety Series document contains the second revised Definition and Recommendations, which were established in 1985. The Annexes to the document contain a description of the calculations which form the basis of the quantitative Definition, a comparison between the new and the previous version and a list of all the meetings held during the process of establishing the new document

Recommended protocol for standardization in collecting and interpreting radiological environmental data

International Nuclear Information System (INIS)

Denham, D.H.; Kathren, R.L.

1989-02-01

Current reductions in ''allowable'' levels of radiation and radioactive materials in the environment and an increased public awareness of naturally occurring radioactive materials have reinforced the need for consistency in evaluating the radiological environment. A key concern is the identification and interpretation of environmental levels of radiation and radioactive materials resulting from nuclear facility operations. If these levels can be detected and their source(s) identified, then corrective actions can be taken to eliminate or greatly reduce the environmental impacts of the facility operations. In this paper we address the lack of definitive guidance necessary to determine incremental levels of significance (or insignificance), and we propose a series of protocols to achieve more consistent collection and interpretation of radiological environmental data. 8 refs

Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

Science.gov (United States)

Fink, Bernd; Schlumberger, Michael; Oremek, Damian

2017-08-01

The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before. (1) What proportion of patients treated with single-stage acetabular reconstruction as part of a two-stage revision for an infected THA remain free from infection at 2 or more years? (2) What are the Harris hip scores after the first stage and at 2 years or more after the definitive reimplantation? Between June 2009 and June 2014, we treated all patients undergoing surgical treatment for an infected THA using a single-stage acetabular revision as part of a two-stage THA exchange if the acetabular defect classification was Paprosky Types 2B, 2C, 3A, 3B, or pelvic discontinuity and a two-stage procedure was preferred for the femur. The procedure included removal of all components, joint débridement, definitive acetabular reconstruction (with a cage to bridge the defect, and a cemented socket), and a temporary cemented femoral component at the first stage; the second stage consisted of repeat joint and femoral débridement and exchange of the femoral component to a cementless device. During the period noted, 35 patients met those definitions and were treated with this approach. No patients were lost to followup before 2 years; mean followup was 42 months (range, 24-84 months). The clinical evaluation was performed with the Harris hip scores and resolution of infection was assessed by the absence of clinical signs of infection and a C-reactive protein level less than 10 mg/L. All

A Review of the New European Technical Recommendations for Monitoring Individuals Occupationally Exposed to External Radiation

International Nuclear Information System (INIS)

Dijk, J.W.E. van; Alves, J.G.; Ambrosi, P.; Bartlett, D.T.; Currivan, L.; Fantuzzi, E.; Kamenopoulou, V.

2013-01-01

This paper reviews the revised Technical Recommendations for Monitoring Individuals Occupationally Exposed to External Radiation as issued by the European Commission as Radiation Protection 160. These recommendations are aimed at all stakeholders in radiation protection dosimetry with an emphasis in the responsible technical staff of approved dosimetry services. This paper briefly touches each Chapter and ends with a more in depth section on the uncertainty evaluation of dose measurements. -- Highlights: ► Recommendations on all aspects of running an approved dosimetry service. ► Radiation protection framework. ► Metrology of personal dosimeters. ► QC and QA of individual monitoring

Treatment with Ca-DTPA of internal contaminations by plutonium and americium: Recommendations for writing protocols in Cea and AREVA centers; Traitement par le Ca-DTPA des contaminations internes par le plutonium et l'americium: recommandations pour la redaction de protocoles dans les centres CEA et AREVA

Energy Technology Data Exchange (ETDEWEB)

Grappin, L. [CEA Cadarache, DEN, Service de Sante au Travail, 13 - Saint-Paul-lez-Durance (France); Legoff, J.P.; Andre, F. [CEA Valduc, Service de Sante au Travail, 21 - Is-sur-Tille (France); Carbone, L.; Agrinier, A.L. [CEA Marcoule, DEN, Service de Sante au Travail, 30 (France); Courtay, C.; Aninat, M. [AREVA, Service de Sante au Travail, La Hague, 50 - Beaumont-Hague (France); Amabile, J.C. [SPRA, HIA Percy, 92 - Clamart (France); Florin, A. [CEA Saclay, SDM Service de Sante au Travail, 91 - Gif-sur-Yvette (France)

2009-10-15

The purpose of this document is to provide physicians working in a B.N.F. (Basic Nuclear Facility) with recommendations for the drafting of Ca-DTPA treatment protocols for internal contamination by actinides. These recommendations are based on the results of injections carried out by Cea and AREVA doctors in a working group, with the collaboration of the Army Radiation Protection Service. The study focused on Ca-DTPA IV injection. Other dosage forms, routes of administration as well as adjuvant treatments are also mentioned. For cases of contaminated wounds and inhalation, indicators for treatment with Ca-DTPA, particularly its initialization, the dosage, duration, frequency of administration, the criteria for ending the treatment, then its efficiency and dosimetry gain are covered. A guide for the prescription of the radio toxicological monitoring necessary for the treatment and the dosimetric evaluation is proposed. (authors)

Lack of validation of the Dixtal (DX 2020) upper arm blood pressure monitor, in oscillometric mode, for clinical use in an intensive care unit, according to the European Society of Hypertension-International Protocol revision 2010.

Science.gov (United States)

Gothardo, Ana C L O; Savioli, Amanda F; Santos, Dayanna S; Lamas, José L T

2013-08-01

The aim of the study was to evaluate the accuracy of the oscillometric blood pressure section in the DX 2020 Dixtal multiparametric monitor in adults according to the European Society of Hypertension-International Protocol as revised in 2010 (ESH-IP 2010). The blood pressure was sequentially verified in 33 individuals admitted to an adult ICU (18 men, mean age 44 years) with a mercury column sphygmomanometer (two observers) and the DX 2020 test device (one supervisor). Ninety-nine pairs of differences were obtained. Data analysis followed the ESH-IP 2010 requirements. In the first requirement, the DX 2020 device failed in the validation study in the 5, 10, and 15 mmHg ranges. From the 99 pairs of differences, only 43/73, 69/87, and 81/96 were obtained for systolic blood pressure and 29/65, 56/81, and 71/93 were obtained for diastolic blood pressure. In the second requirement, at least 24 individuals should have, from their comparisons, two under 0-5 mmHg ranges, which was observed only with 16 individuals in the systolic and nine in the diastolic range. Moreover, at maximum, only three readings could have differences of more than 5 mmHg, and this was observed in 10 individuals in the systolic range and 17 individuals in the diastolic range. The DX 2020 automatic multiparametric monitor for blood pressure measurement has not been recommended for clinical use according to the ESH-IP 2010. It is important to highlight that this work refers only to a blood pressure measurement module and that the same conclusion cannot be drawn for its other functions.

Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.

Science.gov (United States)

Lichtenstein, Alice H; Appel, Lawrence J; Brands, Michael; Carnethon, Mercedes; Daniels, Stephen; Franch, Harold A; Franklin, Barry; Kris-Etherton, Penny; Harris, William S; Howard, Barbara; Karanja, Njeri; Lefevre, Michael; Rudel, Lawrence; Sacks, Frank; Van Horn, Linda; Winston, Mary; Wylie-Rosett, Judith

2006-07-04

Improving diet and lifestyle is a critical component of the American Heart Association's strategy for cardiovascular disease risk reduction in the general population. This document presents recommendations designed to meet this objective. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, Americans can substantially reduce their risk of developing cardiovascular disease, which remains the leading cause of morbidity and mortality in the United States.

Validation of the Andon KD595 for clinical use and self-measurement according to the European Society of Hypertension International Protocol.

Science.gov (United States)

Wu, Ning; Zhang, Xuezhong; Wang, Wen; Zhang, Hongye

2016-04-01

This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor Andon KD595 for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were sequentially measured in 33 participants using the standard mercury sphygmomanometer and the Andon KD595 device. Ninety-nine pairs of comparisons were obtained from 33 participants for analysis. The KD595 device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and the observers within a range of 5, 10, and 15 mmHg was 72/99, 93/99, and 96/99, respectively, for SBP and 72/99, 96/99, and 99/99, respectively, for DBP. The device also achieved the targets in part 2 of the validation study. A total of 28 and 25 participants had at least two of the three device-observer differences within 5 mmHg (required≥24) for SBP and DBP, respectively. The number of participants without device-observer difference within 5 mmHg was two for SBP and two for DBP (required≤3). The Andon upper arm blood pressure monitor KD595 has passed the International Protocol requirements and it can be recommended for clinical use and self-measurement in adults.

Validation of the Andon KD5031 for clinical use and self-measurement according to the European Society of Hypertension International Protocol.

Science.gov (United States)

Wu, Ning; Zhang, Xuezhong; Wang, Wen; Zhang, Hongye

2016-10-01

This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure (BP) monitor Andon KD5031 for home BP monitoring according to the European Society of Hypertension International Protocol revision 2010. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were sequentially measured in 33 participants using the standard mercury sphygmomanometer and the Andon KD5031 device. Ninety-nine pairs of comparisons were obtained from 33 participants for analysis. The KD5031 device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and the observers within a range of 5, 10, and 15 mmHg was 66/99, 93/99, and 98/99, respectively, for SBP and 72/99, 94/99, and 99/99, respectively, for DBP. The device also achieved the targets in part 2 of the validation study. Twenty-six participants for both SBP and DBP had at least two of the three device-observer differences within 5 mmHg (required ≥24). The number of participants without a device-observer difference within 5 mmHg was one for SBP and three for DBP (required ≤3). The Andon upper arm BP monitor KD5031 has passed the International Protocol requirements, and it can be recommended for clinical use and self-measurement in adults.

Revised radiation emergency procedures at Pakistan research reactor PINSTECH

International Nuclear Information System (INIS)

Orfi, S.D.; Javed, M.; Ahmad, S.; Akhtar, K.M.; Mubarak, M.A.

1984-12-01

Necessary procedures have been laid down in this report to meet the radiation emergency at Pakistan Research Reactor PINSTECH. The Nuclear Safety Committee PINSTECH (NSCP) had also recommended a number of improvements in the existing procedures. Revision of the procedures was also considered necessary to incorporate into it new radiation units/limits and new emergency equipment available. Radiation emergency preparedness programme is of continuous nature. Latest developments else-where and local experience contribute to the improvement of the existing arrangements under this programme. (A.B.)

Glass Composition Constraint Recommendations for Use in Life-Cycle Mission Modeling

Energy Technology Data Exchange (ETDEWEB)

McCloy, John S.; Vienna, John D.

2010-05-03

The component concentration limits that most influence the predicted Hanford life-cycle HLW glass volume by HTWOS were re-evaluated. It was assumed that additional research and development work in glass formulation and melter testing would be performed to improve the understanding of component effects on the processability and product quality of these HLW glasses. Recommendations were made to better estimate the potential component concentration limits that could be applied today while technology development is underway to best estimate the volume of HLW glass that will eventually be produced at Hanford. The limits for concentrations of P2O5, Bi2O3, and SO3 were evaluated along with the constraint used to avoid nepheline formation in glass. Recommended concentration limits were made based on the current HLW glass property models being used by HTWOS (Vienna et al. 2009). These revised limits are: 1) The current ND should be augmented by the OB limit of OB ≤ 0.575 so that either the normalized silica (NSi) is less that the 62% limit or the OB is below the 0.575 limit. 2) The mass fraction of P2O5 limit should be revised to allow for up to 4.5 wt%, depending on CaO concentrations. 3) A Bi2O3 concentration limit of 7 wt% should be used. 4) The salt accumulation limit of 0.5 wt% SO3 may be increased to 0.6 wt%. Again, these revised limits do not obviate the need for further testing, but make it possible to more accurately predict the impact of that testing on ultimate HLW glass volumes.

Blockchain protocols in clinical trials: Transparency and traceability of consent [version 3; referees: 1 approved, 2 approved with reservations, 1 not approved

Directory of Open Access Journals (Sweden)

Mehdi Benchoufi

2017-07-01

Full Text Available Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing the collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we will built a consent workflow using a rising technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain; thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each revision of the protocol, consent was sought again. We obtained a single document, in a standard open format, that accounted for the whole consent collection process: timestamped consent status with regards to each version of the protocol. This document cannot be corrupted, and can be checked on any dedicated public website. It should be considered as a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened in order to remove the need for third parties, here the trial stakeholders, and give participative control to the peer-to-peer users. In the future, we think that the complex data flow of a clinical trial can be tracked using Blockchain, that a blockchain core functionality, named Smart Contract, could help prevent clinical trial events not to happen in the right chronological order: for example including patients before they consented or analysing case report forms data before freezing the database

Recommended Practices for the Safe Design and Operation of Flywheels

Energy Technology Data Exchange (ETDEWEB)

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

2015-12-01

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

76 FR 40660 - Revisions to the California State Implementation Plan, San Joaquin Valley Air Pollution Control...

Science.gov (United States)

2011-07-11

... Report 05/20/10 04/05/11 and Recommendations on Agricultural Burning. On May 6, 2011, EPA determined that... disease, decreased lung function, visibility impairment, and damage to vegetation and ecosystems. Section... open burning of agricultural waste and other materials. Rule 4103 was revised largely to implement...

Open pneumothorax: the spectrum and outcome of management based on Advanced Trauma Life Support recommendations.

Science.gov (United States)

Kong, V Y; Liu, M; Sartorius, B; Clarke, D L

2015-08-01

The current management of open pneumothorax (OPTX) is based on Advanced Trauma Life Support (ATLS) recommendations and consists of the application of a three-way occlusive dressing, followed by intercostal chest drain insertion. Very little is known regarding the spectrum and outcome of this approach, especially in the civilian setting. We conducted a retrospective review of 58 consecutive patients with OPTX over a four-year period managed in a high volume metropolitan trauma service in South Africa. Of the 58 patients included, 95% (55/58) were male, and the mean age for all patients was 21 years. Ninety-seven percent of all injuries were inflicted by knives and the remaining 3% (2/58) of injuries were inflicted by unknown weapons. 59% of injuries were left sided. In six patients (10%) a protocol violation was present in their management. Five of the six patients (83%) in whom protocol violation occurred developed a life-threatening event (tension PTX) compared to none amongst those where the protocol was followed (p < 0.001). There was no mortality as a direct result of management of OPTX following ATLS recommendations. ATLS recommendations for OPTX are safe and effective. Any deviation from this standard practice is associated with avoidable morbidity and potential mortality.

Nursing Music Protocol and Postoperative Pain.

Science.gov (United States)

Poulsen, Michael J; Coto, Jeffrey

2018-04-01

Pain has always been a major concern for patients and nurses during the postoperative period. Therapies, medicines, and protocols have been developed to improve pain and anxiety but have undesirable risks to the patient. Complementary and alternative medicine therapies have been studied but have not been applied as regular protocols in the hospital setting. Music is one type of complementary and alternative medicine therapy that has been reported to have favorable results on reducing postoperative pain, anxiety, and opioid usage. However, music lacks a protocol that nurses can implement during the perioperative process. This paper is an in-depth literature review assessing a best practice recommendation and protocol that establishes a consensus in the use of music therapy. The results suggest that music therapy may consist of calming, soft tones of 60-80 beats per minute for at least 15-30 minutes at least twice daily during the pre- and postoperative periods. It is suggested that music only be used in conjunction with standards of care and not as the primary intervention of pain or anxiety. This evidence suggests that proper use of music therapy can significantly reduce surgical pain. Implementing these protocols and allowing the freedom of nursing staff to use them may lead to greater reductions in surgical pain and anxiety and a reduction in opioid use. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

High School Students' Recommendations to Improve School Food Environments: Insights From a Critical Stakeholder Group.

Science.gov (United States)

Asada, Yuka; Hughes, Alejandro G; Read, Margaret; Schwartz, Marlene B; Chriqui, Jamie F

2017-11-01

The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) directed the US Department of Agriculture (USDA) to revise school meal standards. Students are most affected by efforts to improve the school food environment; yet, few studies directly include students. This study examined high school students' experiences of school meal reform to gain insight into implementation recommendations. We conducted 5 focus groups with high school students (N = 15) from high schools across 9 states. We also conducted follow-up interviews to further explore personal experiences. Focus groups and interview transcripts were coded and organized in Atlas.ti v7 by analysts, following principles of constant comparative analysis. Students reported overall positive perceptions of the revised school meal standards and supported continued efforts to improve the food environment. Recommendations to improve the food environment included engaging students, focusing on the quality and palatability of meal items, moving toward scratch-cooking, and addressing cafeteria infrastructure. Students' recommendations point to opportunities where school districts, as well as local, state, and federal organizations can work to improve the school food environment. Their insights are directly relevant to USDA's recently released Local School Wellness Policy final rule, of which school meal standards are one provision. © 2017, American School Health Association.

DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

Science.gov (United States)

Hasin, Deborah S.; O’Brien, Charles P.; Auriacombe, Marc; Borges, Guilherme; Bucholz, Kathleen; Budney, Alan; Compton, Wilson M.; Crowley, Thomas; Ling, Walter; Petry, Nancy M.; Schuckit, Marc; Grant, Bridget F.

2013-01-01

Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions. This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available. PMID:23903334

DSM-5 criteria for substance use disorders: recommendations and rationale.

Science.gov (United States)

Hasin, Deborah S; O'Brien, Charles P; Auriacombe, Marc; Borges, Guilherme; Bucholz, Kathleen; Budney, Alan; Compton, Wilson M; Crowley, Thomas; Ling, Walter; Petry, Nancy M; Schuckit, Marc; Grant, Bridget F

2013-08-01

Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available.

Control room envelope unfiltered air inleakage test protocols

International Nuclear Information System (INIS)

Lagus, P.L.; Grot, R.A.

1997-01-01

In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs

Control room envelope unfiltered air inleakage test protocols

Energy Technology Data Exchange (ETDEWEB)

Lagus, P.L. [Lagus Applied Technology, San Diego, CA (United States); Grot, R.A. [Lagus Applied Technology, Olney, MD (United States)

1997-08-01

In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs.

Pregnancy outcome of “delayed start” GnRH antagonist protocol versus GnRH antagonist protocol in poor responders: A clinical trial study

Directory of Open Access Journals (Sweden)

Abbas Aflatoonian

2017-08-01

Full Text Available Background: Management of poor-responding patients is still major challenge in assisted reproductive techniques (ART. Delayed-start GnRH antagonist protocol is recommended to these patients, but little is known in this regards. Objective: The goal of this study was assessment of delayed-start GnRH antagonist protocol in poor responders, and in vitro fertilization (IVF outcomes. Materials and Methods: This randomized clinical trial included sixty infertile women with Bologna criteria for ovarian poor responders who were candidate for IVF. In case group (n=30, delayed-start GnRH antagonist protocol administered estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation with gonadotropin. Control group (n=30 treated with estrogen priming antagonist protocol. Finally, endometrial thickness, the rates of oocytes maturation, , embryo formation, and pregnancy were compared between two groups. Results: Rates of implantation, chemical, clinical, and ongoing pregnancy in delayed-start cycles were higher although was not statistically significant. Endometrial thickness was significantly higher in case group. There were no statistically significant differences in the rates of oocyte maturation, embryo formation, and IVF outcomes between two groups. Conclusion: There is no significant difference between delayed-start GnRH antagonist protocol versus GnRH antagonist protocol.

Can arthroscopic revision surgery for shoulder instability be a fair option?

Science.gov (United States)

De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

2014-04-01

the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery.

International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol.

Science.gov (United States)

Rusbridge, Clare; Long, Sam; Jovanovik, Jelena; Milne, Marjorie; Berendt, Mette; Bhatti, Sofie F M; De Risio, Luisa; Farqhuar, Robyn G; Fischer, Andrea; Matiasek, Kaspar; Muñana, Karen; Patterson, Edward E; Pakozdy, Akos; Penderis, Jacques; Platt, Simon; Podell, Michael; Potschka, Heidrun; Stein, Veronika M; Tipold, Andrea; Volk, Holger A

2015-08-28

Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic epilepsy in humans, for example some focal cortical dysplasias, which may only apparent with special sequences, imaging planes and/or particular techniques used in performing the MRI scan. As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners. Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies. A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.

Revised uranium--plutonium cycle PWR and BWR models for the ORIGEN computer code

International Nuclear Information System (INIS)

Croff, A.G.; Bjerke, M.A.; Morrison, G.W.; Petrie, L.M.

1978-09-01

Reactor physics calculations and literature searches have been conducted, leading to the creation of revised enriched-uranium and enriched-uranium/mixed-oxide-fueled PWR and BWR reactor models for the ORIGEN computer code. These ORIGEN reactor models are based on cross sections that have been taken directly from the reactor physics codes and eliminate the need to make adjustments in uncorrected cross sections in order to obtain correct depletion results. Revised values of the ORIGEN flux parameters THERM, RES, and FAST were calculated along with new parameters related to the activation of fuel-assembly structural materials not located in the active fuel zone. Recommended fuel and structural material masses and compositions are presented. A summary of the new ORIGEN reactor models is given

Improvement of burn pain management through routine pain monitoring and pain management protocol.

Science.gov (United States)

Yang, Hyeong Tae; Hur, Giyeun; Kwak, In-Suk; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook

2013-06-01

Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n=58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n=49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS). The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8±2.0 versus 3.9±1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8±2.8 versus 3.7±2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance. Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

OARSI Clinical Trials Recommendations: Hand imaging in clinical trials in osteoarthritis.

Science.gov (United States)

Hunter, D J; Arden, N; Cicuttini, F; Crema, M D; Dardzinski, B; Duryea, J; Guermazi, A; Haugen, I K; Kloppenburg, M; Maheu, E; Miller, C G; Martel-Pelletier, J; Ochoa-Albíztegui, R E; Pelletier, J-P; Peterfy, C; Roemer, F; Gold, G E

2015-05-01

Tremendous advances have occurred in our understanding of the pathogenesis of hand osteoarthritis (OA) and these are beginning to be applied to trials targeted at modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply hand imaging assessments in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Revising and editing for translators

CERN Document Server

Mossop, Brian

2014-01-01

Revising and Editing for Translators provides guidance and learning materials for translation students learning to edit texts written by others, and professional translators wishing to improve their self-revision ability or learning to revise the work of others. Editing is understood as making corrections and improvements to texts, with particular attention to tailoring them to the given readership. Revising is this same task applied to draft translations. The linguistic work of editors and revisers is related to the professional situations in which they work. Mossop offers in-depth coverage of a wide range of topics, including copyediting, style editing, structural editing, checking for consistency, revising procedures and principles, and translation quality assessment. This third edition provides extended coverage of computer aids for revisers, and of the different degrees of revision suited to different texts. The inclusion of suggested activities and exercises, numerous real-world examples, a proposed gra...

Recommendations regarding splenectomy in hereditary hemolytic anemias

Science.gov (United States)

Iolascon, Achille; Andolfo, Immacolata; Barcellini, Wilma; Corcione, Francesco; Garçon, Loïc; De Franceschi, Lucia; Pignata, Claudio; Graziadei, Giovanna; Pospisilova, Dagmar; Rees, David C.; de Montalembert, Mariane; Rivella, Stefano; Gambale, Antonella; Russo, Roberta; Ribeiro, Leticia; Vives-Corrons, Jules; Martinez, Patricia Aguilar; Kattamis, Antonis; Gulbis, Beatrice; Cappellini, Maria Domenica; Roberts, Irene; Tamary, Hannah

2017-01-01

Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children. PMID:28550188

Procedures in external radiation therapy dosimetry with electron and photon beams with maximum energies between 1 and 50 MeV

International Nuclear Information System (INIS)

1980-01-01

The International Commission on Radiation Units and Measurements (ICRU) has published general recommendations on dosimetry procedures for photons (ICRU 1969) and for electrons (ICRU 1972). These should preferably be supplemented by national or regional suggestions covering practical details of routine dosimetry procedures and taking into account the particular requirements and provisions of the country and region. Local recommendations have been prepared for the United Kingdom, the USA, West Germany and the Nordic countries. The present report contains a revised Nordic protocol. Several reasons have motivated this revision. After publication of the first protocol several reports have been published giving new data on various effects which can change the factors used with ionization chamber dosimetry. The SI-units for the radiologic quantities should be applied. Another important reason is that the former Nordic recommendations were mainly based on investigations with betatrons, while within the Nordic countries now several other kinds of accelerators are used (standing wave and travelling wave linear accelerators and microtrons) with usually different properties, which have to be considered. Improved concepts for stating beam quality and beam uniformity etc are therefore introduced in the present report. (Auth.)

New recommendations from the International Commission on Radiological Protection-a review

International Nuclear Information System (INIS)

Wrixon, A D

2008-01-01

For almost half a century, the International Commission on Radiological Protection (ICRP) has revised its recommendations on radiological protection with an average frequency of about 10 years, building on the experience gained in their implementation. This has ensured that the recommendations remain up to date and fit for purpose and it is this that has led in turn to their wide acceptance internationally. Indeed, the 1990 version of the recommendations forms the basis of the international radiological protection standards and the systems of control of exposure to ionizing radiation in many countries throughout the world. This version introduced new concepts and a more holistic approach to radiological protection but marrying the different exposure situations into one coherent framework has proved not to be straightforward and further reflection seemed necessary in order to satisfy both those who are responsible for the development of the control systems as well as a broader audience. Review of the 1990 recommendations started around 1998 and, since then, many ideas have been explored and avenues followed. Eventually, new recommendations were agreed by the Commission at its meeting in Essen in March 2007. This paper provides a review of these new recommendations and their possible implications. (topical review)

Discussion on Implementation of ICRP Recommendations Concerning Reference Levels and Optimisation

International Nuclear Information System (INIS)

2013-02-01

national plans. The International Atomic Energy Agency (IAEA) has adopted the ICRP recommendations into its revised Basic Safety Standards (BSSs). In practice, the full implementation will take some time. The EGIRES undertook this work to produce a report that would hopefully contribute to the common understanding of these important concepts and that would therefore assist in the use of reference levels and optimisation in the development of protection strategies in national plans. This report provides emergency management authorities in the NEA's member countries with clear and concise information and recommendations on key issues, possible approaches, and a summary of experience for implementing the new ICRP recommendations and revised BSSs for emergency exposure situations and for resultant existing exposure situations. (authors)

Extraction of microplastic from biota: recommended acidic digestion destroys common plastic polymers

DEFF Research Database (Denmark)

Enders, Kristina; Lenz, Robin; Beer, Sabrina

2017-01-01

particles of various polymer types. In the present study we report that a digestion protocol recently recommended by ICES using nitric and perchloric acid has strong detrimental effects on several common plastic polymers, in particular polyamide and polyurethane and to a lesser degree acrylonitrile...

Revised ultraviolet absorption cross sections of H2CO for the HITRAN database

International Nuclear Information System (INIS)

Chance, K.; Orphal, J.

2011-01-01

A revised set of temperature-dependent absorption cross sections for ultraviolet (UV) measurements of formaldehyde (H 2 CO) has been derived from two existing sets of laboratory cross sections, one using a Fourier transform spectrometer (FTS), and one using a grating instrument. This is conducted to satisfy the recommendation of the HITRAN Advisory Committee to provide a dataset with the spectral resolution and wavelength calibration of Fourier transform spectrometer measurements with the better intensity calibration that the grating measurements obtained. The re-scaled cross sections are now in the HITRAN database, and are recommended for use in atmospheric measurements and modeling, including photolysis calculations.

Loosening After Acetabular Revision

DEFF Research Database (Denmark)

Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.

2014-01-01

The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years...

Patient-reported outcome (PRO assessment in clinical trials: a systematic review of guidance for trial protocol writers.

Directory of Open Access Journals (Sweden)

Melanie Calvert

Full Text Available Evidence suggests there are inconsistencies in patient-reported outcome (PRO assessment and reporting in clinical trials, which may limit the use of these data to inform patient care. For trials with a PRO endpoint, routine inclusion of key PRO information in the protocol may help improve trial conduct and the reporting and appraisal of PRO results; however, it is currently unclear exactly what PRO-specific information should be included. The aim of this review was to summarize the current PRO-specific guidance for clinical trial protocol developers.We searched the MEDLINE, EMBASE, CINHAL and Cochrane Library databases (inception to February 2013 for PRO-specific guidance regarding trial protocol development. Further guidance documents were identified via Google, Google scholar, requests to members of the UK Clinical Research Collaboration registered clinical trials units and international experts. Two independent investigators undertook title/abstract screening, full text review and data extraction, with a third involved in the event of disagreement. 21,175 citations were screened and 54 met the inclusion criteria. Guidance documents were difficult to access: electronic database searches identified just 8 documents, with the remaining 46 sourced elsewhere (5 from citation tracking, 27 from hand searching, 7 from the grey literature review and 7 from experts. 162 unique PRO-specific protocol recommendations were extracted from included documents. A further 10 PRO recommendations were identified relating to supporting trial documentation. Only 5/162 (3% recommendations appeared in ≥50% of guidance documents reviewed, indicating a lack of consistency.PRO-specific protocol guidelines were difficult to access, lacked consistency and may be challenging to implement in practice. There is a need to develop easily accessible consensus-driven PRO protocol guidance. Guidance should be aimed at ensuring key PRO information is routinely included in

Implication of new CEC recommendations for individual monitoring for external radiation doses to the skin and the extremities

DEFF Research Database (Denmark)

Christensen, P.; Julius, H.W.; Marshall, T.O.

1991-01-01

A drafting group consisting of the above authors has assisted the CEC in revising the CEC document Technical Recommendations for Monitoring the Exposure to Individuals to External Radiation, EUR 5287, published in 1975. The paper highlights sections of the revised version relating particularly...... to irradiation of the skin and the extremities and focusses on problems connected to exposure to weakly penetrating radiations. Concepts of individual monitoring for external radiation exposures to the skin of the whole body and to the extremities are discussed and guidance is given as regards dose quantities...

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation.

Science.gov (United States)

Camacho, Jhon; Medina Ch, Ana María; Landis-Lewis, Zach; Douglas, Gerald; Boyce, Richard

2018-04-13

The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. Our study will further the understanding of the role of mobile decision support systems in the implementation

Guidelines and format for preparation and submission of declarations pursuant to Articles 2 and 3 of the Model Protocol Additional to Safeguards Agreements

International Nuclear Information System (INIS)

2005-01-01

The information to be provided to the International Atomic Energy Agency (hereinafter referred to as 'the Agency') by States under an additional protocol (INFCIRC/540) is identified in Article 2. The timing with which the information is to be provided is specified in Article 3. It was widely recognized during the negotiation of the additional protocol that States and the Agency would need explanation and guidance, regarding the information to be declared, beyond that possible to incorporate in the language of the protocol itself. The Board of Governors, meeting in special session on 15 May 1997 to approve the additional protocol, was assured that such guidance would be quickly available to States. The initial Additional Protocol Reporting Guidelines, drawing from Programme 93+2 documentation and the negotiating record of Committee 24, were published in August 1997. A simplified set of Guidelines was subsequently produced for States whose safeguards agreement includes a small quantities protocol. The Guidelines serve two purposes. First, they provide specificity as to what information is required and at what level of detail. Second, the Guidelines provide a consistent reporting format. The Guidelines have been supplemented with Agency developed software, the PROTOCOL REPORTER, which simplifies the process through which States can prepare and submit their declarations electronically. There is no legal requirement that States follow the Guidelines in preparing and submitting their Article 2 declarations. However, if States submit declarations prepared according to these Guidelines, it will reduce greatly the Agency's workload in processing, reviewing and storing the information provided. With minor exceptions, all States that have submitted declarations prior to 2004 have followed the Guidelines. The process of improving the Guidelines, based on the cumulative experience of States and the Agency, began in mid-2002. The process involved the development of a detailed

Guidelines and format for preparation and submission of declarations pursuant to Articles 2 and 3 of the Model Protocol Additional to Safeguards Agreements

International Nuclear Information System (INIS)

2004-01-01

The information to be provided to the International Atomic Energy Agency (hereinafter referred to as 'the Agency') by States under an additional protocol (INFCIRC/540) is identified in Article 2. The timing with which the information is to be provided is specified in Article 3. It was widely recognized during the negotiation of the additional protocol that States and the Agency would need explanation and guidance, regarding the information to be declared, beyond that possible to incorporate in the language of the protocol itself. The Board of Governors, meeting in special session on 15 May 1997 to approve the additional protocol, was assured that such guidance would be quickly available to States. The initial Additional Protocol Reporting Guidelines, drawing from Programme 93+2 documentation and the negotiating record of Committee 24, were published in August 1997. A simplified set of Guidelines was subsequently produced for States whose safeguards agreement includes a small quantities protocol. The Guidelines serve two purposes. First, they provide specificity as to what information is required and at what level of detail. Second, the Guidelines provide a consistent reporting format. The Guidelines have been supplemented with Agency developed software, the PROTOCOL REPORTER, which simplifies the process through which States can prepare and submit their declarations electronically. There is no legal requirement that States follow the Guidelines in preparing and submitting their Article 2 declarations. However, if States submit declarations prepared according to these Guidelines, it will reduce greatly the Agency's workload in processing, reviewing and storing the information provided. With minor exceptions, all States that have submitted declarations prior to 2004 have followed the Guidelines. The process of improving the Guidelines, based on the cumulative experience of States and the Agency, began in mid-2002. The process involved the development of a detailed

Generating Private Recommendations Efficiently Using Homomorphic Encryption and Data Packing

DEFF Research Database (Denmark)

Erkin, Zekeriya; Veugen, Thijs; Toft, Tomas

2012-01-01

Recommender systems have become an important tool for personalization of online services. Generating recommendations in online services depends on privacy-sensitive data collected from the users. Traditional data protection mechanisms focus on access control and secure transmission, which provide...... them under encryption to generate recommendations. By introducing a semitrusted third party and using data packing, we construct a highly efficient system that does not require the active participation of the user. We also present a comparison protocol, which is the first one to the best of our...... security only against malicious third parties, but not the service provider. This creates a serious privacy risk for the users. In this paper, we aim to protect the private data against the service provider while preserving the functionality of the system. We propose encrypting private data and processing...

Performance Analysis of On-Demand Routing Protocols in Wireless Mesh Networks

Directory of Open Access Journals (Sweden)

Arafatur RAHMAN

2009-01-01

Full Text Available Wireless Mesh Networks (WMNs have recently gained a lot of popularity due to their rapid deployment and instant communication capabilities. WMNs are dynamically self-organizing, self-configuring and self-healing with the nodes in the network automatically establishing an adiej hoc network and preserving the mesh connectivity. Designing a routing protocol for WMNs requires several aspects to consider, such as wireless networks, fixed applications, mobile applications, scalability, better performance metrics, efficient routing within infrastructure, load balancing, throughput enhancement, interference, robustness etc. To support communication, various routing protocols are designed for various networks (e.g. ad hoc, sensor, wired etc.. However, all these protocols are not suitable for WMNs, because of the architectural differences among the networks. In this paper, a detailed simulation based performance study and analysis is performed on the reactive routing protocols to verify the suitability of these protocols over such kind of networks. Ad Hoc On-Demand Distance Vector (AODV, Dynamic Source Routing (DSR and Dynamic MANET On-demand (DYMO routing protocol are considered as the representative of reactive routing protocols. The performance differentials are investigated using varying traffic load and number of source. Based on the simulation results, how the performance of each protocol can be improved is also recommended.

75 FR 56131 - Endangered and Threatened Wildlife and Plants; Draft Revised Recovery Plan for the Northern...

Science.gov (United States)

2010-09-15

... on the MOCA network recommended in the 2008 Recovery Plan and will instead use the model results to... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R1-ES-2010-N184; 10120-1113-0000-C2] Endangered and Threatened Wildlife and Plants; Draft Revised Recovery Plan for the Northern Spotted Owl...

Air and radon pathways screenings methodologies for the next revision of the E-area PA

Energy Technology Data Exchange (ETDEWEB)

Dyer, J. A. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2017-10-31

The strategic plan for the next E-Area Low-Level Waste Facility Performance Assessment includes recommended changes to the screening criteria used to reduce the number of radioisotopes that are to be considered in the air and radon pathways incorporated into the GoldSim® atmospheric release model (ARM). For the air pathway, a revised screening methodology was developed based on refinement of previous E-Area PA screening approaches and consideration of the strategic plan recommendations. The revised methodology has three sequential screening steps for each radioisotope: (1) volatility test using the Periodic Table of the Elements, (2) stability test based on half-life, and (3) stability test based on volatility as measured by the Henry’s Law constant for the assumed dominant gaseous species or vapor pressure in the case of tritiated water. Of the 1252 radioisotopes listed in the International Commission on Radiological Protection Publication 107, only the 10 that satisfied all three steps of the revised screening methodology will be included in the ARM. They are: Ar-37, Ar-39, Ar-42, C-14, H-3, Hg-194, Hg-203, Kr-81, Kr-85, and Xe-127. For the radon pathway, a revised screening methodology was developed that also has three sequential steps: (1) identify all decay chains that terminate at Rn-222, (2) screen out parents that decay through U-238 because of its 4.5-billion-year primordial half-life, and (3) eliminate remaining parents whose half-life is shorter than one day. Of the 86 possible decay chains leading to Rn-222, six decay chains consist of 15 unique radioisotopes that will be incorporated into the ARM. The 15 radioisotopes are: U-238, Th-234, Pa-234m, Pu-238, U-234, Th-230, Ra-226, Cf-246, Cm-242, Am-242m, Am-242, Np-238, Np-234, Pa-230, and Rn-222.

Massage in children with cancer: effectiveness of a protocol

Directory of Open Access Journals (Sweden)

Luís Manuel da Cunha Batalha

2013-11-01

Conclusions: despite the small sample size, massage therapy appears to be a useful intervention in reducing pain in children with cancer. However, there are still questions regarding the effectiveness of this massage protocol. The authors recommend its use due to its contribution to the promotion of the child's well-being and quality of life.

Health effects models for nuclear power plant accident consequence analysis. Part 1, Introduction, integration, and summary: Revision 2

Energy Technology Data Exchange (ETDEWEB)

Evans, J.S. [Harvard School of Public Health, Boston, MA (United States); Abrahmson, S. [Wisconsin Univ., Madison, WI (United States); Bender, M.A. [Brookhaven National Lab., Upton, NY (United States); Boecker, B.B.; Scott, B.R. [Inhalation Toxicology Research Inst., Albuquerque, NM (United States); Gilbert, E.S. [Battelle Pacific Northwest Lab., Richland, WA (United States)

1993-10-01

This report is a revision of NUREG/CR-4214, Rev. 1, Part 1 (1990), Health Effects Models for Nuclear Power Plant Accident Consequence Analysis. This revision has been made to incorporate changes to the Health Effects Models recommended in two addenda to the NUREG/CR-4214, Rev. 1, Part 11, 1989 report. The first of these addenda provided recommended changes to the health effects models for low-LET radiations based on recent reports from UNSCEAR, ICRP and NAS/NRC (BEIR V). The second addendum presented changes needed to incorporate alpha-emitting radionuclides into the accident exposure source term. As in the earlier version of this report, models are provided for early and continuing effects, cancers and thyroid nodules, and genetic effects. Weibull dose-response functions are recommended for evaluating the risks of early and continuing health effects. Three potentially lethal early effects -- the hematopoietic, pulmonary, and gastrointestinal syndromes are considered. Linear and linear-quadratic models are recommended for estimating the risks of seven types of cancer in adults - leukemia, bone, lung, breast, gastrointestinal, thyroid, and ``other``. For most cancers, both incidence and mortality are addressed. Five classes of genetic diseases -- dominant, x-linked, aneuploidy, unbalanced translocations, and multifactorial diseases are also considered. Data are provided that should enable analysts to consider the timing and severity of each type of health risk.

Improved perception of communication and compliance with a revised, intensive care unit-specific bedside communication sheet.

Science.gov (United States)

Aponte-Patel, Linda; Sen, Anita

2015-01-01

Although many pediatric intensive care units (PICUs) use beside communication sheets (BCSs) to highlight daily goals, the optimal format is unknown. A site-specific BCS could improve both PICU communication and compliance completing the BCS. Via written survey, PICU staff at an academic children's hospital provided recommendations for improving and revising an existing BCS. Pre- and post-BCS revision, PICU staff were polled regarding PICU communication and BCS effectiveness, and daily compliance for completing the BCS was monitored. After implementation of the revised BCS, staff reporting "excellent" or "very good" day-to-day communication within the PICU increased from 57% to 77% (P = .02). Compliance for completing the BCS also increased significantly (75% vs 83%, P = .03). Introduction of a focused and concise BCS tailored to a specific PICU leads to improved perceptions of communication by PICU staff and increased compliance completing the daily BCS. © The Author(s) 2014.

MRI of Creutzfeldt-Jakob disease: Imaging features and recommended MRI protocol

Energy Technology Data Exchange (ETDEWEB)

Collie, D.A.; Sellar, R.J.; Zeidler, M.; Colchester, A.C.F.; Knight, R.; Will, R.G

2001-09-01

Creutzfeldt-Jakob Disease (CJD) is a rare, progressive and invariably fatal neurodegenerative disease characterized by specific histopathological features. Of the four subtypes of CJD described, the commonest is sporadic CJD (sCJD). More recently, a new clinically distinct form of the disease affecting younger patients, known as variant CJD (vCJD), has been identified, and this has been causally linked to the bovine spongiform encephalopathy (BSE) agent in cattle. Characteristic appearances on magnetic resonance imaging (MRI) have been identified in several forms of CJD; sCJD may be associated with high signal changes in the putamen and caudate head and vCJD is usually associated with hyperintensity of the pulvinar (posterior nuclei) of the thalamus. These appearances and other imaging features are described in this article. Using appropriate clinical and radiological criteria and tailored imaging protocols, MRI plays an important part in the in vivodiagnosis of this disease. Collie, D.A. et al. (2001)

MRI of Creutzfeldt-Jakob disease: Imaging features and recommended MRI protocol

International Nuclear Information System (INIS)

Collie, D.A.; Sellar, R.J.; Zeidler, M.; Colchester, A.C.F.; Knight, R.; Will, R.G.

2001-01-01

Creutzfeldt-Jakob Disease (CJD) is a rare, progressive and invariably fatal neurodegenerative disease characterized by specific histopathological features. Of the four subtypes of CJD described, the commonest is sporadic CJD (sCJD). More recently, a new clinically distinct form of the disease affecting younger patients, known as variant CJD (vCJD), has been identified, and this has been causally linked to the bovine spongiform encephalopathy (BSE) agent in cattle. Characteristic appearances on magnetic resonance imaging (MRI) have been identified in several forms of CJD; sCJD may be associated with high signal changes in the putamen and caudate head and vCJD is usually associated with hyperintensity of the pulvinar (posterior nuclei) of the thalamus. These appearances and other imaging features are described in this article. Using appropriate clinical and radiological criteria and tailored imaging protocols, MRI plays an important part in the in vivodiagnosis of this disease. Collie, D.A. et al. (2001)

Revision 2 of the Program of NPP Krsko Decommissioning and SF and LILW Disposal

International Nuclear Information System (INIS)

Levanat, I.; Lokner, V.; Rapic, A.

2010-01-01

First joint Slovenian-Croatian Program of NPP Krsko Decommissioning and SF and LILW Disposal (DP) was completed in 2004 and formally adopted in 2005. As bilateral agreement on the NPP requires periodic revisions at least each 5 years, revision 2 of DP was started in September 2008, with the purpose to incorporate relevant developments since the 1st revision, to improve the level of details and reliability of DP, and to propose updated and more accurate cost estimates and appropriate financing models. In the first phase of the revision, new supporting studies for DP modules were prepared. Among these studies, the most demanding was the NPP Krsko specific Preliminary Decommissioning Plan (PDP), complying with the IAEA-recommended format, which included development of the NPP decommissioning inventory database. For upgrade of SF management, new and more detailed descriptions with improved cost estimates were prepared. Update of LILW disposal concept was based on new developments and projects prepared for the Slovenian repository. In the second phase of the revision, integrated DP scenarios were formulated and analyzed. They integrate NPP decommissioning together with RW and SF management/disposal into rationally inter-related sequences. Boundary conditions for this revision required: (a) that the reference scenario from the previous revision should be re-examined, with appropriate variations or new alternatives; (b) that the option of the NPP Krsko life extension should also be included; and (c) that the possibility of diverging interests of the contracting parties should also be analyzed (i.e. waste division and separate management). Finally, scenario evaluation is intended to compare the analyzed scenarios taking into account both their feasibility and estimated costs. It should provide the basis for determining future financing of DP, namely the annuities to be paid by the NPP Krsko owners into the national decommissioning funds.(author).

75 FR 984 - Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at CERCLA and RCRA Sites

Science.gov (United States)

2010-01-07

...The Environmental Protection Agency (EPA or the Agency) is announcing a 50-day public comment period for draft recommended interim preliminary remediation goals (PRGs) developed in the Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and Resource Conservation and Recovery Act (RCRA) Sites. EPA's Office of Solid Waste and Emergency and Emergency Response (OSWER) has developed the draft recommended interim PRGs for dioxin in soil. These draft recommended interim PRGs were calculated using existing, peer- reviewed toxicity values and current EPA equations and default exposure assumptions. This Federal Register notice is intended to provide an opportunity for public comment on the draft recommended interim PRGs. EPA will consider any public comments submitted in accordance with this notice and may revise the draft recommended interim PRGs thereafter.

Guidelines for sea dumping packages of radioactive waste. Revised version.

International Nuclear Information System (INIS)

Anon.

1979-04-01

The purpose of these Guidelines is to establish general requirements and provide practical information for the design and manufacture of packages for sea dumping of radioactive waste, in accordance with the terms of the OECD Council Decision establishing a Multilateral Consultation and Surveillance Mechanism for Sea Dumping of Radioactive Waste. These Guidelines are in compliance with the IAEA Revised Definition and Recommendations of 1978, for applying the London Dumping Convention to radioactive waste, and are intended for application under the responsibility of the appropriate national authorities of countries participating in the NEA Mechanism

Prospective evaluation of a protocol for using transabdominal ultrasound to screen for short cervix.

Science.gov (United States)

Pandipati, Santosh; Combs, C Andrew; Fishman, Alan; Lee, Sarah Y; Mallory, Kimberly; Ianovich, Francesca

2015-07-01

We sought to evaluate a recently proposed protocol whereby transabdominal ultrasound of the cervix might be used as a prescreen to select women to undergo or to forgo measurement of cervical length via transvaginal ultrasound (CLvag). This was a prospective cohort study. Measurements of cervical length via transabdominal ultrasound (CLabd) and CLvag were made in women with singleton pregnancy during routine obstetrical ultrasound examination at 18(0/7) to 23(6/7) weeks of gestation. The transabdominal screen was considered positive if CLabd was ≤36 mm with the maternal bladder full or ≤35 mm with the bladder empty, or adequate imaging of the cervix could not be obtained. Sensitivity, specificity, predictive values, and likelihood ratios of a positive screen to detect a short cervix (CLvag ≤25 mm) were calculated. An interim analysis identified several technical problems with CLabd measurements, so the protocol was extensively revised. Under the revised protocol, 1580 women were included. Adequate views of the cervix were obtained via transabdominal imaging in 46% of subjects with the bladder empty and 56% with the bladder full. The correlation between CLabd and CLvag was poor (r = 0.38). Of the 17 patients with a short cervix, 15 had suboptimal transabdominal exams (screen positive) and 2 had CLabd ≤35 mm with bladder empty (screen positive). Sensitivity of the screen was 100% (95% confidence interval, 80.5-100%) but specificity was only 32.2% (95% confidence interval, 29.9-34.6%) and screen positive rate was 66.3%. Several technical problems and limitations of transabdominal imaging of the cervix are shown. Using modern, high-resolution ultrasound equipment, we were unable to adequately image the cervix via transabdominal ultrasound in half the cases. Although we confirmed that a CLabd cutoff value of 35-36 mm is appropriate for detection of short cervix, the technique for measuring CLabd is fraught with technical problems. Practitioners must validate the

Comparison of current recommended regimens of atropinization in organophosphate poisoning.

Science.gov (United States)

Connors, Nicholas J; Harnett, Zachary H; Hoffman, Robert S

2014-06-01

Atropine is the mainstay of therapy in organophosphate (OP) toxicity, though research and consensus on dosing is lacking. In 2004, as reported by Eddleston et al. (J Toxicol Clin Toxicol 42(6):865-75, 2004), they noted variation in recommended regimens. We assessed revisions of original references, additional citations, and electronic sources to determine the current variability in atropine dosing recommendations. Updated editions of references from Eddleston et al.'s work, texts of Internal and Emergency Medicine, and electronic resources were reviewed for atropine dosing recommendations. For comparison, recommendations were assessed using the same mean dose (23.4 mg) and the highest dose (75 mg) of atropine as used in the original paper. Recommendations were also compared with the dosing regimen from the World Health Organization (WHO). Thirteen of the original recommendations were updated and 15 additional references were added giving a convenience sample of 28. Sufficient information to calculate time to targeted dose was provided by 24 of these samples. Compared to 2004, current recommendations have greatly increased the speed of atropinization with 13/24 able to reach the mean and high atropine dose within 30 min compared to 1/36 in 2004. In 2004, there were 13 regimens where the maximum time to reach 75 mg was over 18 h, whereas now, there are 2. While only one recommendation called for doubling the dose for faster escalation in 2004, 15 of the 24 current works include dose doubling. In 2004, Eddleston et al. called for an evidence-based guideline for the treatment of OP poisoning that could be disseminated worldwide. Many current recommendations can adequately treat patients within 1 h. While the WHO recommendations remain slow to treat patients with OP poisoning, other authorities are close to a consensus on rapid atropinization.

International conventions on civil liability for nuclear damage. Revised 1976 ed.

International Nuclear Information System (INIS)

1976-01-01

This revised edition contains the texts of the following multilateral conventions and instruments concerning civil liability for nuclear damage: The Vienna Convention of 21 May 1963 on Civil Liability for Nuclear Damage; The Paris Convention of 29 July 1960 on Third Party Liability in the Field of Nuclear Energy (incorporating the provisions of the Additional Protocol of 28 January 1964); The Brussels Convention of 31 January 1963; Supplementary to the Paris Convention of 29 July 1960 (and incorporating the provisions of the Additional Protocol signed in Paris on 28 January 1964); and the Brussels Convention of 25 May 1962 on the Liability of Operators of Nuclear Ships. Final Act and Resolutions of the International Conference on Civil Liability for Nuclear Damage, held in Vienna from 29 April to 19 May 1963; Final Act of the International Legal Conference on Maritime Carriage of Nuclear Substances, held in Brussels from 29 November to 2 December 1971; and Convention Relating to Civil Liability in the Field of Maritime Carriage of Nuclear Material, adopted at Brussels on 17 December 1971

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel.

Science.gov (United States)

Döhner, Hartmut; Estey, Elihu; Grimwade, David; Amadori, Sergio; Appelbaum, Frederick R; Büchner, Thomas; Dombret, Hervé; Ebert, Benjamin L; Fenaux, Pierre; Larson, Richard A; Levine, Ross L; Lo-Coco, Francesco; Naoe, Tomoki; Niederwieser, Dietger; Ossenkoppele, Gert J; Sanz, Miguel; Sierra, Jorge; Tallman, Martin S; Tien, Hwei-Fang; Wei, Andrew H; Löwenberg, Bob; Bloomfield, Clara D

2017-01-26

The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease. © 2017 by The American Society of Hematology.

Revising Lecture Notes: How Revision, Pauses, and Partners Affect Note Taking and Achievement

Science.gov (United States)

Luo, Linlin; Kiewra, Kenneth A.; Samuelson, Lydia

2016-01-01

Note taking has been categorized as a two-stage process: the recording of notes and the review of notes. We contend that note taking might best involve a three-stage process where the missing stage is revision. This study investigated the benefits of revising lecture notes and addressed two questions: First, is revision more effective than…

The evolution of the system of radiological protection: the justification for new ICRP recommendations

International Nuclear Information System (INIS)

Clarke, R.H.

2003-01-01

ICRP has been encouraging discussion, during the past few years, on the best way of expressing radiological protection philosophy in its next Recommendations, which it plans to publish in 2005. The present Recommendations were initiated by Publication 60 in 1990 and have been complemented by additional publications over the last twelve years. It is now clear that there is a need for the Commission to summarize the totality of the number of numerical values that it has recommended in some ten reports. This has been done in this paper and from these, a way forward is indicated to produce a simplified and more coherent statement of protection philosophy for the start of the 21. century. A radical revision is not envisaged, rather a coherent statement of current policy and a simplification in its application. (author)

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Science.gov (United States)

Arnold, Mark; Bakris, George L.; Bruns, David E.; Horvath, Andrea Rita; Kirkman, M. Sue; Lernmark, Ake; Metzger, Boyd E.; Nathan, David M.

2011-01-01

BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A1c (HbA1c) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended. PMID:21617108

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

Science.gov (United States)

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-01-01

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials. PMID:29259371

Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project.

Science.gov (United States)

Bunch, Azalea Marie; Leasure, A Renee; Carithers, Cathrin; Burnette, Robert E; Berryman, Michael Scott

2016-02-01

The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety. ©2015 American Association of Nurse Practitioners.

Revision 2 of the NPP Krsko Decommissioning Program Is Stalled

International Nuclear Information System (INIS)

Levanat, I.; Lokner, V.; Rapic, A.; Zeleznik, N.; Kralj, M.

2012-01-01

Revision 2 of the joint Slovenian-Croatian Program of NPP Krsko Decommissioning and SF andLILW Disposal was scheduled to be finished and formally approved by the end of 2009, in accordance with the bilateral Agreement on the NPP. Slightly behind the schedule, the Project team completed the entire document during spring of 2010, and in June 2010 drafted a proposal for a peer review of the Program by a dedicated IAEA expert mission. This procedure was agreed upon at the last session (May 2010) of the Intergovernmental Commission for implementation of the Agreement, when the Commission was acquainted with the five scenarios of the Revision 2 and with the estimates of their costs/financing. It was expected that the peer review would be performed soon, and that formal adoption of the Revision 2 would follow. Although in this process of approval some decisions remained to be made by the stakeholders, the Project team did select and recommend one scenario to be used for costing purposes, in order to ensure that most necessary corrections in Program financing would be timely adopted. However, the planned IAEA review was cancelled by the Advisory board, the body nominated by the Commission ''to supervise the activities and resolve the issues raised by the Project team''. By this cancellation, the process of Program revision was effectively stalled, because the Advisory board could not clearly define further course of action: differing views between the Slovenian and the Croatian part of the Advisory board appeared, in particular regarding the set of Program scenarios and regarding the appropriateness of the Revision 2 document for the IAEA review; nonetheless, the Advisory board sent to the Project team a compilation of requests to modify Revision 2 document. The Project team determined that some minor requests were easy to fulfill, but other modifications could only be carried out after changes in the boundary conditions (approved by the Commission), or changes in national

The Canadian Assessment of Physical Literacy: Development of a Model of Children's Capacity for a Healthy, Active Lifestyle Through a Delphi Process.

Science.gov (United States)

Francis, Claire E; Longmuir, Patricia E; Boyer, Charles; Andersen, Lars Bo; Barnes, Joel D; Boiarskaia, Elena; Cairney, John; Faigenbaum, Avery D; Faulkner, Guy; Hands, Beth P; Hay, John A; Janssen, Ian; Katzmarzyk, Peter T; Kemper, Han C; Knudson, Duane; Lloyd, Meghann; McKenzie, Thomas L; Olds, Tim S; Sacheck, Jennifer M; Shephard, Roy J; Zhu, Weimo; Tremblay, Mark S

2016-02-01

The Canadian Assessment of Physical Literacy (CAPL) was conceptualized as a tool to monitor children's physical literacy. The original model (fitness, activity behavior, knowledge, motor skill) required revision and relative weights for calculating/interpreting scores were required. Nineteen childhood physical activity/fitness experts completed a 3-round Delphi process. Round 1 was open-ended questions. Subsequent rounds rated statements using a 5-point Likert scale. Recommendations were sought regarding protocol inclusion, relative importance within composite scores and score interpretation. Delphi participant consensus was achieved for 64% (47/73) of statement topics, including a revised conceptual model, specific assessment protocols, the importance of longitudinal tracking, and the relative importance of individual protocols and composite scores. Divergent opinions remained regarding the inclusion of sleep time, assessment/ scoring of the obstacle course assessment of motor skill, and the need for an overall physical literacy classification. The revised CAPL model (overlapping domains of physical competence, motivation, and knowledge, encompassed by daily behavior) is appropriate for monitoring the physical literacy of children aged 8 to 12 years. Objectively measured domains (daily behavior, physical competence) have higher relative importance. The interpretation of CAPL results should be reevaluated as more data become available.

Acetabular Cup Revision.

Science.gov (United States)

Kim, Young-Ho

2017-09-01

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

Evaluation of Protocol Uniformity Concerning Laparoscopic Cholecystectomy in The Netherlands

Science.gov (United States)

Goossens, Richard H. M.; van Eijk, Daan J.; Lange, Johan F.

2008-01-01

Background Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the “critical view of safety” concept of Strasberg, should reduce the incidence of this complication. Furthermore, owing to the rapid development of minimally invasive surgery, technicians are becoming more frequently involved. To improve communication between the operating team and technicians, standardized actions should also be defined. The aim of this study was to compare existing protocols for laparoscopic cholecystectomy from various Dutch hospitals. Methods Fifteen Dutch hospitals were contacted for evaluation of their protocols for laparoscopic cholecystectomy. All evaluated protocols were divided into six steps and were compared accordingly. Results In total, 13 hospitals responded—5 academic hospitals, 5 teaching hospitals, 3 community hospitals—of which 10 protocols were usable for comparison. Concerning the trocar positions, only minor differences were found. The concept of “critical view of safety” was represented in just one protocol. Furthermore, the order of clipping and cutting the cystic artery and duct differed. Descriptions of instruments and apparatus were also inconsistent. Conclusions Present protocols differ too much to define a universal procedure among surgeons in The Netherlands. The authors propose one (inter)national standardized protocol, including standardized actions. This uniform standardized protocol has to be officially released and recommended by national scientific associations (e.g., the Dutch Society of Surgery) or international societies (e.g., European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons). The aim is to improve patient safety and professional communication, which are necessary for new developments. PMID:18224485

Early cystic bleb needling revision after glaucoma filtering surgery with toxic keratopathy

Directory of Open Access Journals (Sweden)

S. Yu. Petrov

2015-01-01

Full Text Available Clinical case of high thin-wall cystic limited filtering bleb needling revision in the early post-op period after trabeculectomy with sinusotomy accompanied by toxic keratopathy is presented. Optical coherence tomography (OCT demonstrated that filtering bleb height was 2700 μm and bleb wall thickness was 70 μm. Bleb needling revision with its lateralwall dissection and subconjunctival injection of dexamethasone, fluorouracil, and ranibizumab near to the bleb site was performed. In 1.5 hours after the procedure, bleb height decreased to 550 μm (by 5 times while bleb wall thickness increased up to 100 μm. Topical antibacterial, steroid, and non-steroid anti-inflammatory therapy was recommended. The next day IOP level reduced from 11 mm Hg to 4.5 mm Hg. It was accompanied by choroidal effusion that was managed conservatively with cycloplegic agents (drops and injections for 3 days. On day 6, central corneal edema affecting all layers, Descemet’s membrane folds, and ocular hypertension were revealed. Metabolic therapy resolved corneal edema within 3 days. Re-needling bleb revision decreased IOP level to 6.2 mm Hg. This resulted in transient Descemet’s membrane folds. This paper describes filtering bleb needling revision with its lateral wall dissection and anti-inflammatory, cytostatic, and anti-VEGF agents use to prolong glaucoma filtering surgery effect in excessive scarring. The procedure was accompanied by toxic corneal endothelium decompensation with corneal edema and Descemet’s membrane folds treated with active metabolic therapy.

Failure of aseptic revision total knee arthroplasties.

Science.gov (United States)

Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

2015-02-01

In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting.

Science.gov (United States)

Schwarzkopf, Ran; Snir, Nimrod; Sharfman, Zachary T; Rinehart, Joseph B; Calderon, Michael-David; Bahn, Esther; Harrington, Brian; Ahn, Kyle

2016-01-01

A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol. All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs . GA) on these outcomes. The groups were compared using chi-square tests of proportions. The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs . 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols. Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.

International Performance Measurement & Verification Protocol: Concepts and Practices for Improved Indoor Environmental Quality, Volume II (Revised)

Energy Technology Data Exchange (ETDEWEB)

2002-03-01

This protocol serves as a framework to determine energy and water savings resulting from the implementation of an energy efficiency program. It is also intended to help monitor the performance of renewable energy systems and to enhance indoor environmental quality in buildings.

Workshop to promote the ratification of the protocol on heavy metals across the entire UN ECE region

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-12-15

Within the workshop of the German Federal Environment Agency (Dessau-Rosslau, Federal Republic of Germany) at 14th to 16th May, 2008 in Yerevan (Armenia), the following lectures were held: (1) The convention and its protocols - framework and requirements (Tea Aulavuo); (2) Development of the heavy metals protocol up to now (D. Jost); (3) Experiences in transposing the obligations of the HM protocol into national law (Ivan Angelov); (4) Evaluation of concentrations of air pollutants and depositions of HM over the EECCA region (Ilia Ilyin); (5) The effectiveness of the HM protocol - emission reductions and costs (TNO-study) (M. van het Bolscher); (6) Technologies and techniques and their emission reduction potential and costs (Andre Peeters Weem); (7) Synergies of reduction of HM and particulate matter (Katja Kraus); (8) Critical loads / critical levels and effects of HM - integrated assessment (Jean-Paul Hettelingh); (9) Additional technical measures / options and their reduction potential (M. van het Bolscher); (10) Overview of the situation in the EECCA region - evaluation of a questionnaire of the Secretariat of the LRTAP Convention and ideas on revising the protocol and its annexes (Johan Sliggers); (11) Future aims of the TF (Katja Kraus).

Tidal wetlands of the Yaquina and Alsea River estuaries, Oregon: Geographic Information Systems layer development and recommendations for National Wetlands Inventory revisions

Science.gov (United States)

Brophy, Laura S.; Reusser, Deborah A.; Janousek, Christopher N.

2013-01-01

Geographic Information Systems (GIS) layers of current, and likely former, tidal wetlands in two Oregon estuaries were generated by enhancing the 2010 National Wetlands Inventory (NWI) data with expert local field knowledge, Light Detection and Ranging-derived elevations, and 2009 aerial orthophotographs. Data were generated for two purposes: First, to enhance the NWI by recommending revised Cowardin classifications for certain NWI wetlands within the study area; and second, to generate GIS data for the 1999 Yaquina and Alsea River Basins Estuarine Wetland Site Prioritization study. Two sets of GIS products were generated: (1) enhanced NWI shapefiles; and (2) shapefiles of prioritization sites. The enhanced NWI shapefiles contain recommended changes to the Cowardin classification (system, subsystem, class, and/or modifiers) for 286 NWI polygons in the Yaquina estuary (1,133 acres) and 83 NWI polygons in the Alsea estuary (322 acres). These enhanced NWI shapefiles also identify likely former tidal wetlands that are classified as upland in the current NWI (64 NWI polygons totaling 441 acres in the Yaquina estuary; 16 NWI polygons totaling 51 acres in the Alsea estuary). The former tidal wetlands were identified to assist strategic planning for tidal wetland restoration. Cowardin classifications for the former tidal wetlands were not provided, because their current hydrology is complex owing to dikes, tide gates, and drainage ditches. The scope of this project did not include the field evaluation that would be needed to determine whether the former tidal wetlands are currently wetlands, and if so, determine their correct Cowardin classification. The prioritization site shapefiles contain 49 prioritization sites totaling 2,177 acres in the Yaquina estuary, and 39 prioritization sites totaling 1,045 acres in the Alsea estuary. The prioritization sites include current and former (for example, diked) tidal wetlands, and provide landscape units appropriate for basin

Deep-sequencing protocols influence the results obtained in small-RNA sequencing.

Directory of Open Access Journals (Sweden)

Joern Toedling

Full Text Available Second-generation sequencing is a powerful method for identifying and quantifying small-RNA components of cells. However, little attention has been paid to the effects of the choice of sequencing platform and library preparation protocol on the results obtained. We present a thorough comparison of small-RNA sequencing libraries generated from the same embryonic stem cell lines, using different sequencing platforms, which represent the three major second-generation sequencing technologies, and protocols. We have analysed and compared the expression of microRNAs, as well as populations of small RNAs derived from repetitive elements. Despite the fact that different libraries display a good correlation between sequencing platforms, qualitative and quantitative variations in the results were found, depending on the protocol used. Thus, when comparing libraries from different biological samples, it is strongly recommended to use the same sequencing platform and protocol in order to ensure the biological relevance of the comparisons.

Past and Future of the Kyoto Protocol. Final report

International Nuclear Information System (INIS)

Wijen, F.; Zoeteman, K.

2004-01-01

The present report reflects findings from a study on the realization of and prospects for the Kyoto Protocol. The purpose of the study was (1) to obtain insights into the factors that enabled the realization of the Kyoto Protocol, in particular the interactions among major parties involved; (2) to assess the future opportunities and threats of the Kyoto Protocol, in particular against the backdrop of an increasingly globalised world. The study was conducted from February up to December 2003 by (a) reviewing the literature, especially publications on the negotiation history of the Kyoto process, the social interactions enabling the realization of the Protocol, analyses of strengths and weaknesses, and future climate regimes; (b) conducting a series of interviews with representatives from government, academia, non-governmental organisations, and business, who have been - directly or indirectly - involved in the Kyoto process; (c) internal discussions,brainstorming and analysing the Protocol's strengths and weaknesses, possible future scenarios (including policy options), and the management of a possible failure of the Kyoto Protocol. The present report reflects and integrates the different sources. The first section deals with the past and the present. It discusses how the Kyoto Protocol could be realized despite the divergent interests, reflects on its architecture, and analyses major strengths and weaknesses. In the second section, we present possible future scenarios. We explore how different combinations of domestic and international commitment provide possible realities that national government may face when crafting climate policy. The third section provides an in-depth analysis of the possible event that the Kyoto Protocol fails. We discuss its definition and policy implications. The final section is reserved for overall conclusions and policy recommendations

Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance.

Science.gov (United States)

Ari, Seyhmus; Kürşat Cingü, Abdullah; Sahin, Alparslan; Gün, Ramazan; Kiniş, Vefa; Caça, Ihsan

2012-01-01

To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocystorhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance. Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success. Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28). Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

Nuclear safety guide. TID-7016, Revision 2

International Nuclear Information System (INIS)

Thomas, J.T.

1978-01-01

The Nuclear Safety Guide was first issued in 1956 as classified AEC report LA-2063 and was reprinted the next year, unclassified, as TID-7016. Revision 1, published in 1961, extended the scope and refined the guiding information. The present revision of the Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams, experienced in the field. The reader will find a significant change in the character of information presented in this version. Nuclear Criticality Safety has matured in the past twelve years. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the formerGuides by employing appropriate safety factors. In fact, it becomes incumbent on the Criticality Safety Specialist to necessarily impose safety factors consistent with the possible normal and abnormal credible contingencies of an operation as revealed by his evaluation. In its present form the Guide easily becomes a suitable module in any compendium or handbook tailored for internal use by organizations. It is hoped the Guide will continue to serve immediate needs and will encourage continuing and more comprehensive efforts toward organizing nuclear criticality safety information

Nuclear safety guide. TID-7016, Revision 2

Energy Technology Data Exchange (ETDEWEB)

Thomas, J T [ed.

1978-05-01

The Nuclear Safety Guide was first issued in 1956 as classified AEC report LA-2063 and was reprinted the next year, unclassified, as TID-7016. Revision 1, published in 1961, extended the scope and refined the guiding information. The present revision of the Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams, experienced in the field. The reader will find a significant change in the character of information presented in this version. Nuclear Criticality Safety has matured in the past twelve years. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the formerGuides by employing appropriate safety factors. In fact, it becomes incumbent on the Criticality Safety Specialist to necessarily impose safety factors consistent with the possible normal and abnormal credible contingencies of an operation as revealed by his evaluation. In its present form the Guide easily becomes a suitable module in any compendium or handbook tailored for internal use by organizations. It is hoped the Guide will continue to serve immediate needs and will encourage continuing and more comprehensive efforts toward organizing nuclear criticality safety information.

Chapter 15: Commercial New Construction Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

Energy Technology Data Exchange (ETDEWEB)

Kurnik, Charles W. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Keates, Steven [ADM Associates, Inc., Atlanta, GA (United States)

2017-10-09

This protocol is intended to describe the recommended method when evaluating the whole-building performance of new construction projects in the commercial sector. The protocol focuses on energy conservation measures (ECMs) or packages of measures where evaluators can analyze impacts using building simulation. These ECMs typically require the use of calibrated building simulations under Option D of the International Performance Measurement and Verification Protocol (IPMVP).

Recommendations for the use of molecular diagnostics in the diagnosis of allergic dis-eases.

Science.gov (United States)

Villalta, D; Tonutti, E; Bizzaro, N; Brusca, I; Sargentini, V; Asero, R; Bilo, M B; Manzotti, G; Murzilli, F; Cecchi, L; Musarra, A

2018-03-01

The Study Group on Allergology of the Italian Society of Clinical Pathology and Laboratory Medicine (SIPMeL) and the Associazione Italiana degli Allergologi e Immunologi Territoriali e Ospedalieri (AAIITO) developed the present recommendations on the diagnosis of allergic diseases based on the use of molecular allergenic components, whose purpose is to provide the pathologists and the clinicians with information and algorithms enabling a proper use of this second-level diagnostics. Molecular diagnostics allows definition of the exact sensitization profile of the allergic patient. The methodology followed to develop these recommendations included an initial phase of discussion between all the components to integrate the knowledge derived from scientific evidence, a revision of the recommendations made by Italian and foreign experts, and the subsequent production of this document to be disseminated to all those who deal with allergy diagnostics.

The evolution of the system of radiological protection: the justification for new ICRP recommendations

International Nuclear Information System (INIS)

2003-01-01

ICRP has been encouraging discussion during the past few years on the best way of expressing radiological protection philosophy in its next recommendations, which it plans to publish in 2005. The present recommendations were initiated by Publication 60 in 1990 and have been complemented by additional publications over the last 12 years. It is now clear that there is a need for the Commission to summarise the totality of the number of numerical values that it has recommended in some ten reports. This has been done in this paper, and from these a way forward is indicated to produce a simplified and more coherent statement of protection philosophy for the start of the 21st century. A radical revision is not envisaged, rather a coherent statement of current policy and a simplification in its application. (memorandum)

Hanford Site National Environmental Policy Act (NEPA) characterization. Revision 8

Energy Technology Data Exchange (ETDEWEB)

Neitzel, D.A. [ed.; Bjornstad, B.N.; Fosmire, C.J.; Fowler, R.A. [and others

1996-08-01

This eighth revision of the Hanford Site National Environmental Policy Act (NEPA) Characterization presents current environmental data regarding the Hanford Site and its immediate environs. This information is intended for use in preparing Chapters 4 and 6 in Hanford Site-related NEPA documents. Chapter 4 (Affected Environment) includes information on climate and meteorology, geology, hydrology, ecology, historical, archaeological and cultural resources, socioeconomics, and noise. Chapter 6 (Statutory and Regulatory Requirements) provides the preparer with the federal and state regulations, DOE directives and permits, and environmental standards directly applicable to the NEPA documents on the Hanford Site. The following sections were updated in this revision: climate and meteorology; ecology (threatened and endangered species section only); historical; archaeological and cultural resources; and all of chapter 6. No conclusions or recommendations are given in this report. Rather, it is a compilation of information on the Hanford Site environment that can be used directly by Site contractors. This information can also be used by any interested individual seeking baseline data on the hanford Site and its past activities by which to evaluate projected activities and their impacts.

Hanford Site National Environmental Policy Act (NEPA) characterization. Revision 8

International Nuclear Information System (INIS)

Neitzel, D.A.; Bjornstad, B.N.; Fosmire, C.J.; Fowler, R.A.

1996-08-01

This eighth revision of the Hanford Site National Environmental Policy Act (NEPA) Characterization presents current environmental data regarding the Hanford Site and its immediate environs. This information is intended for use in preparing Chapters 4 and 6 in Hanford Site-related NEPA documents. Chapter 4 (Affected Environment) includes information on climate and meteorology, geology, hydrology, ecology, historical, archaeological and cultural resources, socioeconomics, and noise. Chapter 6 (Statutory and Regulatory Requirements) provides the preparer with the federal and state regulations, DOE directives and permits, and environmental standards directly applicable to the NEPA documents on the Hanford Site. The following sections were updated in this revision: climate and meteorology; ecology (threatened and endangered species section only); historical; archaeological and cultural resources; and all of chapter 6. No conclusions or recommendations are given in this report. Rather, it is a compilation of information on the Hanford Site environment that can be used directly by Site contractors. This information can also be used by any interested individual seeking baseline data on the hanford Site and its past activities by which to evaluate projected activities and their impacts

Bibliocable. Revised Edition.

Science.gov (United States)

Cable Television Information Center, Washington, DC.

This selective, annotated bibliography is a revision of the original published in 1972 (ED 071 402). Some 104 books, articles, and reports included here deal with access, applications, franchising, regulation, technology, and other aspects of cable television. The listings are of two types in each category. First are revisions of the original…

What does it cost to deliver information using position-based beaconless forwarding protocols?

KAUST Repository

Bader, Ahmed

2012-04-01

Beaconless position-based forwarding protocols have recently evolved as a promising solution for packet forwarding in wireless sensor networks. Quite a few variants of this class of forwarding protocols have been proposed over the years. One common observation is that they have all been evaluated from the perspective of a single node. Although useful, but a solid understanding of the end-to-end performance is still necessary. In this paper, we shed light on the end-to-end performance of beaconless position-based protocols along three distinct dimensions: energy, latency, and back-off probability. The latter is used as a direct indicator of the network\\'s transport capacity. Consequently, we are able to provide an elaborate response to the question: what does it really cost to deliver a packet in a wireless sensor network using position-based beaconless forwarding protocols? In responding to this question, we highlighted the different performance tradeoffs inherent to beaconless position-based protocols. Furthermore, some operational recommendations are also provided. © 2012 IEEE.

What does it cost to deliver information using position-based beaconless forwarding protocols?

KAUST Repository

Bader, Ahmed; Abed-Meraim, Karim; Alouini, Mohamed-Slim

2012-01-01

Beaconless position-based forwarding protocols have recently evolved as a promising solution for packet forwarding in wireless sensor networks. Quite a few variants of this class of forwarding protocols have been proposed over the years. One common observation is that they have all been evaluated from the perspective of a single node. Although useful, but a solid understanding of the end-to-end performance is still necessary. In this paper, we shed light on the end-to-end performance of beaconless position-based protocols along three distinct dimensions: energy, latency, and back-off probability. The latter is used as a direct indicator of the network's transport capacity. Consequently, we are able to provide an elaborate response to the question: what does it really cost to deliver a packet in a wireless sensor network using position-based beaconless forwarding protocols? In responding to this question, we highlighted the different performance tradeoffs inherent to beaconless position-based protocols. Furthermore, some operational recommendations are also provided. © 2012 IEEE.

Colon cleansing protocol in children: research conditions vs. clinical practice.

Science.gov (United States)

Elitsur, Yoram; Balfaqih, Yaslam; Preston, Deborah

2018-04-01

 Colon preparation rates are the limiting factor for a successful diagnostic colonoscopy in children. Different colon cleansing protocols have been published for use in children. Unfortunately, the applicability of those published research protocols has not been formally evaluated in routine clinical practice. We investigated the success rate of our previously published colon cleansing protocol as utilized in our clinical practice.  This was a retrospective study. In the clinical practice, the colon cleansing protocol included PEG-3350 at a dose of 2 g/kg/day plus Dulcolax (Bisacodyl, Boehringer Ingelheim, TX USA) 5 mg/day for 2 days. Adequate colon preparation was graded between 1 - 5, as previously described, and grade ≥ 4.0 was considered an adequate preparation. Patients were instructed to complete a questionnaire that included PEG-3350 dose, number of stools per day, consistency of each stool, and side effects (vomiting, abdominal pain). Clinical and endoscopic results were compared between the protocol under research conditions and routine practice.  The success rate of the colon preparation in our clinical practice was similar to the results observed under our research protocol (75 % vs. 73.6 %). Moreover, the total number of stools, stool consistency, and the intubation rate of the terminal ileum were also similar. We concluded, that in our experience, the colon cleansing protocol used under research conditions was effective and appropriate for use in routine clinical practice.  We recommend testing each new protocol under the routine conditions of clinical practice to confirm its applicability for general practitioners.

Could we do better? Behavioural tracking on recommended consumer health websites.

Science.gov (United States)

Burkell, Jacquelyn; Fortier, Alexandre

2015-09-01

This study examines behavioural tracking practices on consumer health websites, contrasting tracking on sites recommended by information professionals with tracking on sites returned by Google. Two lists of consumer health websites were constructed: sites recommended by information professionals and sites returned by Google searches. Sites were divided into three groups according to source (Recommended-Only, Google-Only or both) and type (Government, Not-for-Profit or Commercial). Behavioural tracking practices on each website were documented using a protocol that detected cookies, Web beacons and Flash cookies. The presence and the number of trackers that collect personal information were contrasted across source and type of site; a second set of analyses specifically examined Advertising trackers. Recommended-Only sites show lower levels of tracking - especially tracking by advertisers - than do Google-Only sites or sites found through both sources. Government and Not-for-Profit sites have fewer trackers, particularly from advertisers, than do Commercial sites. Recommended sites, especially those from Government or Not-for-Profit organisations, present a lower privacy threat than sites returned by Google searches. Nonetheless, most recommended websites include some trackers, and half include at least one Advertising tracker. To protect patron privacy, information professionals should examine the tracking practices of the websites they recommend. © 2015 Health Libraries Group.

Reforming the CDM SD Tool. Recommendations for Improvement

DEFF Research Database (Denmark)

Arens, Christof; Mersmann, Florian; Beuermann, Christiane

assessment of sustainable development, comparable through mitigation mechanisms and embedded into development planning at the national level. This can then be used to integrate sustainability assessment standards into Performance Measurement Systems such as national Monitoring, Reporting and Verification...... Systems. On the other hand, compliance with standards ensures that countries also meet the requirements of international financial institutions such as the Green Climate Fund. Sustainable development benefits of climate protection instruments are highly relevant for development paths beyond aspects...... initial steps towards a globally applicable standard under an international UN institution. The Wuppertal Institute, together with UNEP DTU Partnership, has developed recommendations for its revision, improvement and enhancement that are outlined in this study....

Desensitization to clopidogrel: a tailor-made protocol.

Science.gov (United States)

Barreira, P; Cadinha, S; Malheiro, D; Moreira da Silva, J P

2014-01-01

Clopidogrel is an antiplatelet drug widely used for treatment and prevention of a variety of cardiovascular diseases. We report a successful desensitization to clopidogrel in a 70-year-old Caucasian man with delayed hypersensitivity (HS) reaction. He developed lip, hand and foot swelling, erythematous papular non-pruritic lesions and arthralgias 2 weeks after starting treatment with clopidogrel 75 mg/d. A 3-hour desensitization protocol was started, achieving a cumulative dose of 154 mg without any reaction, and a daily dose of 75 mg was recommended. On the 4th day, the patient developed skin lesions similar to the previously described. He was treated with topical steroids and oral antihistamines, and the daily dose of clopidogrel was reduced to 20 mg. A new desensitization protocol was established, with a slow dose increment, according to the patient's response. It was only possible to achieve the dose of 75 mg/d after 2 months. Although well tolerated by most patients, HS reactions with clopidogrel may occur and desensitization is rising as a safe alternative in those patients. In delayed reactions with cutaneous lesions, a slower desensitization protocol may be necessary, as in this case.

Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol.

Science.gov (United States)

Khemani, Robinder G; Sward, Katherine; Morris, Alan; Dean, J Michael; Newth, Christopher J L

2011-11-01

Although pediatric intensivists claim to embrace lung protective ventilation for acute lung injury (ALI), ventilator management is variable. We describe ventilator changes clinicians made for children with hypoxemic respiratory failure, and evaluate the potential acceptability of a pediatric ventilation protocol. This was a retrospective cohort study performed in a tertiary care pediatric intensive care unit (PICU). The study period was from January 2000 to July 2007. We included mechanically ventilated children with PaO(2)/FiO(2) (P/F) ratio less than 300. We assessed variability in ventilator management by evaluating actual changes to ventilator settings after an arterial blood gas (ABG). We evaluated the potential acceptability of a pediatric mechanical ventilation protocol we adapted from National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) Acute Respiratory Distress Syndrome (ARDS) Network protocols by comparing actual practice changes in ventilator settings to changes that would have been recommended by the protocol. A total of 2,719 ABGs from 402 patients were associated with 6,017 ventilator settings. Clinicians infrequently decreased FiO(2), even when the PaO(2) was high (>68 mmHg). The protocol would have recommended more positive end expiratory pressure (PEEP) than was used in actual practice 42% of the time in the mid PaO(2) range (55-68 mmHg) and 67% of the time in the low PaO(2) range (ventilator rate (VR) when the protocol would have recommended a change, even when the pH was greater than 7.45 with PIP at least 35 cmH(2)O. There may be lost opportunities to minimize potentially injurious ventilator settings for children with ALI. A reproducible pediatric mechanical ventilation protocol could prompt clinicians to make ventilator changes that are consistent with lung protective ventilation.

Comparison of Different Double Immunostaining Protocols for Paraffin Embedded Liver Tissue

Directory of Open Access Journals (Sweden)

Alexander Schütz

1999-01-01

Full Text Available Most of the double immunostaining protocols that have been introduced so far have been developed for application on fresh frozen material or based on different species antibodies. In liver tissue, general problems of double immunostaining techniques are further complicated by tissue‐specific difficulties, such as necrosis or high intracellular protein content. To assess a reliable double immunostaining protocol for archived, paraffin embedded liver tissue, different protocols based on the use of same species primary antibodies were evaluated in terms of sensitivity, specificity and non‐specific background staining in pathological liver specimens. We compared peroxidase–anti‐peroxidase, alkaline phosphatase–anti‐alkaline phosphatase (PAP/APAP, labelled‐avidin–biotin (LAB/LAB and digoxigenin–anti‐digoxigenin (dig–a‐dig/PAP techniques using different cytokeratin antibodies and an antibody against PCNA. Comparison of the double immunostaining techniques revealed a high sensitivity and specificity in all procedures. Sections, which were stained employing PAP/APAP‐technique, displayed a higher background staining compared to sections which were treated with the LAB/LAB or dig–a‐dig/PAP protocol. In contrast to the dig–a‐dig/PAP protocol, the LAB/LAB technique provides a better time/cost relationship. Therefore, we would like to recommend a modified LAB/LAB protocol for simultaneous detection of different antigens in archived liver tissue.

Total synthesis and structural revision of TMG-chitotriomycin, a specific inhibitor of insect and fungal beta-N-acetylglucosaminidases.

Science.gov (United States)

Yang, You; Li, Yao; Yu, Biao

2009-09-02

TMG-chitotriomycin, a potent and selective inhibitor of the beta-N-acetylglucosaminidases that possesses an unique N,N,N-trimethyl-d-glucosamine (TMG) residue, is revised to be the TMG-beta-(1-->4)-chitotriose instead of the originally proposed alpha-anomer via its total synthesis, for which a highly convergent approach was developed in which the sterically demanding (1-->4)-glycosidic linkages are efficiently constructed by the Au(I)-catalyzed glycosylation protocol with glycosyl o-hexynylbenzoates as donors.

Application of the Commission’s recommendations: the activities of ICRP Committee 4

International Nuclear Information System (INIS)

Lochard, Jacques

2012-01-01

Committee 4 of the International Commission on Radiological Protection (ICRP) is responsible for developing principles, recommendations, and guidance on the protection of man against radiation exposure; and considering their practical application in all exposure situations. The Committee also acts as a major point of contact between ICRP and other international organisations and professional bodies concerned with protection against ionising radiation. The current work of the Committee involves the development of a series of reports on implementation of the 2007 Recommendations, and a reflection on the ethical foundations of the radiological protection system. Following the accident in Fukushima, Committee 4 also initiated an analysis of management of the consequences of the accident, with the objective of revising, if necessary, the Commission’s publications on emergency and post-accident situations.

Considerations about the recommendations of the Commission on the Limits of the Continental Shelf on the Amazon fan

Directory of Open Access Journals (Sweden)

Rodrigo Fernandes More

2014-01-01

Full Text Available In 2004, Brazil submitted to the Commission on the Limits of the Continental Shelf (CLCS a Submission for the outer limit of the Brazilian continental shelf for its extension beyond the limits of 200 nautical miles. In 2007, the CLCS presented its recommendations, however it did not recommend four areas proposed by Brazil, the Amazon Fan among them. The objective of this study is to present the main legal and technical aspects of the controversy about the Amazon Fan, in order to evaluate some alternatives for a future submission, new or revised.

Validation of Omron RS8, RS6, and RS3 home blood pressure monitoring devices, in accordance with the European Society of Hypertension International Protocol revision 2010.

Science.gov (United States)

Takahashi, Hakuo; Yoshika, Masamichi; Yokoi, Toyohiko

2013-01-01

Allowing patients to measure their blood pressure at home is recognized as being of clinical value. However, it is not known how often these measurements are taken correctly. Blood pressure monitors for home use fall into two types based on the position of the cuff, ie, at the upper arm or the wrist. The latter is particularly convenient, as measurements can be taken fully clothed. This study aimed to evaluate the performance of the wrist-type blood pressure monitors Omron RS8 (HEM-6310F-E), Omron RS6 (HEM-6221-E), and Omron RS3 (HEM-6130-E). A team of three trained doctors validated the performance of these devices by comparing the measurements obtained from these devices with those taken using a standard mercury sphygmomanometer. All the devices met the validation requirements of the European Society of Hypertension International Protocol revision 2010. The difference in blood pressure readings between the tested device and the standard mercury sphygmomanometer was within 3 mmHg, which is acceptable according to the European Society of Hypertension guidelines. All the home devices tested were found to be suitable for measuring blood pressure at home because their performance fulfilled the requirement of the guidelines.

Early hearing detection and intervention: 2010 CODEPEH recommendation.

Science.gov (United States)

Trinidad-Ramos, Germán; de Aguilar, Valentín Alzina; Jaudenes-Casaubón, Carmen; Núñez-Batalla, Faustino; Sequí-Canet, José Miguel

2010-01-01

Newborn hearing screening is currently performed routinely in many regional health-care systems in Spain. Despite the remarkable expansion in newborn hearing screening since 2000, its feasibility and the benefits of early identification and intervention, many major challenges still remain. In this article, the Committee for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) updates the recommendations that are considered important for the future development of early hearing detection and intervention (EDHI) systems in the following points: 1. Screening protocols: Separate protocols are recommended for NICU (Neonatal Intensive Care Units) and well-infant nurseries. 2. Diagnostic audiology evaluation. Professionals with skills and expertise in evaluating newborn and young infants should provide diagnosis, selection and fitting of amplification devices. 3. Medical evaluation. Risk factors for congenital and acquired hearing loss have been combined in a single list rather than grouped by time of onset. A stepwise diagnostic paradigm is diagnostically more efficient and cost-effective than a simultaneous testing approach. 4. Early intervention and surveillance. All individuals providing services to infants with hearing loss should have specialized training and expertise in the development of audition, speech and language. Regular surveillance should be performed on developmental milestones, auditory skills, parental concerns, and middle ear status. 5. Quality control. Data management as part of an integrated system is important to monitor and improve the quality of EDHI services. 2009 Elsevier España, S.L. All rights reserved.

One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial.

Science.gov (United States)

Strange, Simon; Whitehouse, Michael R; Beswick, Andrew D; Board, Tim; Burston, Amanda; Burston, Ben; Carroll, Fran E; Dieppe, Paul; Garfield, Kirsty; Gooberman-Hill, Rachael; Jones, Stephen; Kunutsor, Setor; Lane, Athene; Lenguerrand, Erik; MacGowan, Alasdair; Moore, Andrew; Noble, Sian; Simon, Joanne; Stockley, Ian; Taylor, Adrian H; Toms, Andrew; Webb, Jason; Whittaker, John-Paul; Wilson, Matthew; Wylde, Vikki; Blom, Ashley W

2016-02-17

Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function

[Protocol for the study of bone tumours and standardization of pathology reports].

Science.gov (United States)

Machado, Isidro; Pozo, José Juan; Marcilla, David; Cruz, Julia; Tardío, Juan C; Astudillo, Aurora; Bagué, Sílvia

Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology. Copyright © 2016 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.

Implementation of a Rapid, Protocol-based TIA Management Pathway.

Science.gov (United States)

Jarhult, Susann J; Howell, Melissa L; Barnaure-Nachbar, Isabelle; Chang, Yuchiao; White, Benjamin A; Amatangelo, Mary; Brown, David F; Singhal, Aneesh B; Schwamm, Lee H; Silverman, Scott B; Goldstein, Joshua N

2018-03-01

Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup. Recommended workup included brain imaging, vascular imaging, cardiac monitoring, and observation. Patients were included if clinical providers determined the need for workup for TIA. We included consecutive patients presenting during a six-month period prior to protocol implementation, and those presenting between 6-12 months after implementation. Outcomes included ED length of stay (LOS), hospital LOS, use of neuroimaging, and 90-day risk of stroke or TIA. From 01/2012 to 06/2012, 130 patients were evaluated for TIA symptoms in the ED, and from 01/2013 to 06/2013, 150 patients. The final diagnosis was TIA or stroke in 45% before vs. 41% after (p=0.18). Following the intervention, the inpatient admission rate decreased from 62% to 24% (pTIA among those with final diagnosis of TIA was 3% for both periods. Implementation of a TIA protocol significantly reduced ED LOS and total hospital LOS.

Comparison of absorbed dose determinations using the IAEA dosimetry protocol and the ferrous sulphate dosimeter

International Nuclear Information System (INIS)

Mattsson, Olof

1988-01-01

In 1985 a comparison of different revised protocols for the dosimetry of high-energy photon and electron beams was published (Mattsson, 1985). The conclusions were that the agreement in absorbed dose to water determined using the different protocols is very good and that the agreement between ionization chamber and ferrous sulphate dosimetry is generally good. For electron beams the differences obtained with the ionization chamber and ferrous sulphate dosimeters were up to about 2%. The influence of the energy and angular distribution of the electron beams on the ionization chamber dosimetry is not fully considered in the dosimetry protocols. The basis for the ionization chamber dosimetry has recently been changed when the Bureau International des Poids et Mesures (BIPM) in 1986 changed the air-kerma standard. The reason was the adaption of the new stopping-power values reported in the ICRU Report No. 37. To achieve consistency in the ionization chamber dosimetry the interaction coefficients and correction factors given in the dosimetry protocols should also be based on the same set of stopping-power values. This is not the case with the protocols included in the comparison made by Mattsson. However, in the international code of practice by the International Atomic Energy Agency (IAEA, 1987) the new stopping-power values have been used. The formalism is the same as in most of the previous protocols. Mattsson et al. (1989) have shown that the differences in the various steps cancel out for the protocols published by NACP (1980) and by IAEA (1987) for cobalt-60 gamma quality. However, it is also of interest to investigate the influence of the new air-kerma standard and the new values on coefficients and factors given in the IAEA protocol for other beam qualities. Therefore, the data given by Mattsson (1985) have been recalculated using the new air-kerma standard and the IAEA protocol

Preston and Park-Sanders protocols adapted for semi-quantitative isolation of thermotolerant Campylobacter from chicken rinse

DEFF Research Database (Denmark)

Josefsen, Mathilde Hartmann; Lübeck, Peter Stephensen; Aalbaek, B.

2003-01-01

Human campylobacteriosis has become the major cause of foodborne gastrointestinal diseases in several European countries. In order to implement effective control measures in the primary production, and as a tool in risk assessment studies, it is necessary to have sensitive and quantitative...... detection methods. Thus, semi-quantitative detection of thermophilic Campylobacter spp. in 20 naturally contaminated chicken rinse samples was carried out using the two most common standard protocols: Preston and Park-Sanders, as proposed by Nordic Committee on Food Analysis (NMKL) and International...... Standard Organization (ISO), respectively. For both protocols, the chicken rinse samples were prepared in 500 ml buffered peptone water, as recommended in the ISO protocol no. 6887-2. The results indicated that the Preston protocol was superior to the Park-Sanders protocol in supporting growth...

Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures.

Science.gov (United States)

Pfeifer, Christian G; Grechenig, Stephan; Frankewycz, Borys; Ernstberger, Antonio; Nerlich, Michael; Krutsch, Werner

2015-10-01

Fractures of the ankle, hind- and midfoot are amongst the five most common fractures. Besides initial operative or non-operative treatment, rehabilitation of the patients plays a crucial role for fracture union and long term functional outcome. Limited evidence is available with regard to what a rehabilitation regimen should include and what guidelines should be in place for the initial clinical course of these patients. This study therefore investigated the current rehabilitation concepts after fractures of the ankle, hind- and midfoot. Written rehabilitation protocols provided by orthopedic and trauma surgery institutions in terms of recommendations for weight bearing, range of motion (ROM), physiotherapy and choice of orthosis were screened and analysed. All protocols for lateral ankle fractures type AO 44A1, AO 44B1 and AO 44C1, for calcaneal fractures and fractures of the metatarsal as well as other not specific were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. 209 rehabilitation protocols for ankle fractures type AO 44B1 and AO 44C1, 98 for AO 44A1, 193 for metatarsal fractures, 142 for calcaneal fractures, 107 for 5(th) metatarsal base fractures and 70 for 5(th) metatarsal Jones fractures were evaluated. The mean time recommended for orthosis treatment was 6.04 (SD 0.04) weeks. While the majority of protocols showed a trend towards increased weight bearing and increased ROM over time, the best consensus was noted for weight bearing recommendations. Our study shows that there exists a huge variability in rehabilitation of fractures of the ankle-, hind- and midfoot. This may be contributed to a lack of consensus (e.g. missing publication of guidelines), individualized patient care (e.g. in fragility fractures) or lack of specialization. This study might serve as basis for prospective randomized controlled trials in order to optimize rehabilitation for these common fractures. Copyright © 2015 Elsevier Ltd

Guidance document for revision of DOE Order 5820.2A, Radioactive Waste Technical Support Program. Revision 1

Energy Technology Data Exchange (ETDEWEB)

Kudera, D.E.; McMurtrey, C.D.; Meagher, B.G.

1993-04-01

This document provides guidance for the revision of DOE Order 5820.2A, ``Radioactive Waste Management.`` Technical Working Groups have been established and are responsible for writing the revised order. The Technical Working Groups will use this document as a reference for polices and procedures that have been established for the revision process. The overall intent of this guidance is to outline how the order will be revised and how the revision process will be managed. In addition, this document outlines technical issues considered for inclusion by a Department of Energy Steering Committee.

Regulations for the safe transport of radioactive materials. 1973 revised edition (as amended).

International Nuclear Information System (INIS)

1979-01-01

On the basis of a comprehensive review carried out by a panel of experts, a revised version of the International Atomic Energy Agency's Regulations for the Safe Transport of Radioactive Materials was approved by the Board of Governors in September 1972 and published in April 1973 as Safety Series No.6 - 1973 Revised Edition. Minor amendments, together with a number of changes of detail were promulgated by the Director General in 1975 and 1977. In October 1978, the Standing Advisory Group on the Safe Transport of Radioactive Materials, established by the Director General in 1977, reviewed and recommended a small number of additional amendments. The recommendations of SAGSTRAM were subsequently accepted by the Director General. All these minor amendments and changes of detail are incorporated in the present text of the Regulations. The purpose of these Regulations is to establish standards of safety which provide an acceptable level of control of the radiation hazards to persons, property and the environment that are associated with the transport of radioactive material. They apply to the transport by land, water or air, including transport on own account, of radioactive material other than that which is an integral part of the means of transport. Transport includes any operation incidental to the whole course of carriage, such as loading, unloading and storage in transit. The term includes both normal transport and that under accident conditions

Protocol for physical assessment in patients with fibromyalgia syndrome.

Science.gov (United States)

dos Santos, Michele R; Moro, Claudia M C; Vosgerau, Dilmeire S R

2014-01-01

Fibromyalgia syndrome (FMS) is a chronic disease that causes pain and fatigue, presenting a negative impact on quality of life. Exercise helps maintaining physical fitness and influences directly on the improvement of quality of life. Develop a protocol for health-related physical fitness assessment of patients with FMS with tests that are feasible and appropriate for this population. An exploratory and analytical literature review was performed, seeking to determine the tests used by the scientific community. With this in mind, we performed a literature revision through the use of virtual libraries databases: PubMed, Bireme, Banco de Teses e Dissertações da Capes and Biblioteca Digital Brasileira de Teses e Dissertações, published in between 1992-2012. A variety of tests was found; the following, by number of citations, stood out: Body Mass Index (BMI) and bioimpedance; 6-minute walk; handgrip strength (dynamometer, 1RM [Repetition Maximum]); Sit and reach and Shoulder flexibility; Foot Up and Go, and Flamingo balance. These are the tests that should make up the protocol for the physical evaluation of FMS patients, emphasizing their ease of use.

Protocols for Thermoluminescence and Optically Stimulated Luminescence Research at DOSAR

International Nuclear Information System (INIS)

Bernal, SM

2004-01-01

The Life Sciences Division (LSD) of Oak Ridge National Laboratory (ORNL) has a long record of radiation dosimetry research at the Dosimetry Applications Research (DOSAR) facility complex. These facilities have been used by a broad segment of the research community to perform a variety of experiments in areas including, but not limited to, radiobiology, radiation dosimeter and instrumentation development and calibration, and materials testing in a variety of radiation environments. Collaborations with the University of Tennessee-Knoxville (UTK) have also led to important contributions in the area of archaeometry, particularly as it relates to the use of radiation dosimetry to date archaeological artifacts. This manual is to serve as the primary instruction and operation manual for dosimetric and archaeometric research at DOSAR involving thermoluminescence (TL) and optically stimulated luminescence (OSL). Its purpose is to (1) provide protocols for common practices associated with the research, (2) outline the relevant organizational structure, (3) identify the Quality Assurance plan, and (4) describe all the procedures, operations, and responsibilities for safe and proper operation of associated equipment. Each person who performs research at DOSAR using TL/OSL equipment is required to read the latest revision of this manual and be familiar with its contents, and to sign and date the manual's master copy indicating that the manual has been read and understood. The TL/OSL Experimenter is also required to sign the manual after each revision to signify that the changes are understood. Each individual is responsible for completely understanding the proper operation of the TL/OSL equipment used and for following the guidance contained within this manual. The instructions, protocols, and operating procedures in this manual do not replace, supersede, or alter the hazard mitigation controls identified in the Research Safety Summary (''Thermoluminescence/Optically Stimulated

Implementation of the 1990 Recommendations of ICRP in the countries of the European community

International Nuclear Information System (INIS)

Stather, J.W.; Clarke, R.H.

1992-01-01

The International Commission on Radiological Protection (ICRP) has published new Recommendations in ICRP Publication 60. These 1990 Recommendations provide a System of Radiological Protection that takes account of the most recent information on the effects on health of exposure to ionizing radiation and trends in the setting of safety standards. Within the European Community the Recommendations of ICRP are implemented through a Euratom Directive which is binding on Member States and which is at present being revised by the Article 31 Group and must eventually be ratified by the Council of Ministers. It is expected that the new Directive will broadly endorse the principles of protection given in the 1990 recommendations together with the dose limits for both workers and members of the public. There are likely to be some modifications to the 1990 Recommendations that are mainly related to their practical application. As it will be some time before the Directive is incorporated in national regulations a number of Member States have taken independent initiatives. The development of dose constraints for occupational, medical and public exposure is being seen by national organizations in many countries as a significant new approach to improving standards of radiation protection. (author)

The UK's Draft Guidance for Health in SEA in light of HIA community priorities and the UNECE SEA Protocol

International Nuclear Information System (INIS)

Posas, Paula J.

2011-01-01

The Protocol on Strategic Environmental Assessment (SEA) to the United Nations Economic Commission for Europe (UNECE) Espoo Convention came into force on 11 July 2010. This Protocol, to which the European Union is party, gives a legal basis for enhanced attention to human health in the SEA process. In this context, the United Kingdom's (UK's) 2007 Draft Guidance on Health in Strategic Environmental Assessment represents an important early government-led effort to bring health issues and public health considerations more significantly into the SEA process. Since the UK is a worldwide leader in environmental and various other types of impact assessment, and since other countries may eventually consider its example in efforts to meet UNECE SEA Protocol requirements, scrutiny of its outputs is warranted. This paper thus examines the UK's Draft Guidance from both HIA academic and practitioner perspectives. First it assesses the extent to which the Draft Guidance reflects recent issues and lessons learned in the academic literature. In order to make the assessment, a meta-analysis of 70 HIA-related peer-reviewed articles was undertaken to extract authors' priority recommendations. These recommendations were subsequently compared with the contents of the Draft Guidance. Secondly, the Draft Guidance was assessed for its accordance with recommendations of the UNECE SEA Protocol background paper written by two HIA practitioners. Overall, the Draft Guidance's accordance with both sets of recommendations was found to be high, with only a few easily-remedied gaps. This evaluation suggests that the UK's Draft Guidance can be a useful starting point in the creation of future guidance on health in SEA in both the UK and other countries.

Deciding to adopt revised and new psychological and neuropsychological tests: an inter-organizational position paper.

Science.gov (United States)

Bush, Shane S; Sweet, Jerry J; Bianchini, Kevin J; Johnson-Greene, Doug; Dean, Pamela M; Schoenberg, Mike R

2018-04-01

Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making. Ethical and professional issues were reviewed and considered. The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.

3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

Directory of Open Access Journals (Sweden)

Andrew J. Hughes

2017-01-01

Full Text Available Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12®. The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11).

Science.gov (United States)

Krueger, Richard B; Reed, Geoffrey M; First, Michael B; Marais, Adele; Kismodi, Eszter; Briken, Peer

2017-07-01

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

[Current recommendations for basic/advanced life support : Addressing unanswered questions and future prospects].

Science.gov (United States)

Fink, K; Schmid, B; Busch, H-J

2016-11-01

The revised guidelines for cardiopulmonary resuscitation were implemented by the European Resuscitation Council (ERC) in October 2015. There were few changes concerning basic and advanced life support; however, some issues were clarified compared to the ERC recommendations from 2010. The present paper summarizes the procedures of basic and advanced life support according to the current guidelines and highlights the updates of 2015. Furthermore, the article depicts future prospects of cardiopulmonary resuscitation that may improve outcome of patients after cardiac arrest in the future.

Revised IAEA Code of Conduct on the Safety and Security of Radioactive Sources

International Nuclear Information System (INIS)

Wheatley, J. S.

2004-01-01

The revised Code of Conduct on the Safety and Security of Radioactive Sources is aimed primarily at Governments, with the objective of achieving and maintaining a high level of safety and security of radioactive sources through the development, harmonization and enforcement of national policies, laws and regulations; and through the fostering of international co-operation. It focuses on sealed radioactive sources and provides guidance on legislation, regulations and the regulatory body, and import/export controls. Nuclear materials (except for sources containing 239Pu), as defined in the Convention on the Physical Protection of Nuclear Materials, are not covered by the revised Code, nor are radioactive sources within military or defence programmes. An earlier version of the Code was published by IAEA in 2001. At that time, agreement was not reached on a number of issues, notably those relating to the creation of comprehensive national registries for radioactive sources, obligations of States exporting radioactive sources, and the possibility of unilateral declarations of support. The need to further consider these and other issues was highlighted by the events of 11th September 2001. Since then, the IAEA's Secretariat has been working closely with Member States and relevant International Organizations to achieve consensus. The text of the revised Code was finalized at a meeting of technical and legal experts in August 2003, and it was submitted to IAEA's Board of Governors for approval in September 2003, with a recommendation that the IAEA General Conference adopt it and encourage its wide implementation. The IAEA General Conference, in September 2003, endorsed the revised Code and urged States to work towards following the guidance contained within it. This paper summarizes the history behind the revised Code, its content and the outcome of the discussions within the IAEA Board of Governors and General Conference. (Author) 8 refs

Development of Characterization Protocol for Mixed Liquid Radioactive Waste Classification

International Nuclear Information System (INIS)

Norasalwa Zakaria; Syed Asraf Wafa; Wo, Y.M.; Sarimah Mahat; Mohamad Annuar Assadat Husain

2017-01-01

Mixed organic liquid waste generated from health-care and research activities containing tritium, carbon-14, and other radionuclide posed specific challenges in its management. Often, this waste becomes legacy waste in many nuclear facilities and being considered as 'problematic' waste. One of the most important recommendations made by IAEA is to perform multistage processes aiming at declassification of the waste. At this moment, approximately 3000 bottles of mixed liquid waste, with estimated volume of 6000 litres are currently stored at the National Radioactive Waste Management Centre, Malaysia and some have been stored for more than 25 years. The aim of this study is to develop a characterization protocol towards reclassification of these wastes. The characterization protocol entails waste identification, waste screening and segregation, and analytical radionuclides profiling using analytical procedures involving gross alpha beta, and gamma spectrometry. The results obtained from the characterization protocol are used to establish criteria for speedy classification of the waste. (author)

Development of characterization protocol for mixed liquid radioactive waste classification

Energy Technology Data Exchange (ETDEWEB)

Zakaria, Norasalwa, E-mail: norasalwa@nuclearmalaysia.gov.my [Waste Technology Development Centre, Malaysian Nuclear Agency, 43000 Kajang, Selangor (Malaysia); Wafa, Syed Asraf [Radioisotop Technology and Innovation, Malaysian Nuclear Agency, 43000 Kajang, Selangor (Malaysia); Wo, Yii Mei [Radiochemistry and Environment, Malaysian Nuclear Agency, 43000 Kajang, Selangor (Malaysia); Mahat, Sarimah [Material Technology Group, Malaysian Nuclear Agency, 43000 Kajang, Selangor (Malaysia)

2015-04-29

Mixed liquid organic waste generated from health-care and research activities containing tritium, carbon-14, and other radionuclides posed specific challenges in its management. Often, these wastes become legacy waste in many nuclear facilities and being considered as ‘problematic’ waste. One of the most important recommendations made by IAEA is to perform multistage processes aiming at declassification of the waste. At this moment, approximately 3000 bottles of mixed liquid waste, with estimated volume of 6000 litres are currently stored at the National Radioactive Waste Management Centre, Malaysia and some have been stored for more than 25 years. The aim of this study is to develop a characterization protocol towards reclassification of these wastes. The characterization protocol entails waste identification, waste screening and segregation, and analytical radionuclides profiling using various analytical procedures including gross alpha/ gross beta, gamma spectrometry, and LSC method. The results obtained from the characterization protocol are used to establish criteria for speedy classification of the waste.

Supporting documentation for the 1997 revision to the DOE Insulation Fact Sheet

Energy Technology Data Exchange (ETDEWEB)

Stovall, T.K.

1997-08-22

The Department of Energy (DOE) Insulation Fact Sheet has been revised to reflect developments in energy conservation technology and the insulation market. A nationwide insulation cost survey was made by polling insulation contractors and builders, and the results are reported here. These costs, along with regional weather data, regional fuel costs, and fuel-specific system efficiencies were used to produce recommended insulation levels for new and existing houses. This report contains all of the methodology, algorithms, assumptions, references, and data resources that were used to produce the 1997 DOE Insulation Fact Sheet.

An approach to standardization of urine sediment analysis via suggestion of a common manual protocol.

Science.gov (United States)

Ko, Dae-Hyun; Ji, Misuk; Kim, Sollip; Cho, Eun-Jung; Lee, Woochang; Yun, Yeo-Min; Chun, Sail; Min, Won-Ki

2016-01-01

The results of urine sediment analysis have been reported semiquantitatively. However, as recent guidelines recommend quantitative reporting of urine sediment, and with the development of automated urine sediment analyzers, there is an increasing need for quantitative analysis of urine sediment. Here, we developed a protocol for urine sediment analysis and quantified the results. Based on questionnaires, various reports, guidelines, and experimental results, we developed a protocol for urine sediment analysis. The results of this new protocol were compared with those obtained with a standardized chamber and an automated sediment analyzer. Reference intervals were also estimated using new protocol. We developed a protocol with centrifugation at 400 g for 5 min, with the average concentration factor of 30. The correlation between quantitative results of urine sediment analysis, the standardized chamber, and the automated sediment analyzer were generally good. The conversion factor derived from the new protocol showed a better fit with the results of manual count than the default conversion factor in the automated sediment analyzer. We developed a protocol for manual urine sediment analysis to quantitatively report the results. This protocol may provide a mean for standardization of urine sediment analysis.

Education and training requirements in the revised European Basic Safety Standards Directive

International Nuclear Information System (INIS)

Mundigl, S.

2009-01-01

The European Commission is currently developing a modified European Basic Safety Standards Directive covering two major objectives: the consolidation of existing European Radiation Protection legislation, and the revision of the European Basic Safety Standards. The consolidation will merge the following five Directives into one single Directive: the Basic Safety Standards Directive, the Medical Exposures Directive, the Public Information Directive, the Outside Workers Directive, and the Directive on the Control of high-activity sealed radioactive sources and orphan sources. The revision of the European Basic Safety Standards will take account of the latest recommendations by the International Commission on Radiological Protection (ICRP) and shall improve clarity of the requirements where appropriate. It is planned to introduce more binding requirements on natural radiation sources, on criteria for clearance, and on the cooperation between Member States for emergency planning and response, as well as a graded approach for regulatory control. One additional goal is to achieve greater harmonisation between the European BSS and the international BSS. Following a recommendation from the Article 31 Group of Experts, the current draft of the modified BSS will highlight the importance of education and training by dedicating a specific title to radiation protection education, training and information. This title will include a general requirement on the Member States to ensure the establishment of an adequate legislative and administrative framework for providing appropriate radiation protection education, training and information. In addition, there will be specific requirements on training in the medical field, on information and training of workers in general, of workers potentially exposed to orphan sources, and to emergency workers. The revised BSS directive will include requirements on the competence of a radiation protection expert (RPE) and of a radiation protection

Recommendations to designers aimed at minimizing radiation dose incurred in operation, maintenance, inspection and repair of light-water reactors

International Nuclear Information System (INIS)

1978-01-01

In the framework of the exchange of experience between nuclear power plant operators organized by the services of the Commission of the European Communities an ad-hoc working party elaborated recommendations particularly directed to those concerned with design of light water reactor plants. The necessary design measures which should be followed to minimize radiation dose incurred in operation, maintenance, inspection and repair of such reactors are listed. The recommendations are based on recent views expressed by operating utilities within the Community. It is intended to revise these recommendations at suitable intervals in order to make use of the most recent experience and to keep the report up to date with the actual state of art in nuclear technology

The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009.

Science.gov (United States)

Kreyenbuhl, Julie; Buchanan, Robert W; Dickerson, Faith B; Dixon, Lisa B

2010-01-01

The Schizophrenia Patient Outcomes Research Team (PORT) project has played a significant role in the development and dissemination of evidence-based practices for schizophrenia. In contrast to other clinical guidelines, the Schizophrenia PORT Treatment Recommendations, initially published in 1998 and first revised in 2003, are based primarily on empirical data. Over the last 5 years, research on psychopharmacologic and psychosocial treatments for schizophrenia has continued to evolve, warranting an update of the PORT recommendations. In consultation with expert advisors, 2 Evidence Review Groups (ERGs) identified 41 treatment areas for review and conducted electronic literature searches to identify all clinical studies published since the last PORT literature review. The ERGs also reviewed studies preceding 2002 in areas not covered by previous PORT reviews, including smoking cessation, substance abuse, and weight loss. The ERGs reviewed over 600 studies and synthesized the research evidence, producing recommendations for those treatments for which the evidence was sufficiently strong to merit recommendation status. For those treatments lacking empirical support, the ERGs produced parallel summary statements. An Expert Panel consisting of 39 schizophrenia researchers, clinicians, and consumers attended a conference in November 2008 in which consensus was reached on the state of the evidence for each of the treatment areas reviewed. The methods and outcomes of the update process are presented here and resulted in recommendations for 16 psychopharmacologic and 8 psychosocial treatments for schizophrenia. Another 13 psychopharmacologic and 4 psychosocial treatments had insufficient evidence to support a recommendation, representing significant unmet needs in important treatment domains.

Revised FAO methodology for crop-water requirements

International Nuclear Information System (INIS)

Smith, M.; Allen, R.; Pereira, L.

1998-01-01

In the early 1970s, the Food and Agriculture Organization of the United Nations (FAO) developed a practical procedure to estimate crop-water requirements that has become a widely accepted standard, in particular for irrigation studies. Since its publication as FAO Irrigation and Drainage Paper, new concepts and advances in research have revealed shortcomings in the methodology and made necessary a review and revision. A consultation of experts organized by FAO recommended the adoption of the Penman-Monteith combination method as a new standard for reference evapotranspiration, and advised on procedures for calculation of the various parameters. By defining the reference crop as hypothetical with an assumed height of 0.12 m, a surface resistance of 70 s m -1 and an albedo of 0.23, closely resembling the evaporation of an extensive surface of actively growing and adequately watered green grass of uniform height, the FAO Penman-Monteith method was developed, overcoming previous deficiencies and providing values more consistent with actual crop-water-use data worldwide. Furthermore, recommendations have been developed for the use of the FAO Penman-Monteith method with limited climatic data, largely eliminating the need for any other reference evapotranspiration methods and creating a consistent and transparent basis for a globally valid standard for crop-water-requirement calculations. (author)

48 CFR 15.307 - Proposal revisions.

Science.gov (United States)

2010-10-01

... AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 15.307 Proposal revisions. (a) If an... allow proposal revisions to clarify and document understandings reached during negotiations. At the... submit a final proposal revision. The contracting officer is required to establish a common cut-off date...

International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol

DEFF Research Database (Denmark)

Rusbridge, Clare; Long, Sam; Jovanovik, Jelena

2015-01-01

Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials...... sequences, imaging planes and/or particular techniques used in performing the MRI scan. As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification...... of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can...

Validation of the Konsung QD217A for clinical use and self-measurement according to the European Society of Hypertension International Protocol.

Science.gov (United States)

Wu, Ning; Zhang, Xuezhong; Wang, Wen; Zhang, Hongye

2015-08-01

This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure (BP) monitor Konsung QD217A for home BP monitoring according to the European Society of Hypertension International Protocol revision 2010. Three trained observers validated the performance of these devices by comparing the measurements obtained from these devices with those taken using a standard mercury sphygmomanometer. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were sequentially measured in 33 participants using a standard mercury sphygmomanometer and the Konsung QD217A device. A total of 99 pairs of comparisons were obtained from 33 participants. The QD217A device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and the observers within a range of 5, 10 and 15 mmHg was 70/99, 92/99 and 96/99, respectively, for SBP and 80/99, 94/99 and 99/99, respectively, for DBP. The device also achieved the targets in part 2 of the validation study. A total of 27 and 31 participants for SBP and DBP, respectively, showed at least two of the three device-observers differences within 5 mmHg (required≥24). The number of participants without device-observer difference within 5 mmHg was one for SBP and one for DBP (required≤3). The Konsung upper arm BP monitor QD217A has passed the International Protocol requirements and it can be recommended for clinical use and self-measurement in adults. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Revised Bethesda Guidelines for Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) and Microsatellite Instability

Science.gov (United States)

Umar, Asad; Boland, C. Richard; Terdiman, Jonathan P.; Syngal, Sapna; de la Chapelle, Albert; Rüschoff, Josef; Fishel, Richard; Lindor, Noralane M.; Burgart, Lawrence J.; Hamelin, Richard; Hamilton, Stanley R.; Hiatt, Robert A.; Jass, Jeremy; Lindblom, Annika; Lynch, Henry T.; Peltomaki, Païvi; Ramsey, Scott D.; Rodriguez-Bigas, Miguel A.; Vasen, Hans F. A.; Hawk, Ernest T.; Barrett, J. Carl; Freedman, Andrew N.; Srivastava, Sudhir

2010-01-01

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is a common autosomal dominant syndrome characterized by early age at onset, neoplastic lesions, and microsatellite instability (MSI). Because cancers with MSI account for approximately 15% of all colorectal cancers and because of the need for a better understanding of the clinical and histologic manifestations of HNPCC, the National Cancer Institute hosted an international workshop on HNPCC in 1996, which led to the development of the Bethesda Guidelines for the identification of individuals with HNPCC who should be tested for MSI. To consider revision and improvement of the Bethesda Guidelines, another HNPCC workshop was held at the National Cancer Institute in Bethesda, MD, in 2002. In this commentary, we summarize the Workshop presentations on HNPCC and MSI testing; present the issues relating to the performance, sensitivity, and specificity of the Bethesda Guidelines; outline the revised Bethesda Guidelines for identifying individuals at risk for HNPCC; and recommend criteria for MSI testing. PMID:14970275

[Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery].

Science.gov (United States)

Cánovas Gaillemin, B; Sastre Martos, J; Moreno Segura, G; Llamazares Iglesias, O; Familiar Casado, C; Abad de Castro, S; López Pardo, R; Sánchez-Cabezudo Muñoz, M A

2011-01-01

Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life.

7 CFR 3015.115 - Budget revisions.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2) of...

Comparison of the ‘ESPEN guidelines on nutrition in cancer patients 2016’ with the recommendations of the Dutch Dietitians in Oncology Group

NARCIS (Netherlands)

Kok, Annemieke; Doornink, Niki; Ariens, Marleen; Beijer, Sandra; van den Berg, Manon; Jager-Wittenaar, Harriët; van Lieshout, Rianne; Sijtema, Bea; van Veen, Merel; Breedveld-Peters, Jose

Rationale: In 2016, a completely revised second version of the ‘Handbook Nutrition in Cancer’ (HNC, in Dutch) by the Dutch Dietitians Oncology Group (DDOG) was published. In this project, the DDOG evaluated similarities and potential discrepancies between DDOG recommendations and the ESPEN

The Impact of the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children Food Package Revisions on Participants: A Systematic Review.

Science.gov (United States)

Schultz, Daniel Joseph; Byker Shanks, Carmen; Houghtaling, Bailey

2015-11-01

For the first time since 1980, the US Department of Agriculture Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policies were revised in 2009 to meet the Institute of Medicine's nutrition recommendations. These changes included increases in fruits, vegetables, whole grains, and low-fat dairy to improve nutrition and health of WIC participants. Our systematic review of the literature assessed the influence that the 2009 WIC food package revisions have had on dietary intake, healthy food and beverage availability, and breastfeeding participation. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Four electronic databases were searched between April 1 and 30, 2014, for peer-reviewed research. Two reviewers screened the articles, extracted the data, and established inter-rater reliability by discussing and resolving discrepancies. Twenty articles were included that met our inclusion criteria. Nine of the studies analyzed changes in dietary intake, eight examined changes in healthy food and beverage availability, and three evaluated breastfeeding participation exclusively. The review demonstrated an improved dietary intake and an increase in the availability of healthier foods and beverages in authorized WIC stores. The revised food package was also associated with improved dietary intake of WIC participants. Mixed results were demonstrated in regard to improved breastfeeding outcomes. Further research is needed to assess the influence of WIC 2009 food package revisions on breastfeeding outcomes and to make conclusions about broad nutrition-related implications. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

A study on scar revision

Directory of Open Access Journals (Sweden)

Ashutosh Talwar

2016-04-01

Full Text Available Introduction: Scars are psychologically distressing for the patients and have an impact on the quality of life and self esteem of the patients. Scar revision is an aesthetic skill which is mastered by plastic surgeons and encroached now by dermatosurgeons. Scars on the face are aesthetically unacceptable and various techniques have been improvised for making a scar aesthetically acceptable. Various types of techniques are used for scar revision like W plasty, Z plasty and VY plasty. Aims: To see the efficacy of various scar revision techniques including Z plasty, VY plasty and W plasty in 30 patients with disfiguring scars. Methods: We selected twenty patients of disfiguring scars for the study. The scars from various causes including trauma and burns were included in our study. Various techniques of scar revision include Z plasty, W plasty and VY plasty were performed according to the type and site of scar. Results: Male: female was 1.5: 1. The scar revision surgery yielded excellent results with minimal complications including haematoma formation, secondary infection and delayed healing seen in 5% patients each. Regarding the efficacy of scar revision, excellent improvement was seen in 60% patients, moderate improvement was seen in 30% patients and mild improvement was seen in 10% patients. Conclusions: Dermatologists can employ a number of surgical scar revision techniques. While some are better suited to treat specific types of scars, they can be used in combination with each other or with adjunctive therapies to achieve optimal results.

Development and implementation of the Dutch protocol for rehabilitative management in amyotrophic lateral sclerosis.

Science.gov (United States)

van den Berg, J P; de Groot, I J M; Joha, B C; van Haelst, J M; van Gorcom, P; Kalmijn, S

2004-12-01

In the Netherlands, rehabilitation care plays an important role in the symptomatic and palliative treatment of ALS patients. However, until 1999 there were no guidelines or practice parameters available for the management of ALS. Therefore, the Dutch protocol for rehabilitative management in ALS was developed. We describe the development process, the outcome and implementation of the protocol. A concept management protocol was written and the Delphi method was selected to develop the protocol further. This method comprises repetitive discussion sessions from postulates, using a combination of written questionnaires and work-conferences. Between 80 and 90 persons (rehabilitation team members of different professional backgrounds and neurologists) were involved in this process. The protocol was implemented by sending it to all consultants in rehabilitation medicine in the Netherlands; they were asked to inform all the treatment team members about the final protocol and to implement it in their treatment of ALS patients. The protocol was developed in 1999, implemented in 2000 and evaluated in 2001. Recommendations for improvement were made during the evaluation and improvements are currently being developed by an expert group. The protocol is widely used (88.9%) by consultants in rehabilitation medicine and their treatment teams in the Netherlands. The Dutch protocol for rehabilitative management was developed to provide an optimal and adequate care plan for patients with ALS. It is widely used in the Netherlands.

Proposal of recommendations for quality control in computerized tomography, with emphasis in new technologies

International Nuclear Information System (INIS)

Rodrigues, Marlon da Silva Brandao; Neves, Camila Nascimento das

2016-01-01

The use of computed tomography (CT) has continuously grown over the years and expanding its applications in different medical procedures. As a result, there was an increase of frequency and in collective dose. One of the strategies to maximize the benefits of this important imaging modality is the implementation of optimization of protection programs. As part of this process, a quality control should be established to ensure the correct performance of the scanner. Quality control protocols can be very useful to carry out all tests in a standard methodology and well-established tolerance values. However, to keep up with the constant advances in technology, these protocols must be constantly reviewed and updated to allow its application in different existing models. The objective of this work is to develop a quality control protocol based on international recommendations and in national standards. (author)

Summary and recommendations of the NRC/INEL Activated Carbon Testing Program

International Nuclear Information System (INIS)

Scarpellino, C.D.; Sill, C.W.

1986-01-01

The Committee on Nuclear Air and Gas Treatment (CONAGT) of the American Society of Mechanical Engineers (ASME) sponsored an interlaboratory testing program, round-robin, of nuclear-grade activated carbon. The results of this round-robin revealed gross differences in penetration of radio-labeled methyl iodide as measured by the various laboratories when using Method A of the ASTM D-3803-79 Standard. These differences prompted the Nuclear Regulatory Commission (NRC) to establish the NRC/INEL Activated Carbon Testing Program to determine the causes of these discrepancies and to provide recommendations that could lead to an accurate and reliable testing procedure that would ensure an adequate method for assessing the capability of activated carbon to remove radioiodine from gas streams within commercial nuclear power plants. The NRC/INEL Activated Carbon Testing Program has conducted formal and informal interlaboratory comparisons to identify problems with the test method and its application and to assess the effectiveness of changes to procedures and equipment voluntarily implemented by commercial laboratories to mitigate the disparity of test results. The results of the first formal NRC/INEL Interlaboratory Comparison (IC) essentially verified the CONAGT round-robin results despite the use of a detailed test protocol. This data indicated that many of the participating laboratories probably had been operating outside the ASTM specifications for relative humidity (RH) and flow. In addition, this process provided information which was used to modify the testing protocol employed for the second NRC/INEL Interlaboratory Comparison (IC-2) to make it more rugged and reliable. These changes to the protocol together with the results of INEL sensitivity testing are the basis for the recommendations presented

Validation of four devices: Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670 for home blood pressure measurement according to the European Society of Hypertension International Protocol

Directory of Open Access Journals (Sweden)

Topouchian J

2014-01-01

Full Text Available Jirar Topouchian,1 Davide Agnoletti,1 Jacques Blacher,1 Ahmed Youssef,1 Mirna N Chahine,2,3 Isabel Ibanez,3 Nathalie Assemani,3 Roland Asmar1–31Centre de Diagnostic, Hôpital Hôtel-Dieu, Paris, France; 2Faculty of Medicine of the Lebanese University, 3Foundation-Medical Research Institutes, Beirut, LebanonBackground: Four oscillometric devices, including the Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670, designed for self-blood pressure measurement (SBPM were evaluated according to the European Society of Hypertension (ESH International Protocol Revision 2010 in four separate studies.Methods: The four devices measure brachial blood pressure (BP using the oscillometric method. The Withings BP-800 has to be connected to an Apple® iOS device such as an iPhone®, iPad®, or iPod®. The ESH International Protocol Revision 2010 includes a total number of 33 subjects. The difference between observer and device BP values was calculated for each measure. Ninety-nine pairs of BP differences were classified into three categories (≤5 mmHg, ≤10 mmHg, ≤15 mmHg. The protocol procedures were followed precisely in each of the four studies.Results: All four tested devices passed the validation process. The mean differences between the device and mercury readings were: −1.8±5.1 mmHg and −0.4±2.8 mmHg for systolic and diastolic BP, respectively, using the Omron M6 Comfort device; 2.5±4.6 mmHg and −1.2±4.3 mmHg for the Omron HEM-7420 device; −0.2±5.0 mmHg and 0.4±4.2 mmHg for the Withings BP-800 device; and 3.0±5.3 mmHg and 0.3±5.2 mmHg for the Polygreen KP-7670 device.Conclusion: Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670 readings differing by less than 5 mmHg, 10 mmHg, and 15 mmHg fulfill the ESH International Protocol Revision 2010 requirements, and therefore are suitable for use by patients for SBPM, if used correctly.Keywords: Omron M6 Comfort, Omron HEM-7420, Withings BP-800

Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting.

Science.gov (United States)

Eloma, Amanda S; Tucciarone, Jason M; Hayes, Edmund M; Bronson, Brian D

2018-01-01

The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal. To evaluate the prescribing patterns and appropriate use of the CIWA-Ar protocol in a general hospital setting, as determined by the presence or absence of documented AWS risk factors, patients' ability to communicate, and provider awareness of the CIWA-Ar order. This retrospective chart review included 118 encounters of hospitalized patients placed on a CIWA-Ar protocol during one year. The following data were collected for each encounter: patient demographics, admitting diagnosis, ability to communicate, and admission blood alcohol level; and medical specialty of the clinician ordering CIWA-Ar, documentation of the presence or absence of established AWS risk factors, specific parameters of the protocol ordered, service admitted to, provider documentation of awareness of the active protocol within 48 h of initial order, total benzodiazepine dose equivalents administered and associated adverse events. 57% of patients who started on a CIWA-Ar protocol had either zero or one documented risk factor for AWS (19% and 38% respectively). 20% had no documentation of recent alcohol use. 14% were unable to communicate. 19% of medical records lacked documentation of provider awareness of the ordered protocol. Benzodiazepine associated adverse events were documented in 15% of encounters. The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.

Dietary Recommendations for Cyclists during Altitude Training

Science.gov (United States)

Michalczyk, Małgorzata; Czuba, Miłosz; Zydek, Grzegorz; Zając, Adam; Langfort, Józef

2016-01-01

The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like “live high, train high” (LH-TH), “live high, train low” (LH-TL) or “intermittent hypoxic training” (IHT). Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented. PMID:27322318

Dietary Recommendations for Cyclists during Altitude Training.

Science.gov (United States)

Michalczyk, Małgorzata; Czuba, Miłosz; Zydek, Grzegorz; Zając, Adam; Langfort, Józef

2016-06-18

The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like "live high, train high" (LH-TH), "live high, train low" (LH-TL) or "intermittent hypoxic training" (IHT). Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented.

Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions

Directory of Open Access Journals (Sweden)

Rajendra K Ghritlaharey

2012-01-01

Full Text Available Background: The aim of this study was to review the management of ventriculoperitoneal (VP shunt complications in children. Patients and Methods: During the last 5 years (January 1, 2006 to December 31, 2010, 236 VP shunt operations were performed in children under 12 years of age; of these, 40 (16.94% developed shunt complications and those who underwent VP shunt revisions were studied. Results: This prospective study included 40 (28 boys and 12 girls children and required 48 shunt revisions. Complications following VP shunts that required shunt revisions were peritoneal catheter/peritoneal end malfunction (18, shunt/shunt tract infections (7, extrusion of peritoneal catheter through anus (5, ventricular catheter malfunction (4, cerebrospinal fluid (CSF leak from abdominal wound (4, shunt system failure (2, ventricular end/shunt displacement (2, CSF pseudocysts peritoneal cavity (2, extrusion of peritoneal catheter from neck, chest, abdominal scar and through umbilicus, one each. Four-fifth of these shunt complications occurred within 6 months of previous surgery. Surgical procedures done during shunt revisions in order of frequency were revision of peritoneal part of shunt (27, 56.25%, revision of entire shunt system (6, 12.5%, extra ventricular drainage and delayed re-shunt (5, 10.41%, shunt removal and delayed re-shunt (5, 10.41%, opposite side shunting (2, 4.16%, cysts excision and revision of peritoneal catheter (2, 4.16% and revision of ventricular catheter (1, 2.08%. The mortalities following VP shunt operations were 44 (18.64% and following shunt revisions were 4 (10%. Conclusions: VP shunt done for hydrocephalus in children is not only prone for complications and need for revision surgery but also associated with considerable mortality.

Performance Improvement Based Authentication Protocol for Intervessel Traffic Service Data Exchange Format Protocol Based on U-Navigation System in WoT Environment

Directory of Open Access Journals (Sweden)

Byunggil Lee

2014-01-01

Full Text Available International Association of Lighthouse Authorities (IALA is developing the standard intersystem VTS exchange format (IVEF protocol for exchange of navigation and vessel information between VTS systems and between VTS and vessels. VTS (vessel traffic system is an important marine traffic monitoring system which is designed to improve the safety and efficiency of navigation and the protection of the marine environment. And the demand of Inter-VTS networking has been increased for realization of e-Navigation as shore side collaboration for maritime safety. And IVEF (inter-VTS data exchange format for inter-VTS network has become a hot research topic of VTS system. Currently, the IVEF developed by the International Association of Lighthouse Authorities (IALA does not include any highly trusted certification technology for the connectors. The output of standardization is distributed as the IALA recommendation V-145, and the protocol is implemented with an open source. The IVEF open source, however, is the code used to check the functions of standard protocols. It is too slow to be used in the field and requires a large memory. And the vessel traffic information requires high security since it is highly protected by the countries. Therefore, this paper suggests the authentication protocol to increase the security of the VTS systems using the main certification server and IVEF.

Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology

Science.gov (United States)

Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.

2016-01-01

The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

Validation of four devices: Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670 for home blood pressure measurement according to the European Society of Hypertension International Protocol.

Science.gov (United States)

Topouchian, Jirar; Agnoletti, Davide; Blacher, Jacques; Youssef, Ahmed; Chahine, Mirna N; Ibanez, Isabel; Assemani, Nathalie; Asmar, Roland

2014-01-01

Four oscillometric devices, including the Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670, designed for self-blood pressure measurement (SBPM) were evaluated according to the European Society of Hypertension (ESH) International Protocol Revision 2010 in four separate studies. The four devices measure brachial blood pressure (BP) using the oscillometric method. The Withings BP-800 has to be connected to an Apple® iOS device such as an iPhone®, iPad®, or iPod®. The ESH International Protocol Revision 2010 includes a total number of 33 subjects. The difference between observer and device BP values was calculated for each measure. Ninety-nine pairs of BP differences were classified into three categories (≤5 mmHg, ≤10 mmHg, ≤15 mmHg). The protocol procedures were followed precisely in each of the four studies. All four tested devices passed the validation process. The mean differences between the device and mercury readings were: -1.8±5.1 mmHg and -0.4±2.8 mmHg for systolic and diastolic BP, respectively, using the Omron M6 Comfort device; 2.5±4.6 mmHg and -1.2±4.3 mmHg for the Omron HEM-7420 device; -0.2±5.0 mmHg and 0.4±4.2 mmHg for the Withings BP-800 device; and 3.0±5.3 mmHg and 0.3±5.2 mmHg for the Polygreen KP-7670 device. Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670 readings differing by less than 5 mmHg, 10 mmHg, and 15 mmHg fulfill the ESH International Protocol Revision 2010 requirements, and therefore are suitable for use by patients for SBPM, if used correctly.

Cochlear implant revision surgeries in children.

Science.gov (United States)

Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo

2018-02-16

The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

An ameliorative protocol for the quantification of purine 5',8-cyclo-2'-deoxynucleosides in oxidized DNA

Science.gov (United States)

Terzidis, Michael; Chatgilialoglu, Chryssostomos

2015-07-01

5',8-Cyclo-2'-deoxyadenosine (cdA) and 5',8-cyclo-2'-deoxyguanosine (cdG) are lesions resulting from hydroxyl radical (HO•) attack on the 5'H of the nucleoside sugar moiety and exist in both 5'R and 5'S diastereomeric forms. Increased levels of cdA and cdG are linked to Nucleotide Excision Repair mechanism deficiency and mutagenesis. Discrepancies in the damage measurements reported over recent years indicated the weakness of the actual protocols, in particular for ensuring the quantitative release of these lesions from the DNA sample and the appropriate method for their analysis. Herein we report the detailed revision leading to a cost-effective and efficient protocol for the DNA damage measurement, consisting of the nuclease benzonase and nuclease P1 enzymatic combination for DNA digestion followed by liquid chromatography isotope dilution tandem mass spectrometry analysis.

24 CFR 968.225 - Budget revisions.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

Protocol for Microplastics Sampling on the Sea Surface and Sample Analysis

Science.gov (United States)

Kovač Viršek, Manca; Palatinus, Andreja; Koren, Špela; Peterlin, Monika; Horvat, Petra; Kržan, Andrej

2016-01-01

Microplastic pollution in the marine environment is a scientific topic that has received increasing attention over the last decade. The majority of scientific publications address microplastic pollution of the sea surface. The protocol below describes the methodology for sampling, sample preparation, separation and chemical identification of microplastic particles. A manta net fixed on an »A frame« attached to the side of the vessel was used for sampling. Microplastic particles caught in the cod end of the net were separated from samples by visual identification and use of stereomicroscopes. Particles were analyzed for their size using an image analysis program and for their chemical structure using ATR-FTIR and micro FTIR spectroscopy. The described protocol is in line with recommendations for microplastics monitoring published by the Marine Strategy Framework Directive (MSFD) Technical Subgroup on Marine Litter. This written protocol with video guide will support the work of researchers that deal with microplastics monitoring all over the world. PMID:28060297

Breaking bad news-what patients want and what they get: evaluating the SPIKES protocol in Germany.

Science.gov (United States)

Seifart, C; Hofmann, M; Bär, T; Riera Knorrenschild, J; Seifart, U; Rief, W

2014-03-01

Evaluation of the SPIKES protocol, a recommended guideline for breaking bad news, is sparse, and information about patients' preferences for bad-news delivery in Germany is lacking. Being the first actual-theoretical comparison of a 'breaking bad news' guideline, the present study evaluates the recommended steps of the SPIKES protocol. Moreover, emotional consequences and quality of bad-news delivery are investigated. A total of 350 cancer patients answered the MABBAN (Marburg Breaking Bad News Scale), a questionnaire representing the six SPIKES subscales, asking for the procedure, perception and satisfaction of the first cancer disclosure and patient's assign to these items. Only 46.2% of the asked cancer patients are completely satisfied with how bad news had been broken to them. The overall quality is significantly related to the emotional state after receiving bad news (r = -0.261, P bad news were delivered, and the resulting rang list of patients' preferences indicates that the SPIKES protocol do not fully meet the priorities of cancer patients in Germany. It could be postulated that the low satisfaction of patients observed in this study reflects the highly significant difference between patients' preferences and bad-news delivery. Therefore, some adjunctions to the SPIKES protocol should be considered, including a frequent reassurance of listeners' understanding, the perpetual possibility to ask question, respect for prearrangement needs and the conception of bad-news delivery in a two-step procedure.

Cost savings using a protocol approach to manage anemia in a hemodialysis unit.

Science.gov (United States)

Charlesworth, Emily C; Richardson, Robert M; Battistella, Marisa

2014-01-01

National guidelines recommend using anemia management protocols to guide treatment. The objective of this study was to determine if an anemia management protocol would improve hemoglobin (Hgb) indices in hemodialysis patients and to measure whether the protocol would reduce the use and cost of darbepoetin alfa (DBO) and intravenous (IV) iron in hemodialysis patients. An anemia management protocol was created and implemented for hemodialysis patients at our institution. A retrospective observational review of the use of DBO and IV iron as well as changes in Hgb, transferrin saturation and ferritin in 174 patients was conducted 6 months before and after implementation of the anemia protocol. The number of Hgb measurements in the target range increased from 44.3 to 46.0% (p = 0.48) after protocol implementation. The mean weekly dose of DBO was reduced from 34.56 ± 31.12 to 31.11 ± 28.64 μg post-protocol implementation (p = 0.011), which translated to a cost savings of USD 41,649 over 6 months. The mean monthly IV iron dose also decreased from 139.56 ± 98.83 to 97.65 ± 79.05 mg (p DBO and iron agents while increasing the number of patients in the target Hgb range, which led to significant cost savings in the treatment of anemia.

Protocol for the estimation of average indoor radon-daughter concentrations: Second edition

International Nuclear Information System (INIS)

Langner, G.H. Jr.; Pacer, J.C.

1988-05-01

The Technical Measurements Center has developed a protocol which specifies the procedures to be used for determining indoor radon-daughter concentrations in support of Department of Energy remedial action programs. This document is the central part of the protocol and is to be used in conjunction with the individual procedure manuals. The manuals contain the information and procedures required to implement the proven methods for estimating average indoor radon-daughter concentration. Proven in this case means that these methods have been determined to provide reasonable assurance that the average radon-daughter concentration within a structure is either above, at, or below the standards established for remedial action programs. This document contains descriptions of the generic aspects of methods used for estimating radon-daughter concentration and provides guidance with respect to method selection for a given situation. It is expected that the latter section of this document will be revised whenever another estimation method is proven to be capable of satisfying the criteria of reasonable assurance and cost minimization. 22 refs., 6 figs., 3 tabs

Updating the U.S. SMART dispersant efficacy monitoring protocol

International Nuclear Information System (INIS)

Trudel, K.; Belore, R.; VanHaverbeke, M.; Mullin, J.

2009-01-01

The Special Monitoring of Applied Response Technologies (SMART) is a written dispersant effectiveness monitoring protocol developed in the United States in the mid 1990s. It has been the subject of considerable review and research since its development. This paper reported on the 2007-2008 review of the SMART dispersant effectiveness monitoring protocol which involved the following 3 tasks: (1) stakeholders reviewed their experience with SMART and identified the key deficiencies in the current protocol, (2) the SMART monitoring experience gathered during dispersant effectiveness testing at the Ohmsett National Oil Spill Response Test Facility was reviewed to evaluate the usefulness of existing SMART decision criteria, (3) available commercial off-the-shelf instruments (COTS) were surveyed to identify the instruments that might be more effective or simpler to use than those presently in use. The review concluded that the three-tiered approach in SMART was appropriate, but better guidance was needed for users. In addition, the fluorometer historically used for monitoring of dispersed oil was found to have several operating challenges and should be replaced with more modern equipment. It was recommended that all U.S. government sponsored monitoring teams work with identical instruments and operating protocols. The COTS survey identified 6 potentially suitable submersible and field-portable fluorometers and three particle-size analyzers. 26 refs., 5 tabs., 1 fig

An Efficient Recommendation Filter Model on Smart Home Big Data Analytics for Enhanced Living Environments

Science.gov (United States)

Chen, Hao; Xie, Xiaoyun; Shu, Wanneng; Xiong, Naixue

2016-01-01

With the rapid growth of wireless sensor applications, the user interfaces and configurations of smart homes have become so complicated and inflexible that users usually have to spend a great amount of time studying them and adapting to their expected operation. In order to improve user experience, a weighted hybrid recommender system based on a Kalman Filter model is proposed to predict what users might want to do next, especially when users are located in a smart home with an enhanced living environment. Specifically, a weight hybridization method was introduced, which combines contextual collaborative filter and the contextual content-based recommendations. This method inherits the advantages of the optimum regression and the stability features of the proposed adaptive Kalman Filter model, and it can predict and revise the weight of each system component dynamically. Experimental results show that the hybrid recommender system can optimize the distribution of weights of each component, and achieve more reasonable recall and precision rates. PMID:27754456

An Efficient Recommendation Filter Model on Smart Home Big Data Analytics for Enhanced Living Environments

Directory of Open Access Journals (Sweden)

Hao Chen

2016-10-01

Full Text Available With the rapid growth of wireless sensor applications, the user interfaces and configurations of smart homes have become so complicated and inflexible that users usually have to spend a great amount of time studying them and adapting to their expected operation. In order to improve user experience, a weighted hybrid recommender system based on a Kalman Filter model is proposed to predict what users might want to do next, especially when users are located in a smart home with an enhanced living environment. Specifically, a weight hybridization method was introduced, which combines contextual collaborative filter and the contextual content-based recommendations. This method inherits the advantages of the optimum regression and the stability features of the proposed adaptive Kalman Filter model, and it can predict and revise the weight of each system component dynamically. Experimental results show that the hybrid recommender system can optimize the distribution of weights of each component, and achieve more reasonable recall and precision rates.

An Efficient Recommendation Filter Model on Smart Home Big Data Analytics for Enhanced Living Environments.

Science.gov (United States)

Chen, Hao; Xie, Xiaoyun; Shu, Wanneng; Xiong, Naixue

2016-10-15

With the rapid growth of wireless sensor applications, the user interfaces and configurations of smart homes have become so complicated and inflexible that users usually have to spend a great amount of time studying them and adapting to their expected operation. In order to improve user experience, a weighted hybrid recommender system based on a Kalman Filter model is proposed to predict what users might want to do next, especially when users are located in a smart home with an enhanced living environment. Specifically, a weight hybridization method was introduced, which combines contextual collaborative filter and the contextual content-based recommendations. This method inherits the advantages of the optimum regression and the stability features of the proposed adaptive Kalman Filter model, and it can predict and revise the weight of each system component dynamically. Experimental results show that the hybrid recommender system can optimize the distribution of weights of each component, and achieve more reasonable recall and precision rates.

Protocol for a qualitative study exploring perspectives on the INternational CLassification of Diseases (11th revision); Using lived experience to improve mental health Diagnosis in NHS England: INCLUDE study.

Science.gov (United States)

Hackmann, Corinna; Green, Amanda; Notley, Caitlin; Perkins, Amorette; Reed, Geoffrey M; Ridler, Joseph; Wilson, Jon; Shakespeare, Tom

2017-09-03

Developed in dialogue with WHO, this research aims to incorporate lived experience and views in the refinement of the International Classification of Diseases Mental and Behavioural Disorders 11th Revision (ICD-11). The validity and clinical utility of psychiatric diagnostic systems has been questioned by both service users and clinicians, as not all aspects reflect their lived experience or are user friendly. This is critical as evidence suggests that diagnosis can impact service user experience, identity, service use and outcomes. Feedback and recommendations from service users and clinicians should help minimise the potential for unintended negative consequences and improve the accuracy, validity and clinical utility of the ICD-11. The name INCLUDE reflects the value of expertise by experience as all aspects of the proposed study are co-produced. Feedback on the planned criteria for the ICD-11 will be sought through focus groups with service users and clinicians. The data from these groups will be coded and inductively analysed using a thematic analysis approach. Findings from this will be used to form the basis of co-produced recommendations for the ICD-11. Two service user focus groups will be conducted for each of these diagnoses: Personality Disorder, Bipolar I Disorder, Schizophrenia, Depressive Disorder and Generalised Anxiety Disorder. There will be four focus groups with clinicians (psychiatrists, general practitioners and clinical psychologists). This study has received ethical approval from the Coventry and Warwickshire HRA Research Ethics Committee (16/WM/0479). The output for the project will be recommendations that reflect the views and experiences of experts by experience (service users and clinicians). The findings will be disseminated via conferences and peer-reviewed publications. As the ICD is an international tool, the aim is for the methodology to be internationally disseminated for replication by other groups. ClinicalTrials.gov: NCT03131505

Designing protocols for the human teeth biobank of the Universidad Nacional de Colombia

Directory of Open Access Journals (Sweden)

Lina Constanza Gonzáles-Pita

2014-07-01

Full Text Available Protocols in a Tooth Bank are essential in order to assure smooth operation, reproducibility and standardization that minimize cross contamination, maintain original characteristics and physicochemical properties of teeth, fulll ethical and legal regulations and a proper disposal of residues. Objective: to propose the disinfection, storing and transportation protocols for the UNTB. Methods: A literature search was conducted using the words “teeth, human, tooth bank, disinfection, sterilization, storage, organization, biosecurity, biobank, protocol, prevention” in the Pubmed, Science Direct and Scielo databases. 37 papers ranging from 1988 up to 2014 were selected. International and Colombian ethical and legal regulations for organ donation, handling and investigation were taken into account as well as laboratory observations and chemical basic principles gained through several undergraduate and graduate thesis. All this input was carefully studied, analysed and critically modied for setting the recommended processes for the conversion of donated teeth into organs suitable for research. Results: Collection, transportation, cleaning/disinfection and storing protocols were planned and elaborated. Conclusions: Based on scientic literature, national and international regulations and experimental experience, several protocols for the UNTB were presented.

International Performance Measurement and Verification Protocol: Concepts and Options for Determining Energy and Water Savings, Volume I (Revised)

Energy Technology Data Exchange (ETDEWEB)

2002-03-01

This protocol serves as a framework to determine energy and water savings resulting from the implementation of an energy efficiency program. It is also intended to help monitor the performance of renewable energy systems and to enhance indoor environmental quality in buildings.

Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases

DEFF Research Database (Denmark)

Sudoł-Szopińska, Iwona; Jurik, Anne Grethe; Eshed, Iris

2015-01-01

This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee regarding the standards of the use of MRI in the diagnosis of musculoskeletal rheumatic diseases. The recommendations discuss (1) the role of MRI in current classification criteria...... of musculoskeletal rheumatic diseases (including early diagnosis of inflammation, disease follow-up, and identification of disease complications); (2) the impact of MRI on the diagnosis of axial and peripheral spondyloarthritis, rheumatoid arthritis, and juvenile spondyloarthritis; (3) MRI protocols for the axial...

Comparison of mild and microdose GnRH agonist flare protocols on IVF outcome in poor responders.

Science.gov (United States)

Karimzadeh, Mohammad Ali; Mashayekhy, Mehri; Mohammadian, Farnaz; Moghaddam, Fatemeh Mansoori

2011-05-01

To compare the IVF outcome of clomiphene citrate/gonadotropin/antagonist (mild protocol) and microdose GnRH agonist flare protocols for poor responders undergoing in vitro fertilization. 159 poor responder patients were randomized and ovarian stimulation was performed with clomiphene citrate, gonadotropin and antagonist (group I) or microdose GnRH agonist flare (group II) protocols. Main outcome was clinical pregnancy rate and secondary outcomes were doses of gonadotropin administration and duration of stimulation. There were no significant differences in age, causes of infertility, basal FSH, BMI, duration of infertility, E(2) level on the day of hCG injection in both groups. Although the cancellation, fertilization, and clinical pregnancy rates were similar in both groups, the endometrial thickness, number of retrieved oocytes, mature oocytes and implantation rate were significantly higher in mild protocol. The doses of gonadotropin administration and duration of stimulation were significantly lower in mild protocol. We recommend mild protocol in assisted reproductive technology cycles for poor responders based on our results regarding less doses of used gonadotropin and a shorter duration of stimulation.

Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System.

Science.gov (United States)

Edsberg, Laura E; Black, Joyce M; Goldberg, Margaret; McNichol, Laurie; Moore, Lynn; Sieggreen, Mary

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development.

Microcomputers and the Improvement of Revision Skills.

Science.gov (United States)

Balajthy, Ernest; And Others

1987-01-01

Discusses use of word processing software as an effective tool in writing and revision instruction, and describes the role of the teacher. Examples of exercises that encourage revision and of software designed to teach effective revision skills are reviewed. (MBR)

Individual questions of financial control and revision

Directory of Open Access Journals (Sweden)

В. М. Глібко

2015-05-01

Full Text Available Problem setting. In modern conditions at investigation and gathering of proofs in criminal proceedings according to item 93 CPC of Ukraine collecting of proofs which is carried out by the criminal proceedings parties, victim is important, the representative of the legal person, in which relation carries out manufacture, including a way истребования and receptions from public authorities, local governments, the enterprises, establishments and organisations, official and physical persons of things, documents, data, conclusions of experts, conclusions of revisions and certificates of checks. Recent research and publications analisis. In scientific sources questions of carrying out of revisions S. B.Zhivko, V.V.Akimov, G.Demjanchuk, J.Buzdugan is considered. Paper objective. Article purpose is studying and definition of a place of revision among forms of inspection of the state control and use of results of revision in criminal proceedings. Paper main body. Off-schedule exit revision that is revision which is not provided in plans of work of body of the state financial control is considered and is spent at presence at least one of the circumstances listed in item 11 of the Law of Ukraine «About main principles of realisation of the state financial control in Ukraine». If revision is carried out on request of investigating bodies it is spent on the basis of the petition of the inspector and accepted by the results of consideration of this petition of the decision of the investigatory judge. The primary goal of revision on request of investigating bodies or on the basis of court definition is reception of proofs on business. Therefore the revision certificate admits the written proof as on the basis of its conclusion of the inspector, the public prosecutor receives the information on a perfect crime, abusing, and also on the persons who have committed a crime, on the period of commission of crime and an amount of damage. In criminal

Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

DEFF Research Database (Denmark)

Rasmussen, J V; Polk, A; Sorensen, A K

2014-01-01

In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

Expedited technology demonstration project (Revised mixed waste management facility project) Project baseline revision 4.0 and FY98 plan

International Nuclear Information System (INIS)

Adamson, M. G.

1997-01-01

The re-baseline of the Expedited Technology Demonstration Project (Revised Mixed Waste Facility Project) is designated as Project Baseline Revision 4.0. The last approved baseline was identified as Project Baseline Revision 3.0 and was issued in October 1996. Project Baseline Revision 4.0 does not depart from the formal DOE guidance followed by, and contained in, Revision 3.0. This revised baseline document describes the MSO and Final Forms testing activities that will occur during FY98, the final year of the ETD Project. The cost estimate for work during FY98 continues to be $2.OM as published in Revision 3.0. However, the funds will be all CENRTC rather than the OPEX/CENTRC split previously anticipated. LLNL has waived overhead charges on ETD Project CENRTC funds since the beginning of project activities. By requesting the $2.OM as all CENTRC a more aggressive approach to staffing and testing can be taken. Due to a cost under- run condition during FY97 procurements were made and work was accomplished, with the knowledge of DOE, in the Feed Preparation and Final Forms areas that were not in the scope of Revision 3.0. Feed preparation activities for FY98 have been expanded to include the drum opening station/enclosure previously deleted

Perforated Sigmoid Diverticular Disease: a Management Protocol

Science.gov (United States)

Moin, Thajammul

2008-01-01

Background: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. Methods: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this. Results: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination. Conclusions: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease. PMID:18435896

Chest tuberculosis: Radiological review and imaging recommendations

International Nuclear Information System (INIS)

Bhalla, Ashu Seith; Goyal, Ankur; Guleria, Randeep; Gupta, Arun Kumar

2015-01-01

Chest tuberculosis (CTB) is a widespread problem, especially in our country where it is one of the leading causes of mortality. The article reviews the imaging findings in CTB on various modalities. We also attempt to categorize the findings into those definitive for active TB, indeterminate for disease activity, and those indicating healed TB. Though various radiological modalities are widely used in evaluation of such patients, no imaging guidelines exist for the use of these modalities in diagnosis and follow-up. Consequently, imaging is not optimally utilized and patients are often unnecessarily subjected to repeated CT examinations, which is undesirable. Based on the available literature and our experience, we propose certain recommendations delineating the role of imaging in the diagnosis and follow-up of such patients. The authors recognize that this is an evolving field and there may be future revisions depending on emergence of new evidence

Circumcision revision in male children

Directory of Open Access Journals (Sweden)

Mohammed A. Al-Ghazo

2006-08-01

Full Text Available OBJECTIVE: To determine indications for circumcision revision and to identify the specialty of the person who performed unsatisfactory primary circumcision. MATERIALS AND METHODS: The authors reviewed medical records of 52 cases that underwent circumcision revision over a 6-year period (1998 to 2004. Sleeve surgical technique was used for revision in patients with redundant foreskin or concealed penis, penoplasty for partial or complete degloving of the penis and meatotomy for external meatal stenosis. The mean age of children was 32 months (range 6 months to 9 years. RESULTS: Most of unsatisfactory primary circumcisions (86.7% were performed by laymen. All patients who underwent circumcision revision had good to excellent cosmetic results. CONCLUSION: Primary circumcision performed by laymen carry a high complication rate and serious complications may occur. A period of training and direct supervision by physicians is required before allowing laymen to perform circumcision independently.

Protocol of specific health monitoring: ionizing radiation, 11 years later; Protocolo de vigilancia sanitaria especifica: radiaciones ionizantes, 11 anos despues

Energy Technology Data Exchange (ETDEWEB)

Castillejo Puertas, F. M.

2016-08-01

Since the approval on November 11{sup t}h 2003 of the Protocol of Specific Health Monitoring for Workers Exposed to Ionizing Radiation a study has been carried out to discover its effectiveness. These areas were examined: the daily practice od accupational medicine and, in particular, its specific task in the application of the different clinical/labour criteria for workers exposed to ionizing radiation or at risk of radioactive contamination; the degree of its uses as well as the updates and improvements. For that purpose, a descriptive bibliographic revision has been used for the last 11 years. The results revealed the lack of updates of the Protocol as well as the few usable objective criteria, when the clinical/labour aptitudes are reflected upon. (Author)

Nuclear safety guide TID-7016 Revision 2

International Nuclear Information System (INIS)

Thomas, J.T.

1980-01-01

The present revision of TID-7016 Nuclear Safety Guide is discussed. This Guide differs significantly from its predecessor in that the latter was intentionally conservative in its recommendations. Firmly based on experimental evidence of criticality, the original Guide and the first revision were considered to be of most value to organizations whose activities with fissionable materials were not extensive and, secondarily, that it would serve as a point of departure for members of established nuclear safety teams, experienced in the field. The reader will find a significant change in the character of information presented in this version. Nuclear Criticality Safety has matured in the past twelve years. The advance of calculational capability has permitted validated calculations to extend and substitute for experimental data. The broadened data base has enabled better interpolation, extension, and understanding of available, information, especially in areas previously addressed by undefined but adequate factors of safety. The content has been thereby enriched in qualitative guidance. The information inherently contains, and the user can recapture, the quantitative guidance characteristic of the former Guides by employing appropriate safety factors. In fact, it becomes incumbent on the Criticality Safety Specialist to necessarily impose safety factors consistent with the possible normal and abnormal credible contingencies of an operation as revealed by his evaluation. In its present form the Guide easily becomes a suitable module in any compendium or handbook tailored for internal use by organizations. It is hoped the Guide will continue to serve immediate needs and will encourage continuing and more comprehensive efforts toward organizing nuclear criticality safety information

The economic impact of revision otologic surgery.

Science.gov (United States)

Nadimi, Sahar; Leonetti, John P; Pontikis, George

2016-03-01

Revision otologic surgery places a significant economic burden on patients and the healthcare system. We conducted a retrospective chart analysis to estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy. We reviewed the medical records of all 189 adults who had undergone CWD mastoidectomy performed by the senior author between June 2006 and August 2011 at Loyola University Medical Center in Maywood, Ill. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery in Illinois and at the national level. Of the 189 CWD mastoidectomies, 89 were primary and 100 were revision procedures. The total charge for the revision cases was $2,783,700, and the net reimbursement (collections) was $846,289 (30.4%). Using Illinois Hospital Association data, we estimated that reimbursement for 387 revision CWD mastoidectomies that had been performed in fiscal year 2011 was nearly $3.3 million. By extrapolating our data to the national level, we estimated that 9,214 patients underwent revision CWD mastoidectomy in the United States during 2011, which cost the national healthcare system roughly $76 million, not including lost wages and productivity. Known causes of failed CWD mastoidectomies that often result in revision surgery include an inadequate meatoplasty, a facial ridge that is too high, residual diseased air cells, and recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, which could have a positive impact on the economic strain related to this procedure at the local, state, and national levels.

Meeting the Climate Challenge. Recommendations of the International Climate Change Taskforce

International Nuclear Information System (INIS)

2005-01-01

To chart a way forward, an International Climate Change Taskforce, composed of leading scientists, public officials, and representatives of business and non-governmental organisations, was established at the invitation of three leading public policy institutes - the Institute for Public Policy Research, the Center for American Progress and The Australia Institute. The Taskforce's aim has been to develop proposals to consolidate and build on the gains achieved under the UNFCCC and the Kyoto Protocol to ensure that climate change is addressed effectively over the long term. In doing so, the Taskforce has met twice, in Windsor, United Kingdom and Sydney, Australia, where they reviewed and debated detailed research papers prepared by the Taskforce Secretariat, provided by the three founding organisations. The Taskforce's recommendations are to all governments and policy-makers worldwide. However, particular emphasis is placed on providing independent advice to the governments of the Group of Eight (G8) and the European Union (EU) in the context of the UK's presidencies of both organisations in 2005, during which Prime Minister Tony Blair has pledged to make addressing climate change a priority. The recommendations are also made in the context of the start of international negotiations in 2005 on future collective action on climate change, and the need to engage the governments of those industrialised countries that have not ratified the Kyoto Protocol

Investigation of metal toxicity to tropical biota. Recommendations for revision of Australian water quality guidelines

International Nuclear Information System (INIS)

Marchich, S.

1997-01-01

The specific objectives of this study were to: review available data on the toxicity of metals to aquatic biota in tropical Australia; identify metals considered to be priority toxicants to aquatic biota in tropical Australia; and employ previously developed toxicity testing protocols for two tropical freshwater species to obtain preliminary toxicity data for two priority metals. From the literature review, it was concluded that insufficient metal toxicity data exist for Australian tropical species. Data were absent for a range of metals (eg Ag, As, Al, Cr, Hg, Ni, Sb and Se) listed in the current Australian water quality guidelines. Aluminium, Cd, Co, Cu, Ni, Mn, Pb, U, V and Zn were identified as priority metals of potential ecotoxicological concern in aquatic ecosystems of tropical Australia, largely as a consequence of mining activities, but also from urban impacts. Instead of testing the toxicity of the priority metals for which data do not currently exist (ie Al, Co, Ni and V), it was deemed more important to conduct further experimental work on Cu and U, in the context of elucidating the relatively high variability in the toxic response of these two metals. As a result, Cu and U were selected and toxicity tests conducted using two tropical freshwater species (green hydra (Hydra viridissima) and gudgeon fish (Mogurnda mogurnda)) from the Australian wet/dry tropics using test protocols designed to maximise the greatest sensitivity of metal response in the shortest period of time. Hydra viridissima was about eight times more sensitive to Cu than U, whereas M. mogurnda was about twenty times more sensitive. Once differences between the sublethal and lethal endpoints of the two organisms were corrected by statistical extrapolation, H. viridissima was approximately seven times more sensitive than M. mogurnda to U, but only about three times more sensitive to Cu. Both species were more sensitive to Cu than U. These results are generally consistent with those from

Implementation of a quality control protocol in a radiotherapy planning system; Implementacion de un protocolo de control de calidad en un sistema de planificacion de radioterapia

Energy Technology Data Exchange (ETDEWEB)

Condori, P.; Paucar, R. [Clinica San Pablo, Lima (Peru). Servicio de Radioterapia

2004-07-01

Due to the impossibility of each particular case analysis and taking as example the spanish protocol (Under revision), necessary tests have been performed for the verification of the calculations for the Multidata planning system, including: calculation algorithms, reconstruction of the rectangular beams, light modulators, irregular fields, fields summation, weights, normalization, prescription and calculation of UM, for the teletherapy planning.

Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.

Science.gov (United States)

Popovic, D; Benabarre, A; Crespo, J M; Goikolea, J M; González-Pinto, A; Gutiérrez-Rojas, L; Montes, J M; Vieta, E

2014-12-01

To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

Science.gov (United States)

Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

2017-09-01

Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Management of radon: a review of ICRP recommendations

International Nuclear Information System (INIS)

Vaillant, Ludovic; Bataille, Céline

2012-01-01

This article proposes a review of past and current ICRP publications dealing with the management of radon exposures. Its main objective is to identify and discuss the driving factors that have been used by the Commission during the last 50 years so as to better appreciate current issues regarding radon exposure management. The analysis shows that major evolutions took place in very recent years. As far as the management of radon exposures is concerned, ICRP recommended, until ICRP Publication 103 (ICRP 2007 ICRP Publication 103; Ann. ICRP 37), to use action levels and to consider only exposures above these levels. The Commission has reviewed its approach and now proposes to manage any radon exposure through the application of the optimisation principle and associated reference levels. As far as the assessment of the radon risk is concerned, it appears that the successive changes made by ICRP did not have a strong impact on the values of radon gas concentration recommended as action levels either in dwellings or in workplaces. The major change occurred in late 2009 with the publication of the ICRP Statement on Radon, which acknowledged that the radon risk has been underestimated by a factor of 2, thus inducing a major revision of radon reference levels. (review)

How to Revise, and Revise Really Well, for Premier Academic Journals

DEFF Research Database (Denmark)

LaPlaca, Peter J.; Lindgreen, Adam; Vanhamme, Joelle

2018-01-01

Most of the premier academic journals in all fields routinely have rejection rates of 80%, 95%, or higher. All journals prefer articles that make significant contributions to the field. Revising a manuscript and responding properly to the comments of reviewers and editors often is challenging....... This article discusses how to revise effectively a manuscript according to the (minor or major) comments of reviewers and editors for premier academic journals. We provide a series of tips for helping the authors in their endeavor, making the process less arduous and improving the possibility of a positive...

A taxonomic revision of the genus Podocarpus

NARCIS (Netherlands)

Laubenfels, de D.J.

1985-01-01

In connection with the forthcoming revision of the Coniferae for the Flora Malesiana, the author thought it necessary to revise the genus Podocarpus. Although this genus has a substantial representation in Malesia (30 species), the revision is too involved to be appropriate with the Flora Malesiana

Protocol Implementation Generator

DEFF Research Database (Denmark)

Carvalho Quaresma, Jose Nuno; Probst, Christian W.

2010-01-01

Users expect communication systems to guarantee, amongst others, privacy and integrity of their data. These can be ensured by using well-established protocols; the best protocol, however, is useless if not all parties involved in a communication have a correct implementation of the protocol and a...... Generator framework based on the LySatool and a translator from the LySa language into C or Java....... necessary tools. In this paper, we present the Protocol Implementation Generator (PiG), a framework that can be used to add protocol generation to protocol negotiation, or to easily share and implement new protocols throughout a network. PiG enables the sharing, verification, and translation...

Nevada Test Site Radiological Control Manual. Revision 1

Energy Technology Data Exchange (ETDEWEB)

None, None

2010-02-09

This document supersedes DOE/NV/25946--801, “Nevada Test Site Radiological Control Manual,” Revision 0 issued in October 2009. Brief Description of Revision: A minor revision to correct oversights made during revision to incorporate the 10 CFR 835 Update; and for use as a reference document for Tenant Organization Radiological Protection Programs.

Report on the second meeting of the project advisory committee (technical) for IAEA/WHO project EGY/6/004 (Egyptian Cancer Project) 3-9 April 1984, at NEMROCK, Cairo

International Nuclear Information System (INIS)

Taylor, C.G.B.

1984-07-01

The purpose of the meeting was to review the first year's work and make recommendations for the future. The Committee dealt mainly with the Training Course, the selection of cases suitable for treatment by simple means, the revision of treatment notes and protocols, planning for the cytology (early diagnosis) programme, the collection and manipulation of data, the extension of the Project in Egypt, and its possible extension to other countries

Dental-CT: image quality and absorbed radiation dose of different scan protocols

International Nuclear Information System (INIS)

Schorn, C.; Alamo, L.; Funke, M.; Grabbe, E.; Visser, H.; Hermann, K.P.

1999-01-01

Purpose: To develop a scan protocol for dental-CT which guarantees good image quality at the lowest possible radiation dose. Methods: In an experimental investigation Dental-CT (HSA, GE, Milwaukee, USA) of the mandible of two human skeletons positioned in a water tank were performed in order to define the most advantageous scan protocol. Tube currents ranged from 40 to 200 mA and the scan technique was modified (axial mode or helical mode with pitches of 1 to 3 and corresponding increments of 0.4 to 1.0 mm). 39 patients underwent a dental-CT with decreased current (80 mA) in the helical scan mode (pitch 2, slice thickness 1 mm). Dose measurements were performed for two different scan protocols (A: axial, 130 mAs, B: helical, 80 mA, pitch 2). Results: The preliminary investigations of image quality showed only a minor effect of the applied current. For the helical scan mode, pitches of more than 2 impaired image quality. A low increment had no advantages. There were no disadvantages in clinical practice using protocol B with decreased tube current. Absorbed radiation dose of dental CT performed with protocol B was decreased to one third in comparison to protocol A. Conclusions: A scan protocol with a low tube current (e.g., 80 mA, for a rotation time of 1 s) and a helical scan mode (e.g., for a slice thickness of 1 mm with a pitch of 2 and an increment of 1 mm) is recommended for performing dental-CT. (orig.) [de

Recurrence of Ewing sarcoma: Is detection by imaging follow-up protocol associated with survival advantage?

NARCIS (Netherlands)

Heinemann, Melina; Ranft, Andreas; Langer, Thorsten; Jürgens, Herbert; Kreyer, Justus; Vieth, Volker; Schäfers, Michael; Weckesser, Matthias; Simon, Thorsten; Hassenpflug, Wolf; Corbacioglu, Selim; Bielack, Stefan; Mayer-Steinacker, Regina; Kühne, Thomas; van den Berg, Henk; Gelderblom, Hans; Bauer, Sebastian; Stegger, Lars; Dirksen, Uta

2018-01-01

The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present

Quarterly report on Defense Nuclear Facilities Safety Board Recommendation 90-7 for the period ending December 31, 1992

International Nuclear Information System (INIS)

Cash, R.J.; Dukelow, G.T.; Forbes, C.J.

1993-03-01

This is the seventh quarterly report on the progress of activities addressing safety issues associated with Hanford Site high-level radioactive waste tanks that contain ferrocyanide compounds. In the presence of oxidizing materials, such as nitrates or nitrites, ferrocyanide can be made to explode in the laboratory by heating it to high temperatures [above 285 degrees C (545 degrees F)]. In the mid 1950s approximately 140 metric tons of ferrocyanide were added to 24 underground high-level radioactive waste tanks. An implementation plan (Cash 1991) responding to the Defense Nuclear Facilities Safety Board Recommendation 90-7 (FR 1990) was issued in March 1991 describing the activities that were planned and underway to address each of the six parts of Recommendation 90-7. A revision to the original plan was transmitted to US Department of Energy by Westinghouse Hanford Company in December 1992. Milestones completed this quarter are described in this report. Contents of this report include: Introduction; Defense Nuclear Facilities Safety Board Implementation Plan Task Activities (Defense Nuclear Facilities Safety Board Recommendation for enhanced temperature measurement, Recommendation for continuous temperature monitoring, Recommendation for cover gas monitoring, Recommendation for ferrocyanide waste characterization, Recommendation for chemical reaction studies, and Recommendation for emergency response planning); Schedules; and References. All actions recommended by the Defense Nuclear Facilities Safety Board for emergency planning by Hanford Site emergency preparedness organizations have been completed

The measurement and analysis of normal incidence solar UVB radiation and its application to the photoclimatherapy protocol for psoriasis at the Dead Sea, Israel.

Science.gov (United States)

Kudish, Avraham I; Harari, Marco; Evseev, Efim G

2011-01-01

The broad-band normal incidence UVB beam radiation has been measured at Neve Zohar, Dead Sea basin, using a prototype tracking instrument composed of a Model 501A UV-Biometer mounted on an Eppley Solar Tracker Model St-1. The diffuse and beam fraction of the solar global UVB radiation have been determined using the concurrently measured solar global UVB radiation. The diffuse fraction was observed to exceed 80% throughout the year. The application of the results of these measurements to the possible revision of the photoclimatherapy protocol for psoriasis patients at the Dead Sea medical spas is now under investigation. The suggested revision would enable the sun-exposure treatment protocol to take advantage of the very high diffuse fraction by allowing the patient to receive the daily dose of UVB radiation without direct exposure to the sun, viz. receive the diffuse UVB radiation under a sunshade. This would require an increase in sun-exposure time intervals, as the UVB radiation intensity beneath a sunshade is less than that on an exposed surface. © 2010 The Authors. Photochemistry and Photobiology © 2010 The American Society of Photobiology.

Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review.

Science.gov (United States)

Sousa-Santos, A R; Amaral, T F

2017-10-16

Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. The aim of this systematic review is to gather all the relevant studies that measured HGS to diagnose sarcopenia and frailty and to identify the differences between the protocols used. A systematic review was carried out following the recommendations of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed and Web of Science were systematically searched, until August 16, 2016. The evidence regarding HGS measurement protocols used to diagnose sarcopenia and frailty was summarised and the most recent protocols regarding the procedure were compared. From the described search 4393 articles were identified. Seventy-two studies were included in this systematic review, in which 37 referred to sarcopenia articles, 33 to frailty and two evaluated both conditions. Most studies presented limited information regarding the protocols used. The majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.

Dietary Recommendations for Cyclists during Altitude Training

Directory of Open Access Journals (Sweden)

Małgorzata Michalczyk

2016-06-01

Full Text Available The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like “live high, train high” (LH-TH, “live high, train low” (LH-TL or “intermittent hypoxic training” (IHT. Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented.

Accuracy of prehospital triage protocols in selecting severely injured patients: A systematic review.

Science.gov (United States)

van Rein, Eveline A J; Houwert, R Marijn; Gunning, Amy C; Lichtveld, Rob A; Leenen, Luke P H; van Heijl, Mark

2017-08-01

Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. To find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary. The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity. A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included "trauma," "trauma center," or "trauma system" combined with "triage," "undertriage," or "overtriage." All studies describing protocol-based triage quality were reviewed. To assess the quality of these type of studies, a new critical appraisal tool was developed. In this review, 21 articles were included with numbers of patients ranging from 130 to over 1 million. Significant predictors for severe injury were: vital signs, suspicion of certain anatomic injuries, mechanism of injury, and age. Sensitivity ranged from 10% to 100%; specificity from 9% to 100%. Nearly all protocols had a low sensitivity, thereby failing to identify severely injured patients. Additionally, the critical appraisal showed poor quality of the majority of included studies. This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve prehospital trauma triage protocols. Systematic review, level III.

Vertical Protocol Composition

DEFF Research Database (Denmark)

Groß, Thomas; Mödersheim, Sebastian Alexander

2011-01-01

The security of key exchange and secure channel protocols, such as TLS, has been studied intensively. However, only few works have considered what happens when the established keys are actually used—to run some protocol securely over the established “channel”. We call this a vertical protocol.......e., that the combination cannot introduce attacks that the individual protocols in isolation do not have. In this work, we prove a composability result in the symbolic model that allows for arbitrary vertical composition (including self-composition). It holds for protocols from any suite of channel and application...

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update.

Science.gov (United States)

Rodrigues, A M; Canhão, H; Marques, A; Ambrósio, C; Borges, J; Coelho, P; Costa, L; Fernandes, S; Gonçalves, I; Gonçalves, M; Guerra, M; Marques, M L; Pimenta, S; Pinto, P; Sequeira, G; Simões, E; Teixeira, L; Vaz, C; Vieira-Sousa, E; Vieira, R; Alvarenga, F; Araújo, F; Barcelos, A; Barcelos, F; Barros, R; Bernardes, M; Canas da Silva, J; Cordeiro, A; Costa, M; Cunha-Miranda, L; Cruz, M; Duarte, A C; Duarte, C; Faustino, A; Figueiredo, G; Fonseca, J E; Furtado, C; Gomes, J; Lopes, C; Mourão, A F; Oliveira, M; Pimentel-Santos, F M; Ribeiro, A; Sampaio da Nóvoa, T; Santiago, M; Silva, C; Silva-Dinis, A; Sousa, S; Tavares-Costa, J; Terroso, G; Vilar, A; Branco, J C; Tavares, V; Romeu, J C; da Silva, Jap

2018-01-01

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with

Recommendations on nuclear and multimodality imaging in IE and CIED infections.

Science.gov (United States)

Erba, Paola Anna; Lancellotti, Patrizio; Vilacosta, Isidre; Gaemperli, Oliver; Rouzet, Francois; Hacker, Marcus; Signore, Alberto; Slart, Riemer H J A; Habib, Gilbert

2018-05-24

In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [ 18 F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [ 18 F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when interpreting images, and the most important results from the literature, and also provide recommendations on the appropriate use of multimodality imaging.

Revised age-dependent doses to members of the public from intake of radionuclides using the new tissue weighting factors

International Nuclear Information System (INIS)

Jain, S.C.; Gupta, M.M.; Nagaratnam, A.; Reddy, A.R.; Mehta, S.C.

1992-01-01

ICRP 56 gave age-dependent dose coefficients to members of the public from intake of most radiologically significant radionuclides that might be released to the environment due to various human activities. It has computed effective dose equivalent (now called effective dose) from these dose coefficients utilising the tissue weighting factors as given by ICRP 26. The recent ICRP 1990 recommendations have revised the tissue weighting factors based on new information on risk estimates of fatal cancer and hereditary disorders. This change in the tissue weighting factors will subsequently affect the computation of effective dose due to intake of various radio-nuclides considered by ICRP 56. The revised effective doses for ingested as well as inhaled radionuclides have been worked out and compared from corresponding earlier values. No change was found in the case of tritiated water, organically bound tritium and 14 C. For the majority of the radionuclides, the revised effective dose was within ± 20% of the earlier values. Larger variations in effective dose were noted for radionuclides which deposit preferentially in one or two organs. (author)

A revised definition of high-level radioactive wastes unsuitable for dumping at sea

International Nuclear Information System (INIS)

Morley, F.

1979-01-01

The IAEA is responsible for defining these wastes, and makes recommendations to be used as a basis for the issue of special permits for the dumping at sea of those radioactive materials not defined as 'unsuitable'. Two IAEA information Circulars list in detail the Provisional (INF CIRC/205/Add. 1. Vienna, IAEA (January 1975)) and Revised (INF/ CIRC/205/Add. 1/Rev. 1. Vienna, IAEA (August 1978)) Definitions with annex material. These two definitions are set out for comparison purposes. The definitions were based on oceanographic and radiological evidence, and a summary is given of the procedures followed during their preparation. (U.K.)

[An overview on the collation and revision of medical books by the Bureau for Revising Medical Books in the Northern Song Dynasty].

Science.gov (United States)

Meng, Yongliang; Liang, Yongxuan

2014-07-01

The Bureau for Revising Medical Books was a temporary agency established by the government of the Northern Song Dynasty in 1057, the 2nd year of Jiayou of Emperor Renzong, exclusively for the edition, revision and publishing of ancient medical books. 11 medical books were revised and edited by 13 Bureau members in a period of 12 years until 1069, the 2nd year of Xining of Emperor ShenZong, which eventually became the final versions until today. 8 medical books were initially planned for the revision, but 11 were actually completed in the end. The time for completing a revision varied from over 10 years at most to less than 1 year at least. Instead of working in the office, the officers of the Bureau for Revising Medical Books did their works at home. The members of the said Bureau came from the Tiju officer of the Bureau for Revising Medical Books and the officials of revising medical books, consisting of both Confucian ministers and medical officers. Confucian ministers played an important role in revising medical books. The Bureau had a strict workflow in electing revising officials, making the project, and the determination of the principles and arrangements of the tasks of editing and proofreading.

BWR normal water chemistry guidelines: 1986 revision

International Nuclear Information System (INIS)

1988-09-01

Boiling water reactors (BWRs) have experienced stress corrosion cracking in the reactor cooling system piping resulting in adverse impacts on plant availability and personnel radiation exposure. The BWR Owners Group and EPRI have sponsored a major research and development program to provide remedies for this stress corrosion cracking problem. This work shows that the likelihood of cracking depends on the plant's water chemistry performance (environment) as well as on material condition and stress level. Plant experience and other research demonstrate that water quality also affects fuel performance and radiation field buildup in BWRs. This report,''BWR Normal Water Chemistry Guidelines: 1986 Revision,'' presents suggested generic water chemistry specifications, justifies the proposed water chemistry limits, suggests responses to out-of-specification water chemistry, discusses available chemical analysis methods as well as data management and surveillance schemes, and details the management philosophy required to successfully implement a water chemistry control program. An appendix contains recommendations for water quality of auxiliary systems. 73 refs., 20 figs., 9 tabs

Emotion Processes in Knowledge Revision

Science.gov (United States)

Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese

2017-01-01

In recent years, a number of insights have been gained into the cognitive processes that explain how individuals overcome misconceptions and revise their previously acquired incorrect knowledge. The current study complements this line of research by investigating the moment-by-moment emotion processes that occur during knowledge revision using a…

75 FR 57597 - Revised Proposal for Revisions to the Schedules of Civil Penalties for a Violation of a Federal...

Science.gov (United States)

2010-09-21

... Revisions to the Schedules of Civil Penalties for a Violation of a Federal Railroad Safety Law or Federal... railroad safety laws and regulations are necessary because many of FRA's civil penalties have not been..., et al. Revised Proposal for Revisions to the Schedules of Civil Penalties for a Violation of a...

Evaluation of pneumococcal vaccination rates after vaccine protocol changes and nurse education in a tertiary care teaching hospital.

Science.gov (United States)

Smith, Jennifer G; Metzger, Nicole L

2011-11-01

Pneumococcal vaccination in eligible patients is recommended by the Infectious Disease Society of America and the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Because hospitalization provides an opportunity to vaccinate patients at high risk for developing serious pneumonia complications, eligibility screening and administration of the pneumococcal vaccine prior to discharge in qualified patients are evaluated by the Joint Commission and the Centers for Medicare Medicaid Services (CMS) as part of pneumococcal vaccination core quality measures. Among patients with an inpatient diagnosis of pneumonia in 2008, 56% in our 580-bed tertiary care teaching hospital, compared with 84% nationwide, received pneumococcal vaccination. To improve pneumococcal vaccination rates for all patients in the study facility and not just those with pneumonia, a multifaceted intervention including a revised nurse screening tool, rescheduling of the vaccine order, storage of the vaccine in automated dispensing cabinets on the nursing unit, and creation of a vaccine tracking system was developed and implemented between August 2009 and October 2009. To determine the impact of a multifaceted intervention on pneumococcal vaccine screening and administration rates in eligible patients according to the CDC recommendations who were admitted to an internal medicine unit of a tertiary care teaching hospital. All patients aged 18 years or older from 2 internal medicine units were identified during 4-month time intervals before (pre-intervention, April through July 2009) and after (post-intervention, November 2009 through February 2010) implementation of the multifaceted pneumococcal vaccine protocol. Of these, 150 patients from each 4-month period were randomly selected for electronic medical record review. Eligibility for pneumococcal vaccination was derived from the CDC recommendations and consensus of the vaccine steering committee at the study institution; the

ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection

International Nuclear Information System (INIS)

Nenot, Jean-Claude; Brenot, Jean; Laurier, Dominique; Rannou, Alain; Thierry, Dominique

2009-01-01

These revised Recommendations for a System of Radiological Protection formally replace the Commission's previous, 1990, Recommendations; and update, consolidate, and develop the additional guidance on the control of exposure from radiation sources issued since 1990. Thus, the present Recommendations update the radiation and tissue weighting factors in the quantities equivalent and effective dose and update the radiation detriment, based on the latest available scientific information of the biology and physics of radiation exposure. They maintain the Commission's three fundamental principles of radiological protection, namely justification, optimisation, and the application of dose limits, clarifying how they apply to radiation sources delivering exposure and to individuals receiving exposure. The Recommendations evolve from the previous process-based protection approach using practices and interventions by moving to an approach based on the exposure situation. They recognise planned, emergency, and existing exposure situations, and apply the fundamental principles of justification and optimisation of protection to all of these situations. They maintain the Commission's current individual dose limits for effective dose and equivalent dose from all regulated sources in planned exposure situations. They reinforce the principle of optimisation of protection, which should be applicable in a similar way to all exposure situations, subject to the following restrictions on individual doses and risks; dose and risk constraints for planned exposure situations, and reference levels for emergency and existing exposure situations. The Recommendations also include an approach for developing a framework to demonstrate radiological protection of the environment

The status of recommendations of the President's Commission on the accident at Three Mile Island: A ten-year review

International Nuclear Information System (INIS)

1989-03-01

This report summarizes the status of actions taken by the US Nuclear Regulatory Commission (NRC) in response to recommendations made by the Presidential Commission on the Accident at Three Mile Island in the 10 years since the accident occurred in March 1979. It also updates NRC's initial response to the Presidential Commission's recommendations contained in ''NRC Views and Analysis of the Recommendations of the President's Commission of the Accident at Three Mile Island'' (NUREG-0632), issued in November 1979. The status of ongoing initiatives for actions not yet complete is also reported for reference purposes. On the basis of its analysis of NRC and the industry, the Presidential Commission found many then-current practices inadequate and in need of improvement. As a result of its recommendations and of guidance from other studies, substantial changes have been made in the 10 years since the accident. This report reflects how, based on Presidential Commission recommendations and continued work, revised practices and standards are now being implemented by NRC and throughout the industry

Kinematic Analysis of a Six-Degrees-of-Freedom Model Based on ISB Recommendation: A Repeatability Analysis and Comparison with Conventional Gait Model.

Science.gov (United States)

Żuk, Magdalena; Pezowicz, Celina

2015-01-01

Objective. The purpose of the present work was to assess the validity of a six-degrees-of-freedom gait analysis model based on the ISB recommendation on definitions of joint coordinate systems (ISB 6DOF) through a quantitative comparison with the Helen Hays model (HH) and repeatability assessment. Methods. Four healthy subjects were analysed with both marker sets: an HH marker set and four marker clusters in ISB 6DOF. A navigated pointer was used to indicate the anatomical landmark position in the cluster reference system according to the ISB recommendation. Three gait cycles were selected from the data collected simultaneously for the two marker sets. Results. Two protocols showed good intertrial repeatability, which apart from pelvic rotation did not exceed 2°. The greatest differences between protocols were observed in the transverse plane as well as for knee angles. Knee internal/external rotation revealed the lowest subject-to-subject and interprotocol repeatability and inconsistent patterns for both protocols. Knee range of movement in transverse plane was overestimated for the HH set (the mean is 34°), which could indicate the cross-talk effect. Conclusions. The ISB 6DOF anatomically based protocol enabled full 3D kinematic description of joints according to the current standard with clinically acceptable intertrial repeatability and minimal equipment requirements.