WorldWideScience

Sample records for standard case definition

  1. Comparing definitions in guidelines and written standards - a case study: 'Trueness'

    International Nuclear Information System (INIS)

    Pavese, F

    2010-01-01

    This paper describes the structure of a repository initiated by IMEKO TC21 to allow the comparison of different definitions and use of the same term or concept in written standards and guidelines available internationally. The method used is illustrated for a case study: the critical concept of 'trueness' and its definitions.

  2. Testing Pneumonia Vaccines in the Elderly: Determining a Case Definition for Pneumococcal Pneumonia in the Absence of a Gold Standard.

    Science.gov (United States)

    Jokinen, Jukka; Snellman, Marja; Palmu, Arto A; Saukkoriipi, Annika; Verlant, Vincent; Pascal, Thierry; Devaster, Jeanne-Marie; Hausdorff, William P; Kilpi, Terhi M

    2017-12-15

    Clinical assessments of vaccines to prevent pneumococcal (Pnc) community-acquired pneumonia (CAP) require sensitive and specific case definitions, but there is no gold standard diagnostic test. To develop a new case definition suitable for vaccine efficacy studies, we applied latent class analysis (LCA) to the results from seven diagnostic tests for Pnc etiology on clinical specimens from 323 elderly radiologically-confirmed pneumonia cases enrolled in The Finnish Community-Acquired Pneumonia Epidemiology study during 2005-2007. Compared to the conventional use of LCA, which is mainly to determine sensitivities and specificities of different tests, we instead used LCA as an appropriate instrument to predict the probability of Pnc etiology for each CAP case based on their test profiles, and utilized the predictions to minimize the sample size that would be needed for a vaccine efficacy trial. When compared to the conventional laboratory criteria of encapsulated Pnc in blood culture or in high-quality sputum culture or urine antigen positivity, our optimized case definition for PncCAP resulted in a trial sample size which was almost 20,000 subjects smaller. We believe that our novel application of LCA detailed here to determine a case definition for PncCAP could also be similarly applied to other diseases without a gold standard. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

  3. Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care.

    Science.gov (United States)

    Vekemans, Johan; Marsh, Kevin; Greenwood, Brian; Leach, Amanda; Kabore, William; Soulanoudjingar, Solange; Asante, Kwaku Poku; Ansong, Daniel; Evans, Jennifer; Sacarlal, Jahit; Bejon, Philip; Kamthunzi, Portia; Salim, Nahya; Njuguna, Patricia; Hamel, Mary J; Otieno, Walter; Gesase, Samwel; Schellenberg, David

    2011-08-04

    An effective malaria vaccine, deployed in conjunction with other malaria interventions, is likely to substantially reduce the malaria burden. Efficacy against severe malaria will be a key driver for decisions on implementation. An initial study of an RTS, S vaccine candidate showed promising efficacy against severe malaria in children in Mozambique. Further evidence of its protective efficacy will be gained in a pivotal, multi-centre, phase III study. This paper describes the case definitions of severe malaria used in this study and the programme for standardized assessment of severe malaria according to the case definition. Case definitions of severe malaria were developed from a literature review and a consensus meeting of expert consultants and the RTS, S Clinical Trial Partnership Committee, in collaboration with the World Health Organization and the Malaria Clinical Trials Alliance. The same groups, with input from an Independent Data Monitoring Committee, developed and implemented a programme for standardized data collection.The case definitions developed reflect the typical presentations of severe malaria in African hospitals. Markers of disease severity were chosen on the basis of their association with poor outcome, occurrence in a significant proportion of cases and on an ability to standardize their measurement across research centres. For the primary case definition, one or more clinical and/or laboratory markers of disease severity have to be present, four major co-morbidities (pneumonia, meningitis, bacteraemia or gastroenteritis with severe dehydration) are excluded, and a Plasmodium falciparum parasite density threshold is introduced, in order to maximize the specificity of the case definition. Secondary case definitions allow inclusion of co-morbidities and/or allow for the presence of parasitaemia at any density. The programmatic implementation of standardized case assessment included a clinical algorithm for evaluating seriously sick children

  4. 18 CFR 801.1 - Standard definitions.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Standard definitions. 801.1 Section 801.1 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL POLICIES § 801.1 Standard definitions. (a) Many terms that will be used in official Commission...

  5. Surveillance of paediatric traumatic brain injuries using the NEISS: choosing an appropriate case definition.

    Science.gov (United States)

    Thompson, Meghan C; Wheeler, Krista K; Shi, Junxin; Smith, Gary A; Groner, Jonathan I; Haley, Kathryn J; Xiang, Huiyun

    2014-01-01

    To evaluate the definition of traumatic brain injury (TBI) in the National Electronic Injury Surveillance System (NEISS) and compare TBI case ascertainment using NEISS vs. ICD-9-CM diagnosis coding. Two data samples from a NEISS participating emergency department (ED) in 2008 were compared: (1) NEISS records meeting the recommended NEISS TBI definition and (2) Hospital ED records meeting the ICD-9-CM CDC recommended TBI definition. The sensitivity and positive predictive value were calculated for the NEISS definition using the ICD-9-CM definition as the gold standard. Further analyses were performed to describe cases characterized as TBIs in both datasets and to determine why some cases were not classified as TBIs in both datasets. There were 1834 TBI cases captured by the NEISS and 1836 TBI cases captured by the ICD-9-CM coded ED record, but only 1542 were eligible for inclusion in NEISS. There were 1403 cases classified as TBIs by both the NEISS and ICD-9-CM diagnosis codes. The NEISS TBI definition had a sensitivity of 91.0% (95% CI = 89.6-92.4%) and positive predictive value of 76.5% (95% CI = 74.6-78.4%). Using the NEISS TBI definition presented in this paper would standardize and improve the accuracy of TBI research using the NEISS.

  6. Standardized Definitions for Code Verification Test Problems

    Energy Technology Data Exchange (ETDEWEB)

    Doebling, Scott William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-09-14

    This document contains standardized definitions for several commonly used code verification test problems. These definitions are intended to contain sufficient information to set up the test problem in a computational physics code. These definitions are intended to be used in conjunction with exact solutions to these problems generated using Exact- Pack, www.github.com/lanl/exactpack.

  7. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection.

    NARCIS (Netherlands)

    Fitzner, Julia; Qasmieh, Saba; Mounts, Anthony Wayne; Alexander, Burmaa; Besselaar, Terry; Briand, Sylvie; Brown, Caroline; Clark, Seth; Dueger, Erica; Gross, Diane; Hauge, Siri; Hirve, Siddhivinayak; Jorgensen, Pernille; Katz, Mark A; Mafi, Ali; Malik, Mamunur; McCarron, Margaret; Meerhoff, Tamara; Mori, Yuichiro; Mott, Joshua; Olivera, Maria Teresa da Costa; Ortiz, Justin R; Palekar, Rakhee; Rebelo-de-Andrade, Helena; Soetens, Loes; Yahaya, Ali Ahmed; Zhang, Wenqing; Vandemaele, Katelijn

    2018-01-01

    The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of

  8. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection

    Science.gov (United States)

    Qasmieh, Saba; Mounts, Anthony Wayne; Alexander, Burmaa; Besselaar, Terry; Briand, Sylvie; Brown, Caroline; Clark, Seth; Dueger, Erica; Gross, Diane; Hauge, Siri; Hirve, Siddhivinayak; Jorgensen, Pernille; Katz, Mark A; Mafi, Ali; Malik, Mamunur; McCarron, Margaret; Meerhoff, Tamara; Mori, Yuichiro; Mott, Joshua; Olivera, Maria Teresa da Costa; Ortiz, Justin R; Palekar, Rakhee; Rebelo-de-Andrade, Helena; Soetens, Loes; Yahaya, Ali Ahmed; Zhang, Wenqing; Vandemaele, Katelijn

    2018-01-01

    Abstract The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009–2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza – i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed in the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden. PMID:29403115

  9. Reliability of case definitions for public health surveillance assessed by Round-Robin test methodology

    Directory of Open Access Journals (Sweden)

    Claus Hermann

    2006-05-01

    Full Text Available Abstract Background Case definitions have been recognized to be important elements of public health surveillance systems. They are to assure comparability and consistency of surveillance data and have crucial impact on the sensitivity and the positive predictive value of a surveillance system. The reliability of case definitions has rarely been investigated systematically. Methods We conducted a Round-Robin test by asking all 425 local health departments (LHD and the 16 state health departments (SHD in Germany to classify a selection of 68 case examples using case definitions. By multivariate analysis we investigated factors linked to classification agreement with a gold standard, which was defined by an expert panel. Results A total of 7870 classifications were done by 396 LHD (93% and all SHD. Reporting sensitivity was 90.0%, positive predictive value 76.6%. Polio case examples had the lowest reporting precision, salmonellosis case examples the highest (OR = 0.008; CI: 0.005–0.013. Case definitions with a check-list format of clinical criteria resulted in higher reporting precision than case definitions with a narrative description (OR = 3.08; CI: 2.47–3.83. Reporting precision was higher among SHD compared to LHD (OR = 1.52; CI: 1.14–2.02. Conclusion Our findings led to a systematic revision of the German case definitions and build the basis for general recommendations for the creation of case definitions. These include, among others, that testable yes/no criteria in a check-list format is likely to improve reliability, and that software used for data transmission should be designed in strict accordance with the case definitions. The findings of this study are largely applicable to case definitions in many other countries or international networks as they share the same structural and editorial characteristics of the case definitions evaluated in this study before their revision.

  10. High definition versus standard definition white light endoscopy for detecting dysplasia in patients with Barrett's esophagus.

    Science.gov (United States)

    Sami, S S; Subramanian, V; Butt, W M; Bejkar, G; Coleman, J; Mannath, J; Ragunath, K

    2015-01-01

    High-definition endoscopy systems provide superior image resolution. The aim of this study was to assess the utility of high definition compared with standard definition endoscopy system for detecting dysplastic lesions in patients with Barrett's esophagus. A retrospective cohort study of patients with non-dysplastic Barrett's esophagus undergoing routine surveillance was performed. Data were retrieved from the central hospital electronic database. Procedures performed for non-surveillance indications, Barrett's esophagus Prague C0M1 classification with no specialized intestinal metaplasia on histology, patients diagnosed with any dysplasia or cancer on index endoscopy, and procedures using advanced imaging techniques were excluded. Logistic regression models were constructed to estimate adjusted odds ratios and 95% confidence intervals comparing outcomes with standard definition and high-definition systems. The high definition was superior to standard definition system in targeted detection of all dysplastic lesions (odds ratio 3.27, 95% confidence interval 1.27-8.40) as well as overall dysplasia detected on both random and target biopsies (odds ratio 2.36, 95% confidence interval 1.50-3.72). More non-dysplastic lesions were detected with the high-definition system (odds ratio 1.16, 95% confidence interval 1.01-1.33). There was no difference between high definition and standard definition endoscopy in the overall (random and target) high-grade dysplasia or cancers detected (odds ratio 0.93, 95% confidence interval 0.83-1.04). Trainee endoscopists, number of biopsies taken, and male sex were all significantly associated with a higher yield for dysplastic lesions. The use of the high-definition endoscopy system is associated with better targeted detection of any dysplasia during routine Barrett's esophagus surveillance. However, high-definition endoscopy cannot replace random biopsies at present time. © 2014 International Society for Diseases of the Esophagus.

  11. Update of the Case Definitions for Population-Based Surveillance of Periodontitis

    Science.gov (United States)

    Eke, Paul I.; Page, Roy C.; Wei, Liang; Thornton-Evans, Gina; Genco, Robert J.

    2018-01-01

    Background This report adds a new definition for mild periodontitis that allows for better descriptions of the overall prevalence of periodontitis in populations. In 2007, the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology developed and reported standard case definitions for surveillance of moderate and severe periodontitis based on measurements of probing depth (PD) and clinical attachment loss (AL) at interproximal sites. However, combined cases of moderate and severe periodontitis are insufficient to determine the total prevalence of periodontitis in populations. Methods The authors proposed a definition for mild periodontitis as ≥2 interproximal sites with AL ≥3 mm and ≥2 interproximal sites with PD ≥4 mm (not on the same tooth) or one site with PD ≥5 mm. The effect of the proposed definition on the total burden of periodontitis was assessed in a convenience sample of 456 adults ≥35 years old and compared with other previously reported definitions for similar categories of periodontitis. Results Addition of mild periodontitis increases the total prevalence of periodontitis by ≈31% in this sample when compared with the prevalence of severe and moderate disease. Conclusion Total periodontitis using the case definitions in this study should be based on the sum of mild, moderate, and severe periodontitis. PMID:22420873

  12. Comparison of different criteria for periodontitis case definition in head and neck cancer individuals.

    Science.gov (United States)

    Bueno, Audrey Cristina; Ferreira, Raquel Conceição; Cota, Luis Otávio Miranda; Silva, Guilherme Carvalho; Magalhães, Cláudia Silami; Moreira, Allyson Nogueira

    2015-09-01

    Different periodontitis case definitions have been used in clinical research and epidemiology. The aim of this study was to determine more accurate criterion for the definition of mild and moderate periodontitis case to be applied to head and neck cancer individuals before radiotherapy. The frequency of periodontitis in a sample of 84 individuals was determined according to different diagnostic criteria: (1) Lopez et al. (2002);(2) Hujoel et al. (2006); (3) Beck et al. (1990); (4) Machtei et al. (1992); (5) Tonetti and Claffey (2005); (6) and Page and Eke (2007). All diagnosis were based on the clinical parameters obtained by a single calibrated examiner (Kw = 0.71). The individuals were evaluated before radiotherapy. They received oral hygiene instructions, and the cases diagnosed with periodontitis (Page and Eke 2007) were treated. The gold standard was the definition 6, and the others were compared by means of agreement, sensitivity (SS), specificity (SP), and the area under ROC curve. The kappa test evaluated the agreement between definitions. The frequency of periodontitis at baseline was 53.6 % (definition 1), 81.0 % (definition 2), 40.5 % (definition 3), 26.2 % (definition 4), 13.1 % (definition 5), and 70.2 % (definition 6). The kappa test showed a moderate agreement between definitions 6 and 2 (59.0 %) and definitions 6 and 1 (56.0 %). The criterion with higher SS (0.92) and SP (0.73) was definition 1. Definition 1 was the most accurate criterion to case periodontitis definition to be applied to head and neck cancer individuals.

  13. Clinical case definition for the diagnosis of acute intussusception.

    Science.gov (United States)

    Bines, Julie E; Ivanoff, Bernard; Justice, Frances; Mulholland, Kim

    2004-11-01

    Because of the reported association between intussusception and a rotavirus vaccine, future clinical trials of rotavirus vaccines will need to include intussusception surveillance in the evaluation of vaccine safety. The aim of this study is to develop and validate a clinical case definition for the diagnosis of acute intussusception. A clinical case definition for the diagnosis of acute intussusception was developed by analysis of an extensive literature review that defined the clinical presentation of intussusception in 70 developed and developing countries. The clinical case definition was then assessed for sensitivity and specificity using a retrospective chart review of hospital admissions. Sensitivity of the clinical case definition was assessed in children diagnosed with intussusception over a 6.5-year period. Specificity was assessed in patients aged clinical case definition accurately identified 185 of 191 assessable cases as "probable" intussusception and six cases as "possible" intussusception (sensitivity, 97%). No case of radiologic or surgically proven intussusception failed to be identified by the clinical case definition. The specificity of the definition in correctly identifying patients who did not have intussusception ranged from 87% to 91%. The clinical case definition for intussusception may assist in the prompt identification of patients with intussusception and may provide an important tool for the future trials of enteric vaccines.

  14. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries.

    Science.gov (United States)

    Kalinowski, Agnieszka; Humphreys, Keith

    2016-07-01

    One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries. A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country. Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10 g pure ethanol, but variation was wide (8-20 g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42 g per day for women and 10-56 g per day for men to 98-140 g per week for women and 150-280 g per week for men. Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research. © 2016 Society for the Study of Addiction.

  15. Diagnosis of measles by clinical case definition in dengue-endemic areas: implications for measles surveillance and control.

    OpenAIRE

    Dietz, V. J.; Nieburg, P.; Gubler, D. J.; Gomez, I.

    1992-01-01

    In many countries, measles surveillance relies heavily on the use of a standard clinical case definition; however, the clinical signs and symptoms of measles are similar to those of dengue. For example, during 1985, in Puerto Rico, 22 (23%) of 94 cases of illnesses with rashes that met the measles clinical case definition were serologically confirmed as measles, but 32 (34%) others were serologically confirmed as dengue. Retrospective analysis at the San Juan Laboratories of the Centers for D...

  16. 21 CFR 130.8 - Conformity to definitions and standards of identity.

    Science.gov (United States)

    2010-04-01

    ... identity. 130.8 Section 130.8 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Conformity to definitions and standards of identity. In the following conditions, among others, a food does not conform to the definition and standard of identity therefor: (a) If it contains an ingredient for...

  17. Case definition for clinical and subclinical bacterial kidney disease (BKD) in Atlantic Salmon (Salmo salar L.) in New Brunswick, Canada.

    Science.gov (United States)

    Boerlage, A S; Stryhn, H; Sanchez, J; Hammell, K L

    2017-03-01

    Bacterial kidney disease (BKD) is considered an important cause of loss in salmon aquaculture in Atlantic Canada. Causative agent of BKD is the Gram-positive bacteria Renibacterium salmoninarum. Infected salmon are often asymptomatic (subclinical infection), and the disease is considered chronic. One of the challenges in quantifying information from farm production and health records is the application of a standardized case definition. Case definitions for farm-level and cage-level clinical and subclinical BKD were developed using retrospective longitudinal data from aquaculture practices in New Brunswick, Canada, combining (i) industry records of weekly production data including mortalities, (ii) field observations for BKD using reports of veterinarians and/or fish health technicians, (iii) diagnostic submissions and test results and (iv) treatments used to control BKD. Case definitions were evaluated using veterinarians' expert judgements as reference standard. Eighty-nine and 66% of sites and fish groups, respectively, were associated with BKD at least once. For BKD present (subclinical or clinical), sensitivity and specificity of the case definition were 75-100% varying between event, fish group, site cycle and level (site pen). For clinical BKD, sensitivities were 29-64% and specificities 91-100%. Industry data can be used to develop sensitive case definitions. © 2016 John Wiley & Sons Ltd.

  18. Differential characterization of emerging skin diseases of rainbow trout--a standardized approach to capturing disease characteristics and development of case definitions.

    Science.gov (United States)

    Oidtmann, B; Lapatra, S E; Verner-Jeffreys, D; Pond, M; Peeler, E J; Noguera, P A; Bruno, D W; St-Hilaire, S; Schubiger, C B; Snekvik, K; Crumlish, M; Green, D M; Metselaar, M; Rodger, H; Schmidt-Posthaus, H; Galeotti, M; Feist, S W

    2013-11-01

    Farmed and wild salmonids are affected by a variety of skin conditions, some of which have significant economic and welfare implications. In many cases, the causes are not well understood, and one example is cold water strawberry disease of rainbow trout, also called red mark syndrome, which has been recorded in the UK since 2003. To date, there are no internationally agreed methods for describing these conditions, which has caused confusion for farmers and health professionals, who are often unclear as to whether they are dealing with a new or a previously described condition. This has resulted, inevitably, in delays to both accurate diagnosis and effective treatment regimes. Here, we provide a standardized methodology for the description of skin conditions of rainbow trout of uncertain aetiology. We demonstrate how the approach can be used to develop case definitions, using coldwater strawberry disease as an example. © 2013 Crown copyright.

  19. A computer case definition for sudden cardiac death.

    Science.gov (United States)

    Chung, Cecilia P; Murray, Katherine T; Stein, C Michael; Hall, Kathi; Ray, Wayne A

    2010-06-01

    To facilitate studies of medications and sudden cardiac death, we developed and validated a computer case definition for these deaths. The study of community dwelling Tennessee Medicaid enrollees 30-74 years of age utilized a linked database with Medicaid inpatient/outpatient files, state death certificate files, and a state 'all-payers' hospital discharge file. The computerized case definition was developed from a retrospective cohort study of sudden cardiac deaths occurring between 1990 and 1993. Medical records for 926 potential cases had been adjudicated for this study to determine if they met the clinical definition for sudden cardiac death occurring in the community and were likely to be due to ventricular tachyarrhythmias. The computerized case definition included deaths with (1) no evidence of a terminal hospital admission/nursing home stay in any of the data sources; (2) an underlying cause of death code consistent with sudden cardiac death; and (3) no terminal procedures inconsistent with unresuscitated cardiac arrest. This definition was validated in an independent sample of 174 adjudicated deaths occurring between 1994 and 2005. The positive predictive value of the computer case definition was 86.0% in the development sample and 86.8% in the validation sample. The positive predictive value did not vary materially for deaths coded according to the ICO-9 (1994-1998, positive predictive value = 85.1%) or ICD-10 (1999-2005, 87.4%) systems. A computerized Medicaid database, linked with death certificate files and a state hospital discharge database, can be used for a computer case definition of sudden cardiac death. Copyright (c) 2009 John Wiley & Sons, Ltd.

  20. The comparison of high and standard definition computed ...

    African Journals Online (AJOL)

    The comparison of high and standard definition computed tomography techniques regarding coronary artery imaging. A Aykut, D Bumin, Y Omer, K Mustafa, C Meltem, C Orhan, U Nisa, O Hikmet, D Hakan, K Mert ...

  1. Analysis of risk factors for schizophrenia with two different case definitions

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Tidselbak Larsen, Janne; Mors, Ole

    2015-01-01

    Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range...... of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient...... contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher...

  2. Accuracy of clinical diagnosis versus the World Health Organization case definition in the Amoy Garden SARS cohort.

    Science.gov (United States)

    Wong, W N; Sek, Antonio C H; Lau, Rick F L; Li, K M; Leung, Joe K S; Tse, M L; Ng, Andy H W; Stenstrom, Robert

    2003-11-01

    To compare the diagnostic accuracy of emergency department (ED) physicians with the World Health Organization (WHO) case definition in a large community-based SARS (severe acute respiratory syndrome) cohort. This was a cohort study of all patients from Hong Kong's Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical findings and WHO case definition criteria were recorded, along with ED diagnoses. Final diagnoses were established independently based on relevant diagnostic tests performed after the ED visit. Emergency physician diagnostic accuracy was compared with that of the WHO SARS case definition. Sensitivity, specificity, predictive values and likelihood ratios were calculated using standard formulae. During the study period, 818 patients presented with SARS-like symptoms, including 205 confirmed SARS, 35 undetermined SARS and 578 non-SARS. Sensitivity, specificity and accuracy were 91%, 96% and 94% for ED clinical diagnosis, versus 42%, 86% and 75% for the WHO case definition. Positive likelihood ratios (LR+) were 21.1 for physician judgement and 3.1 for the WHO criteria. Negative likelihood ratios (LR-) were 0.10 for physician judgement and 0.67 for the WHO criteria, indicating that clinician judgement was a much more powerful predictor than the WHO criteria. Physician clinical judgement was more accurate than the WHO case definition. Reliance on the WHO case definition as a SARS screening tool may lead to an unacceptable rate of misdiagnosis. The SARS case definition must be revised if it is to be used as a screening tool in emergency departments and primary care settings.

  3. An Ontology to Improve Transparency in Case Definition and Increase Case Finding of Infectious Intestinal Disease: Database Study in English General Practice.

    Science.gov (United States)

    de Lusignan, Simon; Shinneman, Stacy; Yonova, Ivelina; van Vlymen, Jeremy; Elliot, Alex J; Bolton, Frederick; Smith, Gillian E; O'Brien, Sarah

    2017-09-28

    result was 19.68% (546/2775). The standard RCGP RSC definition of IID, and its mapping to ICD-10, underestimates disease incidence. The ontological approach identified a larger proportion of new IID cases; the ontology divides contributory elements and enables transparency and comparison of rates. Results illustrate how improved diagnostic coding of IID combined with an ontological approach to case definition would provide a clearer picture of IID in the community, better inform GPs and public health services about circulating disease, and empower them to respond. We need to improve the Pathology Bounded Code List (PBCL) currently used by laboratories to electronically report results. Given advances in stool microbiology testing with a move to nonculture, PCR-based methods, the way microbiology results are reported and coded via PBCL needs to be reviewed and modernized. ©Simon de Lusignan, Stacy Shinneman, Ivelina Yonova, Jeremy van Vlymen, Alex J Elliot, Frederick Bolton, Gillian E Smith, Sarah O'Brien. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 28.09.2017.

  4. Computer-assisted expert case definition in electronic health records.

    Science.gov (United States)

    Walker, Alexander M; Zhou, Xiaofeng; Ananthakrishnan, Ashwin N; Weiss, Lisa S; Shen, Rongjun; Sobel, Rachel E; Bate, Andrew; Reynolds, Robert F

    2016-02-01

    To describe how computer-assisted presentation of case data can lead experts to infer machine-implementable rules for case definition in electronic health records. As an illustration the technique has been applied to obtain a definition of acute liver dysfunction (ALD) in persons with inflammatory bowel disease (IBD). The technique consists of repeatedly sampling new batches of case candidates from an enriched pool of persons meeting presumed minimal inclusion criteria, classifying the candidates by a machine-implementable candidate rule and by a human expert, and then updating the rule so that it captures new distinctions introduced by the expert. Iteration continues until an update results in an acceptably small number of changes to form a final case definition. The technique was applied to structured data and terms derived by natural language processing from text records in 29,336 adults with IBD. Over three rounds the technique led to rules with increasing predictive value, as the experts identified exceptions, and increasing sensitivity, as the experts identified missing inclusion criteria. In the final rule inclusion and exclusion terms were often keyed to an ALD onset date. When compared against clinical review in an independent test round, the derived final case definition had a sensitivity of 92% and a positive predictive value of 79%. An iterative technique of machine-supported expert review can yield a case definition that accommodates available data, incorporates pre-existing medical knowledge, is transparent and is open to continuous improvement. The expert updates to rules may be informative in themselves. In this limited setting, the final case definition for ALD performed better than previous, published attempts using expert definitions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Neutron dosimetry. Terms and definitions. Preliminary standard. Neutronendosimetrie. Begriffe und Benennungen. Vornorm

    Energy Technology Data Exchange (ETDEWEB)

    1978-06-01

    With this standard, definitions and terms are introduced without references. Radiation field quantities and dose quantities are defined as differential quotients like in the consecutive parts of DIN 6814. The stochastic nature of radiation and of its interactions has been accounted for by the fact that each differential quotient is to be understood as the limiting value of the statistic expectancy value of the corresponding differential quotient. The present standard is limited to the definition of non-stochastic quantities for radiation field and dose. It does not include definitions of micro-dose quantities valid for all types of radiation.

  6. Case definition for progressive multifocal leukoencephalopathy following treatment with monoclonal antibodies.

    Science.gov (United States)

    Mentzer, Dirk; Prestel, Jürgen; Adams, Ortwin; Gold, Ralf; Hartung, Hans-Peter; Hengel, Hartmut; Kieseier, Bernd C; Ludwig, Wolf-Dieter; Keller-Stanislawski, Brigitte

    2012-09-01

    Novel immunosuppressive/modulating therapies with monoclonal antibodies (MABs) have been associated with progressive multifocal leukoencephalopathy (PML), a potentially fatal disease of the brain caused by the JC virus. Taking the complex diagnostic testing and heterogeneous clinical presentation of PML into account, an agreed case definition for PML is a prerequisite for a thorough assessment of PML. A working group was established to develop a standardised case definition for PML which permits data comparability across clinical trials, postauthorisation safety studies and passive postmarketing surveillance. The case definition is designed to define levels of diagnostic certainty of reported PML cases following treatment with MABs. It was subsequently used to categorise retrospectively suspected PML cases from Germany reported to the Paul-Ehrlich-Institute as the responsible national competent authority. The algorithm of the case definition is based on clinical symptoms, PCR for JC virus DNA in cerebrospinal fluid, brain MRI, and brain biopsy/autopsy. The case definition was applied to 119 suspected cases of PML following treatment with MABs and is considered to be helpful for case ascertainment of suspected PML cases for various MABs covering a broad spectrum of indications. Even if the available information is not yet complete, the case definition provides a level of diagnostic certainty. The proposed case definition permits data comparability among different medicinal products and among active as well as passive surveillance settings. It may form a basis for meaningful risk analysis and communication for regulators and healthcare professionals.

  7. Osteoporosis-related fracture case definitions for population-based administrative data

    Directory of Open Access Journals (Sweden)

    Lix Lisa M

    2012-05-01

    Full Text Available Abstract Background Population-based administrative data have been used to study osteoporosis-related fracture risk factors and outcomes, but there has been limited research about the validity of these data for ascertaining fracture cases. The objectives of this study were to: (a compare fracture incidence estimates from administrative data with estimates from population-based clinically-validated data, and (b test for differences in incidence estimates from multiple administrative data case definitions. Methods Thirty-five case definitions for incident fractures of the hip, wrist, humerus, and clinical vertebrae were constructed using diagnosis codes in hospital data and diagnosis and service codes in physician billing data from Manitoba, Canada. Clinically-validated fractures were identified from the Canadian Multicentre Osteoporosis Study (CaMos. Generalized linear models were used to test for differences in incidence estimates. Results For hip fracture, sex-specific differences were observed in the magnitude of under- and over-ascertainment of administrative data case definitions when compared with CaMos data. The length of the fracture-free period to ascertain incident cases had a variable effect on over-ascertainment across fracture sites, as did the use of imaging, fixation, or repair service codes. Case definitions based on hospital data resulted in under-ascertainment of incident clinical vertebral fractures. There were no significant differences in trend estimates for wrist, humerus, and clinical vertebral case definitions. Conclusions The validity of administrative data for estimating fracture incidence depends on the site and features of the case definition.

  8. Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

    Science.gov (United States)

    Miller, Dave P.; O'Shaughnessy, Kathryn F.; Wood, Susan A.; Castellino, Ronald A.

    2004-05-01

    Comparative evaluations of reader performance using different modalities, e.g. CT with computer-aided detection (CAD) vs. CT without CAD, generally require a "truth" definition based on a gold standard. There are many situations in which a true invariant gold standard is impractical or impossible to obtain. For instance, small pulmonary nodules are generally not assessed by biopsy or resection. In such cases, it is common to use a unanimous consensus or majority agreement from an expert panel as a reference standard for actionability in lieu of the unknown gold standard for disease. Nonetheless, there are three major concerns about expert panel reference standards: (1) actionability is not synonymous with disease (2) it may be possible to obtain different conclusions about which modality is better using different rules (e.g. majority vs. unanimous consensus), and (3) the variability associated with the panelists is not formally captured in the p-values or confidence intervals that are generally produced for estimating the extent to which one modality is superior to the other. A multi-reader-multi-case (MRMC) receiver operating characteristic (ROC) study was performed using 90 cases, 15 readers, and a reference truth based on 3 experienced panelists. The primary analyses were conducted using a reference truth of unanimous consensus regarding actionability (3 out of 3 panelists). To assess the three concerns noted above: (1) additional data from the original radiology reports were compared to the panel (2) the complete analysis was repeated using different definitions of truth, and (3) bootstrap analyses were conducted in which new truth panels were constructed by picking 1, 2, or 3 panelists at random. The definition of the reference truth affected the results for each modality (CT with CAD and CT without CAD) considered by itself, but the effects were similar, so the primary analysis comparing the modalities was robust to the choice of the reference truth.

  9. Establishment of Valid Laboratory Case Definition for Human Leptospirosis

    NARCIS (Netherlands)

    M.G.A. Goris (Marga); M.M.G. Leeflang (Mariska); K.R. Boer (Kimberly); M. Goeijenbier (Marco); E.C.M. van Gorp (Eric); J.F.P. Wagenaar (Jiri); R.A. Hartskeerl (Rudy)

    2011-01-01

    textabstractLaboratory case definition of leptospirosis is scarcely de ned by a solid evaluation that determines cut-off values in the tests that are applied. This study describes the process of determining optimal cut-off titers of laboratory tests for leptospirosis for a valid case definition of

  10. A Case Definition for Children with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

    OpenAIRE

    Leonard A. Jason; Nicole Porter; Elizabeth Shelleby; David S. Bell; Charles W. Lapp; Kathy Rowe; Kenny De Meirleir

    2008-01-01

    The case definition for chronic fatigue syndrome was developed for adults (Fukuda et al. 1994), and this case definition may not be appropriate for use with children and adolescents. The lack of application of a consistent pediatric definition for this illness and the lack of a reliable instrument to assess it might lead to studies which lack sensitivity and specificity. In this article, a case definition is presented that has been endorsed by the International Association of ME/CFS.

  11. Impact of revising the National Nosocomial Infection Surveillance System definition for catheter-related bloodstream infection in ICU: reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals.

    Science.gov (United States)

    Worth, Leon J; Brett, Judy; Bull, Ann L; McBryde, Emma S; Russo, Philip L; Richards, Michael J

    2009-10-01

    Effective and comparable surveillance for central venous catheter-related bloodstream infections (CLABSIs) in the intensive care unit requires a reproducible case definition that can be readily applied by infection control professionals. Using a questionnaire containing clinical cases, reproducibility of the National Nosocomial Infection Surveillance System (NNIS) surveillance definition for CLABSI was assessed in an Australian cohort of infection control professionals participating in the Victorian Hospital Acquired Infection Surveillance System (VICNISS). The same questionnaire was then used to evaluate the reproducibility of the National Healthcare Safety Network (NHSN) surveillance definition for CLABSI. Target hospitals were defined as large metropolitan (1A) or other large hospitals (non-1A), according to the Victorian Department of Human Services. Questionnaire responses of Centers for Disease Control and Prevention NHSN surveillance experts were used as gold standard comparator. Eighteen of 21 eligible VICNISS centers participated in the survey. Overall concordance with the gold standard was 57.1%, and agreement was highest for 1A hospitals (60.6%). The proportion of congruently classified cases varied according to NNIS criteria: criterion 1 (recognized pathogen), 52.8%; criterion 2a (skin contaminant in 2 or more blood cultures), 83.3%; criterion 2b (skin contaminant in 1 blood culture and appropriate antimicrobial therapy instituted), 58.3%; non-CLABSI cases, 51.4%. When survey questions regarding identification of cases of CLABSI criterion 2b were removed (consistent with the current NHSN definition), overall percentage concordance increased to 62.5% (72.2% for 1A centers). Further educational interventions are required to improve the discrimination of primary and secondary causes of bloodstream infection in Victorian intensive care units. Although reproducibility of the CLABSI case definition is relatively poor, adoption of the revised NHSN definition

  12. Revised surveillance case definition for HIV infection--United States, 2014.

    Science.gov (United States)

    2014-04-11

    Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

  13. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel.

    Science.gov (United States)

    Graham, Stephen M; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E; Gale, Marianne; Gie, Robert P; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J; McNeeley, David F; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R; Swaminathan, Soumya; Wingfield, Claire

    2012-05-15

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.

  14. Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel

    Science.gov (United States)

    Graham, Stephen M.; Ahmed, Tahmeed; Amanullah, Farhana; Browning, Renee; Cardenas, Vicky; Casenghi, Martina; Cuevas, Luis E.; Gale, Marianne; Gie, Robert P.; Grzemska, Malgosia; Handelsman, Ed; Hatherill, Mark; Hesseling, Anneke C.; Jean-Philippe, Patrick; Kampmann, Beate; Kabra, Sushil Kumar; Lienhardt, Christian; Lighter-Fisher, Jennifer; Madhi, Shabir; Makhene, Mamodikoe; Marais, Ben J.; McNeeley, David F.; Menzies, Heather; Mitchell, Charles; Modi, Surbhi; Mofenson, Lynne; Musoke, Philippa; Nachman, Sharon; Powell, Clydette; Rigaud, Mona; Rouzier, Vanessa; Starke, Jeffrey R.; Swaminathan, Soumya; Wingfield, Claire

    2012-01-01

    There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. PMID:22448023

  15. 45 CFR 680.10 - Definitions; cross-references to employee ethical conduct standards and financial disclosure...

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Definitions; cross-references to employee ethical... Foundation § 680.10 Definitions; cross-references to employee ethical conduct standards and financial...-references to employee ethical conduct standards and financial disclosure regulations. Members of the...

  16. Wind turbines and health: An examination of a proposed case definition.

    Science.gov (United States)

    McCunney, Robert J; Morfeld, Peter; Colby, W David; Mundt, Kenneth A

    2015-01-01

    Renewable energy demands have increased the need for new wind farms. In turn, concerns have been raised about potential adverse health effects on nearby residents. A case definition has been proposed to diagnose "Adverse Health Effects in the Environs of Industrial Wind Turbines" (AHE/IWT); initially in 2011 and then with an update in 2014. The authors invited commentary and in turn, we assessed its scientific merits by quantitatively evaluating its proposed application. We used binomial coefficients to quantitatively assess the potential of obtaining a diagnosis of AHE/IWT. We also reviewed the methodology and process of the development of the case definition by contrasting it with guidelines on case definition criteria of the USA Institute of Medicine. The case definition allows at least 3,264 and up to 400,000 possibilities for meeting second- and third-order criteria, once the limited first-order criteria are met. IOM guidelines for clinical case definitions were not followed. The case definition has virtually no specificity and lacks scientific support from peer-reviewed literature. If applied as proposed, its application will lead to substantial potential for false-positive assessments and missed diagnoses. Virtually any new illness that develops or any prevalent illness that worsens after the installation of wind turbines within 10 km of a residence could be considered AHE/IWT if the patient feels better away from home. The use of this case definition in the absence of a thorough medical evaluation with appropriate diagnostic studies poses risks to patients in that treatable disorders would be overlooked. The case definition has significant potential to mislead patients and its use cannot be recommended for application in any health-care or decision-making setting.

  17. Wind turbines and health: An examination of a proposed case definition

    Directory of Open Access Journals (Sweden)

    Robert J McCunney

    2015-01-01

    Full Text Available Renewable energy demands have increased the need for new wind farms. In turn, concerns have been raised about potential adverse health effects on nearby residents. A case definition has been proposed to diagnose "Adverse Health Effects in the Environs of Industrial Wind Turbines" (AHE/IWT; initially in 2011 and then with an update in 2014. The authors invited commentary and in turn, we assessed its scientific merits by quantitatively evaluating its proposed application. We used binomial coefficients to quantitatively assess the potential of obtaining a diagnosis of AHE/IWT. We also reviewed the methodology and process of the development of the case definition by contrasting it with guidelines on case definition criteria of the USA Institute of Medicine. The case definition allows at least 3,264 and up to 400,000 possibilities for meeting second- and third-order criteria, once the limited first-order criteria are met. IOM guidelines for clinical case definitions were not followed. The case definition has virtually no specificity and lacks scientific support from peer-reviewed literature. If applied as proposed, its application will lead to substantial potential for false-positive assessments and missed diagnoses. Virtually any new illness that develops or any prevalent illness that worsens after the installation of wind turbines within 10 km of a residence could be considered AHE/IWT if the patient feels better away from home. The use of this case definition in the absence of a thorough medical evaluation with appropriate diagnostic studies poses risks to patients in that treatable disorders would be overlooked. The case definition has significant potential to mislead patients and its use cannot be recommended for application in any health-care or decision-making setting

  18. Wind turbines and health: An examination of a proposed case definition

    Science.gov (United States)

    McCunney, Robert J.; Morfeld, Peter; Colby, W. David; Mundt, Kenneth A.

    2015-01-01

    Renewable energy demands have increased the need for new wind farms. In turn, concerns have been raised about potential adverse health effects on nearby residents. A case definition has been proposed to diagnose “Adverse Health Effects in the Environs of Industrial Wind Turbines” (AHE/IWT); initially in 2011 and then with an update in 2014. The authors invited commentary and in turn, we assessed its scientific merits by quantitatively evaluating its proposed application. We used binomial coefficients to quantitatively assess the potential of obtaining a diagnosis of AHE/IWT. We also reviewed the methodology and process of the development of the case definition by contrasting it with guidelines on case definition criteria of the USA Institute of Medicine. The case definition allows at least 3,264 and up to 400,000 possibilities for meeting second- and third-order criteria, once the limited first-order criteria are met. IOM guidelines for clinical case definitions were not followed. The case definition has virtually no specificity and lacks scientific support from peer-reviewed literature. If applied as proposed, its application will lead to substantial potential for false-positive assessments and missed diagnoses. Virtually any new illness that develops or any prevalent illness that worsens after the installation of wind turbines within 10 km of a residence could be considered AHE/IWT if the patient feels better away from home. The use of this case definition in the absence of a thorough medical evaluation with appropriate diagnostic studies poses risks to patients in that treatable disorders would be overlooked. The case definition has significant potential to mislead patients and its use cannot be recommended for application in any health-care or decision-making setting. PMID:26168947

  19. Fatigue after stroke: the development and evaluation of a case definition.

    Science.gov (United States)

    Lynch, Joanna; Mead, Gillian; Greig, Carolyn; Young, Archie; Lewis, Susan; Sharpe, Michael

    2007-11-01

    While fatigue after stroke is a common problem, it has no generally accepted definition. Our aim was to develop a case definition for post-stroke fatigue and to test its psychometric properties. A case definition with face validity and an associated structured interview was constructed. After initial piloting, the feasibility, reliability (test-retest and inter-rater) and concurrent validity (in relation to four fatigue severity scales) were determined in 55 patients with stroke. All participating patients provided satisfactory answers to all the case definition probe questions demonstrating its feasibility For test-retest reliability, kappa was 0.78 (95% CI, 0.57-0.94, Pdefinition also had substantially higher fatigue scores on four fatigue severity scales (Pvalidity. The proposed case definition is feasible to administer and reliable in practice, and there is evidence of concurrent validity. It requires further evaluation in different settings.

  20. Case definition and classification of leukodystrophies and leukoencephalopathies

    NARCIS (Netherlands)

    Vanderver, Adeline; Prust, Morgan; Tonduti, Davide; Mochel, Fanny; Hussey, Heather M.; Helman, Guy; Garbern, James; Eichler, Florian; Labauge, Pierre; Aubourg, Patrick; Rodriguez, Diana; Patterson, Marc C.; van Hove, Johan L. K.; Schmidt, Johanna; Wolf, Nicole I.; Boespflug-Tanguy, Odile; Schiffmann, Raphael; van der Knaap, Marjo S.

    2015-01-01

    An approved definition of the term leukodystrophy does not currently exist. The lack of a precise case definition hampers efforts to study the epidemiology and the relevance of genetic white matter disorders to public health. Thirteen experts at multiple institutions participated in iterative

  1. Case definition and classification of leukodystrophies and leukoencephalopathies

    NARCIS (Netherlands)

    Vanderver, A.; Prust, M.; Tonduti, D.; Mochel, F.; Hussey, H.M.; Helman, G.; Garbern, J.; Eichler, F.; Labauge, P.; Aubourg, P.; Rodriguez, D.; Patterson, M.C.; van Hove, J.LK.; Schmidt, J; Wolf, N.I.; Boespflug-Tanguy, O.; Schiffmann, R.; van der Knaap, M.S.

    2015-01-01

    Objective: An approved definition of the term leukodystrophy does not currently exist. The lack of a precise case definition hampers efforts to study the epidemiology and the relevance of genetic white matter disorders to public health. Method: Thirteen experts at multiple institutions participated

  2. Assessment of the accuracy and consistency in the application of standardized surveillance definitions: A summary of the American Journal of Infection Control and National Healthcare Safety Network case studies, 2010-2016.

    Science.gov (United States)

    Wright, Marc-Oliver; Allen-Bridson, Katherine; Hebden, Joan N

    2017-06-01

    The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance definitions are the most widely used criteria for health care-associated infection (HAI) surveillance. NHSN participants agree to conduct surveillance in accordance with the NHSN protocol and criteria. To assess the application of these standardized surveillance specifications and offer infection preventionists (IPs) opportunities for ongoing education, a series of case studies, with questions related to NHSN definitions and criteria were published. Beginning in 2010, case studies with multiple-choice questions based on standard surveillance criteria and protocols were written and published in the American Journal of Infection Control with a link to an online survey. Participants anonymously submitted their responses before receiving the correct answers. The 22 case studies had 7,950 respondents who provided 27,790 responses to 75 questions during the first 6 years. Correct responses were selected 62.5% of the time (17,376 out of 27,290), but ranged widely (16%-87%). In a subset analysis, 93% of participants self-identified as IPs (3,387 out of 3,640), 4.5% were public health professionals (163 out of 3,640), and 2.5% were physicians (90 out of 3,640). IPs responded correctly (62%) more often than physicians (55%) (P = .006). Among a cohort of voluntary participants, accurate application of surveillance criteria to case studies was suboptimal, highlighting the need for continuing education, competency development, and auditing. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  3. Stakeholder Perceptions of Cyberbullying Cases: Application of the Uniform Definition of Bullying.

    Science.gov (United States)

    Moreno, Megan A; Suthamjariya, Nina; Selkie, Ellen

    2018-04-01

    The Uniform Definition of Bullying was developed to address bullying and cyberbullying, and to promote consistency in measurement and policy. The purpose of this study was to understand community stakeholder perceptions of typical cyberbullying cases, and to evaluate how these case descriptions align with the Uniform Definition. In this qualitative case analysis we recruited stakeholders commonly involved in cyberbullying. We used purposeful sampling to identify and recruit adolescents and young adults, parents, and professionals representing education and health care. Participants were asked to write a typical case of cyberbullying and descriptors in the context of a group discussion. We applied content analysis to case excerpts using inductive and deductive approaches, and chi-squared tests for mixed methods analyses. A total of 68 participants contributed; participants included 73% adults and 27% adolescents and young adults. A total of 650 excerpts were coded from participants' example cases and 362 (55.6%) were consistent with components of the Uniform Definition. The most frequently mentioned component of the Uniform Definition was Aggressive Behavior (n = 218 excerpts), whereas Repeated was mentioned infrequently (n = 19). Most participants included two to three components of the Uniform Definition within an example case; none of the example cases included all components of the Uniform Definition. We found that most participants described cyberbullying cases using few components of the Uniform Definition. Findings can be applied toward considering refinement of the Uniform Definition to ensure stakeholders find it applicable to cyberbullying. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. A comparison of standard definitions and sagittal abdominal ...

    Science.gov (United States)

    Introduction: Metabolic syndrome (MeTS) is the cluster of several clinical symptoms that together represent the strongest risk factor for cardiovascular disease. The prevalence of MeTS in adolescents is difficult to estimate given that there are several, but no agreed upon definition of MeTS for this age group. It is important to estimate MeTS and identify at-risk adolescents early in order to provide effective interventions prior to the development of diabetes and coronary heart disease. Objective: Study objectives are to: (1) estimate the prevalence of MeTS in U.S. adolescents using three widely adopted definitions and (2) compare changes in prevalence of MeTS when utilizing sagittal abdominal diameter (SAD) as a component of MeTS. Methods: Data from U.S. adolescents ages 12–19 years (N=970) in the NHANES (2011–2014) were analyzed. MeTS standard definitions developed by Cook et al. (2003), deFerranti et al. (2007), and the International Disease Federation (IDF, 2007) were applied to estimate the sex-stratified, weighted prevalence of MeTS and its individual components (i.e., high waist circumference (WC), hypertension, blood lipid abnormalities, and high fasting blood glucose (FBG)). The definitions were modified by substituting SAD for WC, and weighted MeTS prevalence was re-estimated. Results: Regardless of gender and definition, abnormal blood lipids and high WC were the most prevalent MeTS components. For both sexes, estimated prevalence of componen

  5. Concordance between European and US case definitions of healthcare-associated infections

    Science.gov (United States)

    2012-01-01

    Background Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ). Results Differences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were

  6. Concordance between European and US case definitions of healthcare-associated infections

    Directory of Open Access Journals (Sweden)

    Hansen Sonja

    2012-08-01

    Full Text Available Abstract Background Surveillance of healthcare-associated infections (HAI is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010. Concordance between case definitions was estimated with Cohen’s kappa statistic (κ. Results Differences in HAI definitions were found for bloodstream infection (BSI, pneumonia (PN, urinary tract infection (UTI and the two key terms “intensive care unit (ICU-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94 for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82 for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI

  7. Equivalence of the Traditional and Non-Standard Definitions of Concepts from Real Analysis

    Directory of Open Access Journals (Sweden)

    John Cowles

    2014-06-01

    Full Text Available ACL2(r is a variant of ACL2 that supports the irrational real and complex numbers. Its logical foundation is based on internal set theory (IST, an axiomatic formalization of non-standard analysis (NSA. Familiar ideas from analysis, such as continuity, differentiability, and integrability, are defined quite differently in NSA–some would argue the NSA definitions are more intuitive. In previous work, we have adopted the NSA definitions in ACL2(r, and simply taken as granted that these are equivalent to the traditional analysis notions, e.g., to the familiar epsilon-delta definitions. However, we argue in this paper that there are circumstances when the more traditional definitions are advantageous in the setting of ACL2(r, precisely because the traditional notions are classical, so they are unencumbered by IST limitations on inference rules such as induction or the use of pseudo-lambda terms in functional instantiation. To address this concern, we describe a formal proof in ACL2(r of the equivalence of the traditional and non-standards definitions of these notions.

  8. Evaluation of a surveillance case definition for anogenital warts, Kaiser Permanente northwest.

    Science.gov (United States)

    Naleway, Allison L; Weinmann, Sheila; Crane, Brad; Gee, Julianne; Markowitz, Lauri E; Dunne, Eileen F

    2014-08-01

    Most studies of anogenital wart (AGW) epidemiology have used large clinical or administrative databases and unconfirmed case definitions based on combinations of diagnosis and procedure codes. We developed and validated an AGW case definition using a combination of diagnosis codes and other information available in the electronic medical record (provider type, laboratory testing). We calculated the positive predictive value (PPV) of this case definition compared with manual medical record review in a random sample of 250 cases. Using this case definition, we calculated the annual age- and sex-stratified prevalence of AGW among individuals 11 through 30 years of age from 2000 through 2005. We identified 2730 individuals who met the case definition. The PPV of the case definition was 82%, and the average annual prevalence was 4.16 per 1000. Prevalence of AGW was higher in females compared with males in every age group, with the exception of the 27- to 30-year-olds. Among females, prevalence peaked in the 19- to 22-year-olds, and among males, the peak was observed in 23- to 26-year-olds. The case definition developed in this study is the first to be validated with medical record review and has a good PPV for the detection of AGW. The prevalence rates observed in this study were higher than other published rates, but the age- and sex-specific patterns observed were consistent with previous reports.

  9. Enhanced definition and required examples of common datum imposed by ISO standard

    Science.gov (United States)

    Yan, Yiqing; Bohn, Martin

    2017-12-01

    According to the ISO Geometrical Product Specifications (GPS), the establishment and definition of common datum for geometrical components are not fully defined. There are two main limitations of this standard. Firstly: the explications of ISO examples of common datums are not matched with their corresponding definitions, and secondly: a full definition of common datum is missing. This paper suggests a new approach for an enhanced definition and concrete examples of common datum and proposes a holistic methodology for establishment of common datum for each geometrical component. This research is based on the analysis of physical behaviour of geometrical components, orientation constraints and invariance classes of datums. This approach fills the definition gaps of common datum based on ISO GPS, thereby eliminating those deficits. As a result, an improved methodology for a fully functional defined definition of common datum was formulated.

  10. Defining progression in nonmuscle invasive bladder cancer: it is time for a new, standard definition.

    Science.gov (United States)

    Lamm, Donald; Persad, Raj; Brausi, Maurizio; Buckley, Roger; Witjes, J Alfred; Palou, Joan; Böhle, Andreas; Kamat, Ashish M; Colombel, Marc; Soloway, Mark

    2014-01-01

    Despite being one of the most important clinical outcomes in nonmuscle invasive bladder cancer, there is currently no standard definition of disease progression. Major clinical trials and meta-analyses have used varying definitions or have failed to define this end point altogether. A standard definition of nonmuscle invasive bladder cancer progression as determined by reproducible and reliable procedures is needed. We examine current definitions of nonmuscle invasive bladder cancer progression, and propose a new definition that will be more clinically useful in determining patient prognosis and comparing treatment options. The IBCG (International Bladder Cancer Group) analyzed published clinical trials and meta-analyses that examined nonmuscle invasive bladder cancer progression as of December 2012. The limitations of the definitions of progression used in these trials were considered, as were additional parameters associated with the advancement of nonmuscle invasive bladder cancer. The most commonly used definition of nonmuscle invasive bladder cancer progression is an increase in stage from nonmuscle invasive to muscle invasive disease. Although this definition is clinically important, it fails to include other important parameters of advancing disease such as progression to lamina propria invasion and increase in grade. The IBCG proposes the definition of nonmuscle invasive bladder cancer progression as an increase in T stage from CIS or Ta to T1 (lamina propria invasion), development of T2 or greater or lymph node (N+) disease or distant metastasis (M1), or an increase in grade from low to high. Investigators should consider the use of this new definition to help standardize protocols and improve the reporting of progression. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Tuberculous meningitis: a uniform case definition for use in clinical research.

    Science.gov (United States)

    Marais, Suzaan; Thwaites, Guy; Schoeman, Johan F; Török, M Estée; Misra, Usha K; Prasad, Kameshwar; Donald, Peter R; Wilkinson, Robert J; Marais, Ben J

    2010-11-01

    Tuberculous meningitis causes substantial mortality and morbidity in children and adults. More research is urgently needed to better understand the pathogenesis of disease and to improve its clinical management and outcome. A major stumbling block is the absence of standardised diagnostic criteria. The different case definitions used in various studies makes comparison of research findings difficult, prevents the best use of existing data, and limits the management of disease. To address this problem, a 3-day tuberculous meningitis workshop took place in Cape Town, South Africa, and was attended by 41 international participants experienced in the research or management of tuberculous meningitis. During the meeting, diagnostic criteria were assessed and discussed, after which a writing committee was appointed to finalise a consensus case definition for tuberculous meningitis for use in future clinical research. We present the consensus case definition together with the rationale behind the recommendations. This case definition is applicable irrespective of the patient's age, HIV infection status, or the resources available in the research setting. Consistent use of the proposed case definition will aid comparison of studies, improve scientific communication, and ultimately improve care. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. Definitions Are Important: The Case of Linear Algebra

    Science.gov (United States)

    Berman, Abraham; Shvartsman, Ludmila

    2016-01-01

    In this paper we describe an experiment in a linear algebra course. The aim of the experiment was to promote the students' understanding of the studied concepts focusing on their definitions. It seems to be a given that students should understand concepts' definitions before working substantially with them. Unfortunately, in many cases they do…

  13. Internationally Standardized Cost Item Definitions for Decommissioning of Nuclear Installations

    International Nuclear Information System (INIS)

    Lucien Teunckens; Kurt Pflugrad; Candace Chan-Sands; Ted Lazo

    2000-01-01

    The European Commission (EC), the International Atomic Energy Agency (IAEA), and the Organization for Economic Cooperation and Development/Nuclear Energy Agency (OECD/NEA) have agreed to jointly prepare and publish a standardized list of cost items and related definitions for decommissioning projects. Such a standardized list would facilitate communication, promote uniformity, and avoid inconsistency or contradiction of results or conclusions of cost evaluations for decommissioning projects carried out for specific purposes by different groups. Additionally, a standardized structure would also be a useful tool for more effective cost management. This paper describes actual work and result thus far

  14. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic.

    Science.gov (United States)

    Hsu, Christopher H; Champaloux, Steven W; Keïta, Sakoba; Martel, Lise; Bilivogui, Pepe; Knust, Barbara; McCollum, Andrea M

    2018-01-01

    Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (pdefinition used in Guinea contributed to improved overall sensitivity and specificity.

  15. Chronic kidney disease of nontraditional etiology in Central America: a provisional epidemiologic case definition for surveillance and epidemiologic studies.

    Science.gov (United States)

    Lozier, Matthew; Turcios-Ruiz, Reina Maria; Noonan, Gary; Ordunez, Pedro

    2016-11-01

    SYNOPSIS Over the last two decades, experts have reported a rising number of deaths caused by chronic kidney disease (CKD) along the Pacific coast of Central America, from southern Mexico to Costa Rica. However, this specific disease is not associated with traditional causes of CKD, such as aging, diabetes, or hypertension. Rather, this disease is a chronic interstitial nephritis termed chronic kidney disease of nontraditional etiology (CKDnT). According to the Pan American Health Organization (PAHO) mortality database, there are elevated rates of deaths related to kidney disease in many of these countries, with the highest rates being reported in El Salvador and Nicaragua. This condition has been identified in certain agricultural communities, predominantly among male farmworkers. Since CKD surveillance systems in Central America are under development or nonexistent, experts and governmental bodies have recommended creating standardized case definitions for surveillance purposes to monitor and characterize this epidemiological situation. A group of experts from Central American ministries of health, the U.S. Centers for Disease Control and Prevention (CDC), and PAHO held a workshop in Guatemala to discuss CKDnT epidemiologic case definitions. In this paper, we propose that CKD in general be identified by the standard definition internationally accepted and that a suspect case of CKDnT be defined as a person age CKDnT is defined as a suspect case with the same findings confirmed three or more months later.

  16. Chronic kidney disease of nontraditional etiology in Central America: a provisional epidemiologic case definition for surveillance and epidemiologic studies

    Directory of Open Access Journals (Sweden)

    Matthew Lozier

    Full Text Available SYNOPSIS Over the last two decades, experts have reported a rising number of deaths caused by chronic kidney disease (CKD along the Pacific coast of Central America, from southern Mexico to Costa Rica. However, this specific disease is not associated with traditional causes of CKD, such as aging, diabetes, or hypertension. Rather, this disease is a chronic interstitial nephritis termed chronic kidney disease of nontraditional etiology (CKDnT. According to the Pan American Health Organization (PAHO mortality database, there are elevated rates of deaths related to kidney disease in many of these countries, with the highest rates being reported in El Salvador and Nicaragua. This condition has been identified in certain agricultural communities, predominantly among male farmworkers. Since CKD surveillance systems in Central America are under development or nonexistent, experts and governmental bodies have recommended creating standardized case definitions for surveillance purposes to monitor and characterize this epidemiological situation. A group of experts from Central American ministries of health, the U.S. Centers for Disease Control and Prevention (CDC, and PAHO held a workshop in Guatemala to discuss CKDnT epidemiologic case definitions. In this paper, we propose that CKD in general be identified by the standard definition internationally accepted and that a suspect case of CKDnT be defined as a person age < 60 years with CKD, without type 1 diabetes mellitus, hypertensive diseases, and other well-known causes of CKD. A probable case of CKDnT is defined as a suspect case with the same findings confirmed three or more months later.

  17. Determination of the optimal case definition for the diagnosis of end-stage renal disease from administrative claims data in Manitoba, Canada.

    Science.gov (United States)

    Komenda, Paul; Yu, Nancy; Leung, Stella; Bernstein, Keevin; Blanchard, James; Sood, Manish; Rigatto, Claudio; Tangri, Navdeep

    2015-01-01

    End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period. We determined the sensitivity, specificity, predictive value and overall accuracy of 4 administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status. During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years. Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.

  18. Case definition terminology for paratuberculosis (Johne's disease).

    Science.gov (United States)

    Whittington, R J; Begg, D J; de Silva, K; Purdie, A C; Dhand, N K; Plain, K M

    2017-11-09

    Paratuberculosis (Johne's disease) is an economically significant condition caused by Mycobacterium avium subsp. paratuberculosis. However, difficulties in diagnosis and classification of individual animals with the condition have hampered research and impeded efforts to halt its progressive spread in the global livestock industry. Descriptive terms applied to individual animals and herds such as exposed, infected, diseased, clinical, sub-clinical, infectious and resistant need to be defined so that they can be incorporated consistently into well-understood and reproducible case definitions. These allow for consistent classification of individuals in a population for the purposes of analysis based on accurate counts. The outputs might include the incidence of cases, frequency distributions of the number of cases by age class or more sophisticated analyses involving statistical comparisons of immune responses in vaccine development studies, or gene frequencies or expression data from cases and controls in genomic investigations. It is necessary to have agreed definitions in order to be able to make valid comparisons and meta-analyses of experiments conducted over time by a given researcher, in different laboratories, by different researchers, and in different countries. In this paper, terms are applied systematically in an hierarchical flow chart to enable classification of individual animals. We propose descriptive terms for different stages in the pathogenesis of paratuberculosis to enable their use in different types of studies and to enable an independent assessment of the extent to which accepted definitions for stages of disease have been applied consistently in any given study. This will assist in the general interpretation of data between studies, and will facilitate future meta-analyses.

  19. 9 CFR 381.171 - Definition and standard for “Turkey Ham.”

    Science.gov (United States)

    2010-01-01

    ... Ham.â 381.171 Section 381.171 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Standards of Identity or Composition § 381.171 Definition and standard for “Turkey Ham.” (a) “Turkey Ham... label shall show the word “Turkey” in the same size, style, color, and with the same background as the...

  20. Evaluation of the WHO clinical case definition for pediatric HIV infection in Bloemfontein, South Africa.

    Science.gov (United States)

    van Gend, Christine L; Haadsma, Maaike L; Sauer, Pieter J J; Schoeman, Cornelius J

    2003-06-01

    The WHO clinical case definition for pediatric HIV infection has been designed to be used in countries where diagnostic laboratory resources are limited. We evaluated the WHO case definition to determine whether it is a useful instrument to discriminate between HIV-positive and HIV-negative children. In addition, clinical features not included in this case definition were recorded. We recorded clinical data from 300 consecutively admitted children in a state hospital in Bloemfontein, South Africa, and tested these children for HIV infection. A total of 222 children were included in the study; 69 children (31.1 per cent) were HIV positive. The sensitivity of the WHO case definition in this study was 14.5 per cent, the specificity was 98.6 per cent. Apart from weight loss and generalized dermatitis, the signs of the WHO case definition were significantly more often seen in HIV-positive than in HIV-negative children. Of the clinical signs not included in the WHO case definition, marasmus and hepatosplenomegaly especially occurred more frequently in HIV-positive children. Based on these findings we composed a new case definition consisting of four signs: marasmus, hepatosplenomegaly, oropharyngeal candidiasis, and generalized lymphadenopathy. HIV infection is suspected in a child presenting with at least two of these four signs. The sensitivity of this case definition was 63.2 per cent, the specificity was 96.0 per cent. We conclude that in this study the WHO case definition was not a useful instrument to discriminate between HIV-positive and HIV-negative children, mainly because its sensitivity was strikingly low. The simplified case definition we propose, proved to be more sensitive than the WHO case definition (63.2 vs. 14.5 per cent), whilst its specificity remained high.

  1. Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa.

    Science.gov (United States)

    Nadri, Johara; Sauvageot, Delphine; Njanpop-Lafourcade, Berthe-Marie; Baltazar, Cynthia S; Banla Kere, Abiba; Bwire, Godfrey; Coulibaly, Daouda; Kacou N'Douba, Adele; Kagirita, Atek; Keita, Sakoba; Koivogui, Lamine; Landoh, Dadja E; Langa, Jose P; Miwanda, Berthe N; Mutombo Ndongala, Guy; Mwakapeje, Elibariki R; Mwambeta, Jacob L; Mengel, Martin A; Gessner, Bradford D

    2018-04-01

    During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.

  2. Validity of calendar day-based definitions for community-onset bloodstream infections.

    Science.gov (United States)

    Laupland, Kevin B; Gregson, Daniel B; Church, Deirdre L

    2015-04-02

    Community-onset (CO) bloodstream infections (BSI) are those BSI where the blood culture is drawn culture draw or hospital admission are not always available. We evaluated the validity of using 2- or 3- calendar day based definitions for CO-BSI by comparing to a "gold standard" 48-hour definition. Among the population-based cohort of 14,106 episodes of BSI studied, 10,543 were classified as CO based on "gold standard" 48-hour criteria. When 2-day and 3-day definitions were applied, 10,396 and 10,707 CO-BSI episodes were ascertained, respectively. All but 147 (1.4%) true CO-BSI cases were included by using the 2-day definition. When the 3-day definition was applied, all cases of CO-BSI were identified but and additional 164 (1.5%) cases of hospital-onset HO-BSI were also included. Thus the sensitivity and specificity of the 2-day definition was 98.6% and 100% and for the 3-day definition was 100% and 98.5%, respectively. Overall, only 311 (2.2%) cases were potentially miss-classifiable using either the 2- or 3-calendar day based definitions. Use of either a 2- or 3-day definition is highly accurate for classifying CO-BSI.

  3. Surveillance case definitions for work related upper limb pain syndromes

    OpenAIRE

    Harrington, J. M.; Carter, J. T.; Birrell, L.; Gompertz, D.

    1998-01-01

    OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core grou...

  4. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience.

    Science.gov (United States)

    Gozal, Yair M; Farley, Chad W; Hanseman, Dennis J; Harwell, Daniel; Magner, Mark; Andaluz, Norberto; Shutter, Lori

    2014-08-01

    Shortcomings created by the lack of both a uniform definition of ventriculostomy-associated infection (VAI) and reporting standards have led to widely ranging infections rates (2-24%) whose significance is uncertain. We propose a standardized definition of VAI and a consistent reporting format compliant with Centers for Disease Control and Prevention (CDC) for device-related infections. Using those parameters to establish an infection-control surveillance program, we report our 4-year institutional VAI rates. In this prospective study covering ventriculostomy utilization (October 2006-December 2010), 498 patients had a total of 4,673 ventriculostomy days. By review of the literature and our institutional analysis, we defined VAI as a positive CSF culture in a patient with ventriculostomy catheter, plus one or more of the following (1) fever recorded >101.5 °F or (2) cerebrospinal fluid (CSF) glucose level, either definition and CDC format seems promising toward facilitating future study and guideline development. Given our strict protocol of sterile catheter placement and care, and our institution's low 2.0% infection rates, we propose an infection-rate target of ≤5 per 1,000 device days. Our results suggest that the use of antibiotics or antibiotic-impregnated catheters is unwarranted--a positive given concerns of evolving anti-microbial resistance.

  5. Methods of applying the 1994 case definition of chronic fatigue syndrome - impact on classification and observed illness characteristics.

    Science.gov (United States)

    Unger, E R; Lin, J-M S; Tian, H; Gurbaxani, B M; Boneva, R S; Jones, J F

    2016-01-01

    Multiple case definitions are in use to identify chronic fatigue syndrome (CFS). Even when using the same definition, methods used to apply definitional criteria may affect results. The Centers for Disease Control and Prevention (CDC) conducted two population-based studies estimating CFS prevalence using the 1994 case definition; one relied on direct questions for criteria of fatigue, functional impairment and symptoms (1997 Wichita; Method 1), and the other used subscale score thresholds of standardized questionnaires for criteria (2004 Georgia; Method 2). Compared to previous reports the 2004 CFS prevalence estimate was higher, raising questions about whether changes in the method of operationalizing affected this and illness characteristics. The follow-up of the Georgia cohort allowed direct comparison of both methods of applying the 1994 case definition. Of 1961 participants (53 % of eligible) who completed the detailed telephone interview, 919 (47 %) were eligible for and 751 (81 %) underwent clinical evaluation including medical/psychiatric evaluations. Data from the 499 individuals with complete data and without exclusionary conditions was available for this analysis. A total of 86 participants were classified as CFS by one or both methods; 44 cases identified by both methods, 15 only identified by Method 1, and 27 only identified by Method 2 (Kappa 0.63; 95 % confidence interval [CI]: 0.53, 0.73 and concordance 91.59 %). The CFS group identified by both methods were more fatigued, had worse functioning, and more symptoms than those identified by only one method. Moderate to severe depression was noted in only one individual who was classified as CFS by both methods. When comparing the CFS groups identified by only one method, those only identified by Method 2 were either similar to or more severely affected in fatigue, function, and symptoms than those only identified by Method 1. The two methods demonstrated substantial concordance. While Method 2

  6. Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians.

    Science.gov (United States)

    Pittalis, Silvia; Fusco, Francesco Maria; Lanini, Simone; Nisii, Carla; Puro, Vincenzo; Lauria, Francesco Nicola; Ippolito, Giuseppe

    2009-10-01

    Viral haemorrhagic fevers (VHFs) represent a challenge for public health because of their epidemic potential, and their possible use as bioterrorism agents poses particular concern. In 1999 the World Health Organization (WHO) proposed a case definition for VHFs, subsequently adopted by other international institutions with the aim of early detection of initial cases/outbreaks in western countries. We applied this case definition to reports of Ebola and Marburg virus infections to estimate its sensitivity to detect cases of the disease. We analyzed clinical descriptions of 795 reported cases of Ebola haemorrhagic fever: only 58.5% of patients met the proposed case definition. A similar figure was obtained reviewing 169 cases of Marburg diseases, of which only 64.5% were in accordance with the case definition. In conclusion, the WHO case definition for hemorrhagic fevers is too specific and has poor sensitivity both for case finding during Ebola or Marburg outbreaks, and for early detection of suspected cases in western countries. It can lead to a hazardous number of false negatives and its use should be discouraged for early detection of cases.

  7. DIN 51003: the standard of TXRF basics and definitions

    International Nuclear Information System (INIS)

    Reus, U.; Prange, A.

    2000-01-01

    As part of the world-wide effort to standardize analytical methods, a team of TXRF users has elaborated the draft of a new DIN standard (German Industry Standard) on basic terms and definitions related to TXRF analysis. This draft ('yellow-print') is now open for discussion, and its structure and principal contents will be presented here. The new standard is subdivided into the following subjects: introduction, scope of application and normative remarks; general terms (in x-ray spectroscopy); physics, of TXRF; x-ray sources; conditioning of the primary x-ray beam; measurement of x-ray fluorescence with energy-dispersive spectrometers; samples; measurement and evaluation of data; traceability; applications of TXRF. The more important items will be discussed in the present paper. It should be pointed out that this standard is meant primarily to give a common basis for physical terms and general denotations to be used in TXRF analysis, i.e. it does not include specific working prescriptions for analytical tasks. However, such prescriptions will be given - in a more generalized form - in a number of appendices to the main document, thus covering the major fields of application of TXRF. In order to enable acceptance of the standard on an international basis, an ISO standard is also in preparation. (author)

  8. HIV lipodystrophy case definition using artificial neural network modelling

    DEFF Research Database (Denmark)

    Ioannidis, John P A; Trikalinos, Thomas A; Law, Matthew

    2003-01-01

    OBJECTIVE: A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. METHODS......: The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers...... were trained and validated. Results were compared against logistic regression models using the same information. RESULTS: Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under...

  9. Defining progression in nonmuscle invasive bladder cancer: it is time for a new, standard definition

    NARCIS (Netherlands)

    Lamm, D.; Persad, R.; Brausi, M.; Buckley, R.; Witjes, J.A.; Palou, J.; Bohle, A.; Kamat, A.M.; Colombel, M.; Soloway, M.

    2014-01-01

    PURPOSE: Despite being one of the most important clinical outcomes in nonmuscle invasive bladder cancer, there is currently no standard definition of disease progression. Major clinical trials and meta-analyses have used varying definitions or have failed to define this end point altogether. A

  10. Data Mining: Comparing the Empiric CFS to the Canadian ME/CFS Case Definition

    OpenAIRE

    Jason, Leonard A.; Skendrovic, Beth; Furst, Jacob; Brown, Abigail; Weng, Angela; Bronikowski, Christine

    2011-01-01

    This article contrasts two case definitions for Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS). We compared the empiric CFS case definition (Reeves et al., 2005) and the Canadian ME/CFS Clinical case definition (Carruthers et al., 2003) with a sample of individuals with CFS versus those without. Data mining with decision trees was used to identify the best items to identify patients with CFS. Data mining is a statistical technique that was used to help determine which of the surv...

  11. Case studies can support definitions of workplace innovation in practice

    NARCIS (Netherlands)

    Vaas, F.; Žiauberytė-Jakštienė, R.; Oeij, P.R.

    2017-01-01

    Many practitioners find it problematic to understand and describe workplace innovation (WPI). Whereas there are well-known definitions of WPI, these remain highly abstract. We argue that, for practitioners, case examples of WPI best practices can be a valuable addition to these definitions. In this

  12. Development of a case definition for clinical feline herpesvirus infection in cheetahs (Acinonyx jubatus) housed in zoos.

    Science.gov (United States)

    Witte, Carmel L; Lamberski, Nadine; Rideout, Bruce A; Fields, Victoria; Teare, Cyd Shields; Barrie, Michael; Haefele, Holly; Junge, Randall; Murray, Suzan; Hungerford, Laura L

    2013-09-01

    The identification of feline herpesvirus (FHV) infected cheetahs (Acinonyx jubatus) and characterization of shedding episodes is difficult due to nonspecific clinical signs and limitations of diagnostic tests. The goals of this study were to develop a case definition for clinical FHV and describe the distribution of signs. Medical records from six different zoologic institutions were reviewed to identify cheetahs with diagnostic test results confirming FHV. Published literature, expert opinion, and results of a multiple correspondence analysis (MCA) were used to develop a clinical case definition based on 69 episodes in FHV laboratory confirmed (LC) cheetahs. Four groups of signs were identified in the MCA: general ocular signs, serious ocular lesions, respiratory disease, and cutaneous lesions. Ocular disease occurred with respiratory signs alone, with skin lesions alone, and with both respiratory signs and skin lesions. Groups that did not occur together were respiratory signs and skin lesions. The resulting case definition included 1) LC cheetahs; and 2) clinically compatible (CC) cheetahs that exhibited a minimum of 7 day's duration of the clinical sign groupings identified in the MCA or the presence of corneal ulcers or keratitis that occurred alone or in concert with other ocular signs and skin lesions. Exclusion criteria were applied. Application of the case definition to the study population identified an additional 78 clinical episodes, which represented 58 CC cheetahs. In total, 28.8% (93/322) of the population was identified as LC or CC. The distribution of identified clinical signs was similar across LC and CC cheetahs. Corneal ulcers and/or keratitis, and skin lesions were more frequently reported in severe episodes; in mild episodes, there were significantly more cheetahs with ocular-only or respiratory-only disease. Our results provide a better understanding of the clinical presentation of FHV, while presenting a standardized case definition that can

  13. A medical-legal review regarding the standard of care for epidural injections, with particular reference to a closed case.

    Science.gov (United States)

    Helm, Standiford; Glaser, Scott; Falco, Frank; Henry, Brian

    2010-01-01

    Interventional pain management is an evolving field, with a primary focus on the safety of the patient. One major source of risk to patients is intraarterial or intraneural injections. Interventional pain physicians have considerable interest in identifying techniques which avoid these complications. A recent article has reviewed complications associated with interventional procedures and concluded that the complications were due to deviation from a specific prescribed protocol. One of the cases reviewed went to jury trial and the record of that case is in the public domain. Two of the authors of the recent review were expert witnesses in the trial. They provided conflicting testimony as to alleged violations of the standard of care. Their criticisms also differed from a third criticism contained in the article as well as the protocol being advocated in the article, thus contravening the claim that there is one prescribed protocol which must be followed. The definition of standard of care varies amongst jurisdictions, but is generally defined as either that care which a reasonably well-trained physician in that specialty would provide under similar circumstances or as what would constitute reasonable medical care under the circumstances presented. Analysis of the case which went to trial indicates that there is not one prescribed protocol which must be followed; the definition of standard of care is broader than that. Interventional pain management is an evolving field and the standard of care is broadly defined.

  14. 76 FR 28434 - Notice of Issuance of Statement of Federal Financial Accounting Standard 40, Definitional Changes...

    Science.gov (United States)

    2011-05-17

    ... FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Notice of Issuance of Statement of Federal Financial... of Federal Financial Accounting Standard 6, Accounting for Property, Plant, and Equipment AGENCY... Advisory Board (FASAB) has issued Statement of Federal Financial Accounting Standard 40, Definitional...

  15. A Case for Standards of Counseling Practice.

    Science.gov (United States)

    Anderson, Donald

    1992-01-01

    A mature counseling profession has entered the decade of the 1990s. Several factors including professionalism, accountability, health care consumerism, credentialism, and public demands for quality mental health care indicate a need for more definitive statements on standards of practice in counseling. In response to this need, an eight-point…

  16. Development of a Surveillance Definition for United States-Mexico Binational Cases of Tuberculosis.

    Science.gov (United States)

    Woodruff, Rachel S Yelk; Miner, Mark C; Miramontes, Roque

    Consistently collected binational surveillance data are important in advocating for resources to manage and treat binational cases of tuberculosis (TB). The objective of this study was to develop a surveillance definition for binational (United States-Mexico) cases of TB to assess the burden on US TB program resources. We collaborated with state and local TB program staff members in the United States to identify characteristics associated with binational cases of TB. We collected data on all cases of TB from 9 pilot sites in 5 states (Arizona, California, Colorado, New Mexico, and Texas) during January 1-June 30, 2014, that had at least 1 binational characteristic (eg, "crossed border while on TB treatment" and "received treatment in another country, coordinated by an established, US-funded, binational TB program"). A workgroup of US state, local, and federal partners reviewed results and used them to develop a practical surveillance definition. The pilot sites reported 87 cases of TB with at least 1 binational characteristic during the project period. The workgroup drafted a proposed surveillance definition to include 2 binational characteristics: "crossed border while on TB treatment" (34 of 87 cases, 39%) and "received treatment in another country, coordinated by an established, US-funded, binational TB program" (26 of 87 cases, 30%). Applying the new proposed definition, 39 of 87 pilot cases of TB (45%) met the definition of binational. Input from partners who were responsible for the care and treatment of patients who cross the United States-Mexico border was crucial in defining a binational case of TB.

  17. Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions.

    Science.gov (United States)

    Thriemer, Kamala; Ley, Benedikt; Ley, Benedikt B; Ame, Shaali S; Deen, Jaqueline L; Pak, Gi Deok; Chang, Na Yoon; Hashim, Ramadhan; Schmied, Wolfgang Hellmut; Busch, Clara Jana-Lui; Nixon, Shanette; Morrissey, Anne; Puri, Mahesh K; Ochiai, R Leon; Wierzba, Thomas; Clemens, John D; Ali, Mohammad; Jiddawi, Mohammad S; von Seidlein, Lorenz; Ali, Said M

    2012-01-01

    The gold standard for diagnosis of typhoid fever is blood culture (BC). Because blood culture is often not available in impoverished settings it would be helpful to have alternative diagnostic approaches. We therefore investigated the usefulness of clinical signs, WHO case definition and Widal test for the diagnosis of typhoid fever. Participants with a body temperature ≥37.5°C or a history of fever were enrolled over 17 to 22 months in three hospitals on Pemba Island, Tanzania. Clinical signs and symptoms of participants upon presentation as well as blood and serum for BC and Widal testing were collected. Clinical signs and symptoms of typhoid fever cases were compared to other cases of invasive bacterial diseases and BC negative participants. The relationship of typhoid fever cases with rainfall, temperature, and religious festivals was explored. The performance of the WHO case definitions for suspected and probable typhoid fever and a local cut off titre for the Widal test was assessed. 79 of 2209 participants had invasive bacterial disease. 46 isolates were identified as typhoid fever. Apart from a longer duration of fever prior to admission clinical signs and symptoms were not significantly different among patients with typhoid fever than from other febrile patients. We did not detect any significant seasonal patterns nor correlation with rainfall or festivals. The sensitivity and specificity of the WHO case definition for suspected and probable typhoid fever were 82.6% and 41.3% and 36.3 and 99.7% respectively. Sensitivity and specificity of the Widal test was 47.8% and 99.4 both forfor O-agglutinin and H- agglutinin at a cut-off titre of 1:80. Typhoid fever prevalence rates on Pemba are high and its clinical signs and symptoms are non-specific. The sensitivity of the Widal test is low and the WHO case definition performed better than the Widal test.

  18. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics.

    Science.gov (United States)

    Braga, José Ueleres; Bressan, Clarisse; Dalvi, Ana Paula Razal; Calvet, Guilherme Amaral; Daumas, Regina Paiva; Rodrigues, Nadia; Wakimoto, Mayumi; Nogueira, Rita Maria Ribeiro; Nielsen-Saines, Karin; Brito, Carlos; Bispo de Filippis, Ana Maria; Brasil, Patrícia

    2017-01-01

    Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

  19. Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

    Science.gov (United States)

    Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

    2015-03-01

    Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. 17 CFR 275.222-2 - Definition of “client” for purposes of the national de minimis standard.

    Science.gov (United States)

    2010-04-01

    ... 1940 § 275.222-2 Definition of “client” for purposes of the national de minimis standard. For purposes... definition of “client” provided by section 275.203(b)(3)-1 without giving regard to paragraph (b)(6) of that...

  1. Can the Cancer-related Fatigue Case-definition Criteria Be Applied to Chronic Medical Illness? A Comparison between Breast Cancer and Systemic Sclerosis.

    Science.gov (United States)

    Kwakkenbos, Linda; Minton, Ollie; Stone, Patrick C; Alexander, Susanna; Baron, Murray; Hudson, Marie; Thombs, Brett D

    2015-07-01

    Fatigue is a crucial determinant of quality of life across rheumatic diseases, but the lack of agreed-upon standards for identifying clinically significant fatigue hinders research and clinical management. Case definition criteria for cancer-related fatigue were proposed for inclusion in the International Classification of Diseases. The objective was to evaluate whether the cancer-related fatigue case definition performed equivalently in women with breast cancer and systemic sclerosis (SSc) and could be used to identify patients with chronic illness-related fatigue. The cancer-related fatigue interview (case definition criteria met if ≥ 5 of 9 fatigue-related symptoms present with functional impairment) was completed by 291 women with SSc and 278 women successfully treated for breast cancer. Differential item functioning was assessed with the multiple indicator multiple cause model. Items 3 (concentration) and 10 (short-term memory) were endorsed significantly less often by women with SSc compared with cancer, controlling for responses on other items. Omitting these 2 items from the case definition and requiring 4 out of the 7 remaining symptoms resulted in a similar overall prevalence of cancer-related fatigue in the cancer sample compared with the original criteria (37.4% vs 37.8%, respectively), with 97.5% of patients diagnosed identically with both definitions. Prevalence of chronic illness-related fatigue was 36.1% in SSc using 4 of 7 symptoms. The cancer-related fatigue criteria can be used equivalently to identify patients with chronic illness-related fatigue when 2 cognitive fatigue symptoms are omitted. Harmonized definitions and measurement of clinically significant fatigue will advance research and clinical management of fatigue in rheumatic diseases and other conditions.

  2. Evaluation of the WHO clinical case definition of AIDS among children in India.

    Science.gov (United States)

    Gurprit, Grover; Tripti, Pensi; Gadpayle, A K; Tanushree, Banerjee

    2008-03-01

    The need of a clinical case definition (CCD) for Acquired Immunodeficiency Syndrome (AIDS) was felt by public health agencies to monitor diseases resulting from human immunodeficiency virus (HIV) infection. To test the statistical significance of the existing World Health Organization (WHO) CCD for the diagnosis of AIDS in areas where diagnostic resources are limited in India, a prospective study was conducted in the Paediatrics department at Dr. Ram Manohar Lohia Hospital, New Delhi. 360 cases between 18 months-12 years of age satisfying WHO case definitions of AIDS were included in the study group. Informed consent was taken from the parents. The serum of patients was subjected to ELISA to conform the diagnosis of HIV infection. Our study detected 16.66% (60) of HIV prevalence in children visiting paediatrics outpatient clinic. 20% cases manifested 3 major and 2 minor signs. This definition had a sensitivity of 73.33%, specificity of 90.66%, positive predictive value (PPV) of 61.11% and negative predictive value (NPV) of 94.44%. On using stepwise logistic regression analysis weight loss, chronic fever > 1 month and total lymphocyte count of less than 1500 cells/mm3 emerged as important predictors. Cases showing 2 major and 2 minor signs were 86 (23.89%) with a sensitivity and specificity of 86.66% and 88.66% respectively. Based on these findings, we propose a clinical case definition based on 13 clinical signs and symptoms for paediatric AIDS in India with better sensitivity and PPV than the WHO case definition but with almost similar specificity. Thus multicentric studies are further required to modify these criteria in Indian set up.

  3. Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics.

    Directory of Open Access Journals (Sweden)

    José Ueleres Braga

    Full Text Available Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic.We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features.Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903 and R2 (0·417, and the lowest Brier score 0·096.In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

  4. Validation of a published case definition for tuberculosis-associated immune reconstitution inflammatory syndrome.

    Science.gov (United States)

    Haddow, Lewis J; Moosa, Mahomed-Yunus S; Easterbrook, Philippa J

    2010-01-02

    To evaluate the International Network for the Study of HIV-associated IRIS (INSHI) case definitions for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRIS) in a South African cohort. Prospective cohort of 498 adult HIV-infected patients initiating antiretroviral therapy. Patients were followed up for 24 weeks and all clinical events were recorded. Events with TB-IRIS as possible cause were assessed by consensus expert opinion and INSHI case definition. Positive, negative, and chance-corrected agreement (kappa) were calculated, and reasons for disagreement were assessed. One hundred and two (20%) patients were receiving TB therapy at antiretroviral therapy initiation. Three hundred and thirty-three events were evaluated (74 potential paradoxical IRIS, 259 potential unmasking IRIS). Based on expert opinion, there were 18 cases of paradoxical IRIS associated with TB and/or other opportunistic disease. The INSHI criteria for TB-IRIS agreed in 13 paradoxical cases, giving positive agreement of 72.2%, negative agreement in 52/56 non-TB-IRIS events (92.9%), and kappa of 0.66. There were 19 unmasking TB-IRIS cases based on expert opinion, of which 12 were considered IRIS using the INSHI definition (positive agreement 63.2%). There was agreement in all 240 non-TB-IRIS events (negative agreement 100%) and kappa was 0.76. There was good agreement between the INSHI case definition for both paradoxical and unmasking TB-IRIS and consensus expert opinion. These results support the use of this definition in clinical and research practice, with minor caveats in its application.

  5. Severe versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS

    Science.gov (United States)

    Jason, Leonard; Porter, Nicole; Shelleby, Elizabeth; Till, Lindsay; Bell, David S.; Lapp, Charles W.; Rowe, Kathy; De Meirleir, Kenny

    2009-01-01

    The new diagnostic criteria for pediatric ME/CFS are structurally based on the Canadian Clinical Adult case definition, and have more required specific symptoms than the (Fukuda et al. Ann Intern Med 121:953-959, 1994) adult case definition. Physicians specializing in pediatric ME/CFS referred thirty-three pediatric patients with ME/CFS and 21…

  6. Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana.

    Science.gov (United States)

    DeYoung, Kathryn; Chen, Yushiuan; Beum, Robert; Askenazi, Michele; Zimmerman, Cali; Davidson, Arthur J

    Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

  7. Development of a Gestational Age-Specific Case Definition for Neonatal Necrotizing Enterocolitis.

    Science.gov (United States)

    Battersby, Cheryl; Longford, Nick; Costeloe, Kate; Modi, Neena

    2017-03-01

    Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. Preventive and therapeutic research, surveillance, and quality improvement initiatives are hindered by variations in case definitions. To develop a gestational age (GA)-specific case definition for NEC. We conducted a prospective 34-month population study using clinician-recorded findings from the UK National Neonatal Research Database between December 2011 and September 2014 across all 163 neonatal units in England. We split study data into model development and validation data sets and categorized GA into groups (group 1, less than 26 weeks' GA; group 2, 26 to less than 30 weeks' GA; group 3, 30 to less than 37 weeks' GA; group 4, 37 or more weeks' GA). We entered GA, birth weight z score, and clinical and abdominal radiography findings as candidate variables in a logistic regression model, performed model fitting 1000 times, averaged the predictions, and used estimates from the fitted model to develop an ordinal NEC score and cut points to develop a dichotomous case definition based on the highest area under the receiver operating characteristic curves [AUCs] and positive predictive values [PPVs]. Abdominal radiography performed to investigate clinical concerns. Ordinal NEC likelihood score, dichotomous case definition, and GA-specific probability plots. Of the 3866 infants, the mean (SD) birth weight was 2049.1 (1941.7) g and mean (SD) GA was 32 (5) weeks; 2032 of 3663 (55.5%) were male. The total included 2978 infants (77.0%) without NEC and 888 (23.0%) with NEC. Infants with NEC in group 1 were less likely to present with pneumatosis (31.1% vs 47.2%; P = .01), blood in stool (11.8% vs 29.6%; P definition were 2 or greater for infants in groups 1 and 2, 3 or greater for infants in group 3, and 4 or greater for infants in group 4. The ordinal NEC score and dichotomous case definition discriminated well between infants with (AUC, 87%) and without (AUC, 80%) NEC. The case

  8. The Definition of Pneumonia, the Assessment of Severity, and Clinical Standardization in the Pneumonia Etiology Research for Child Health Study

    Science.gov (United States)

    Wonodi, Chizoba; Moïsi, Jennifer C.; Deloria-Knoll, Maria; DeLuca, Andrea N.; Karron, Ruth A.; Bhat, Niranjan; Murdoch, David R.; Crawley, Jane; Levine, Orin S.; O’Brien, Katherine L.; Feikin, Daniel R.

    2012-01-01

    To develop a case definition for the Pneumonia Etiology Research for Child Health (PERCH) project, we sought a widely acceptable classification that was linked to existing pneumonia research and focused on very severe cases. We began with the World Health Organization’s classification of severe/very severe pneumonia and refined it through literature reviews and a 2-stage process of expert consultation. PERCH will study hospitalized children, aged 1–59 months, with pneumonia who present with cough or difficulty breathing and have either severe pneumonia (lower chest wall indrawing) or very severe pneumonia (central cyanosis, difficulty breastfeeding/drinking, vomiting everything, convulsions, lethargy, unconsciousness, or head nodding). It will exclude patients with recent hospitalization and children with wheeze whose indrawing resolves after bronchodilator therapy. The PERCH investigators agreed upon standard interpretations of the symptoms and signs. These will be maintained by a clinical standardization monitor who conducts repeated instruction at each site and by recurrent local training and testing. PMID:22403224

  9. Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia.

    Science.gov (United States)

    Roth, Daniel E; Gaffey, Michelle F; Smith-Romero, Evelyn; Fitzpatrick, Tiffany; Morris, Shaun K

    2015-12-01

    To explore the variability in childhood acute respiratory infection case definitions for research in low-income settings where there is limited access to laboratory or radiologic investigations. We conducted a systematic review of community-based, longitudinal studies in South Asia published from January 1990 to August 2013, in which childhood acute respiratory infection outcomes were reported. Case definitions were classified by their label (e.g. pneumonia, acute lower respiratory infection) and clinical content 'signatures' (array of clinical features that would be always present, conditionally present or always absent among cases). Case definition heterogeneity was primarily assessed by the number of unique case definitions overall and by label. We also compared case definition-specific acute respiratory infection incidence rates for studies reporting incidence rates for multiple case definitions. In 56 eligible studies, we found 124 acute respiratory infection case definitions. Of 90 case definitions for which clinical content was explicitly defined, 66 (73%) were unique. There was a high degree of content heterogeneity among case definitions with the same label, and some content signatures were assigned multiple labels. Within studies for which incidence rates were reported for multiple case definitions, variation in content was always associated with a change in incidence rate, even when the content differed by a single clinical feature. There has been a wide variability in case definition label and content combinations to define acute upper and lower respiratory infections in children in community-based studies in South Asia over the past two decades. These inconsistencies have important implications for the synthesis and translation of knowledge regarding the prevention and treatment of childhood acute respiratory infection. © 2015 John Wiley & Sons Ltd.

  10. The Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints.

    Science.gov (United States)

    Shiboski, C H; Patton, L L; Webster-Cyriaque, J Y; Greenspan, D; Traboulsi, R S; Ghannoum, M; Jurevic, R; Phelan, J A; Reznik, D; Greenspan, J S

    2009-07-01

    The Oral HIV/AIDS Research Alliance (OHARA) is part of the AIDS Clinical Trials Group (ACTG), the largest HIV clinical trials organization in the world. Its main objective is to investigate oral complications associated with HIV/AIDS as the epidemic is evolving, in particular, the effects of antiretrovirals on oral mucosal lesion development and associated fungal and viral pathogens. The OHARA infrastructure comprises: the Epidemiologic Research Unit (at the University of California San Francisco), the Medical Mycology Unit (at Case Western Reserve University) and the Virology/Specimen Banking Unit (at the University of North Carolina). The team includes dentists, physicians, virologists, mycologists, immunologists, epidemiologists and statisticians. Observational studies and clinical trials are being implemented at ACTG-affiliated sites in the US and resource-poor countries. Many studies have shared end-points, which include oral diseases known to be associated with HIV/AIDS measured by trained and calibrated ACTG study nurses. In preparation for future protocols, we have updated existing diagnostic criteria of the oral manifestations of HIV published in 1992 and 1993. The proposed case definitions are designed to be used in large-scale epidemiologic studies and clinical trials, in both US and resource-poor settings, where diagnoses may be made by non-dental healthcare providers. The objective of this article is to present updated case definitions for HIV-related oral diseases that will be used to measure standardized clinical end-points in OHARA studies, and that can be used by any investigator outside of OHARA/ACTG conducting clinical research that pertains to these end-points.

  11. Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil.

    Science.gov (United States)

    Albuquerque Filho, Alfredo Pereira Leite de; Araújo, Jéssica Guido de; Souza, Inacelli Queiroz de; Martins, Luciana Cardoso; Oliveira, Marta Iglis de; Silva, Maria Jesuíta Bezerra da; Montarroyos, Ulisses Ramos; Miranda Filho, Demócrito de Barros

    2011-01-01

    Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture). Test properties were determined for each cutoff number of the criteria from the case definition. Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (pcase definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

  12. The measures for achieving nZEB standard of retrofitted educational building for specific polish location - case study

    Science.gov (United States)

    Kwiatkowski, Jerzy; Mijakowski, Maciej; Trząski, Adrian

    2017-11-01

    Most of the EU member states have already set a definition of nZEB for new buildings and some of the countries also done it for existing buildings. As there is no definition of nZEB for existing buildings in Poland, the paper will include various considerations of such a standard. Next, a case study of educational building retrofitting to a proposed nZEB standard will be presented. The aim of the paper is to present what measures can be used in order to decrease energy consumption in existing building. The measures are divided into three parts: architectural and construction, installations and energy sources. Thus a complexity of the solutions are presented. As the nZEB standard is related to available energy sources, also an influence of local condition will be considered. Building chosen for analysis is located in an area under historic protection which makes the work even more difficult. It was proved that used solutions were chosen not only to reduce energy demand or increase energy production from renewable energy sources, but also to increase social and aesthetic features of the building.

  13. Validation of two case definitions to identify pressure ulcers using hospital administrative data.

    Science.gov (United States)

    Ho, Chester; Jiang, Jason; Eastwood, Cathy A; Wong, Holly; Weaver, Brittany; Quan, Hude

    2017-08-28

    Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other

  14. Standard definitions of terms relating to dosimetry - approved standard 1973

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    Definitions are presented for terms related to radiation dosimetry. These definitions are the same as, or similar to, those recommended by the International Commission on Radiological Units and Measurements (ICRU) as presented in the National Bureau of Sandards Handbook 62, but attempt has been made to define some of the terms more exactly

  15. Validation of a case definition to define chronic dialysis using outpatient administrative data.

    Science.gov (United States)

    Clement, Fiona M; James, Matthew T; Chin, Rick; Klarenbach, Scott W; Manns, Braden J; Quinn, Robert R; Ravani, Pietro; Tonelli, Marcello; Hemmelgarn, Brenda R

    2011-03-01

    Administrative health care databases offer an efficient and accessible, though as-yet unvalidated, approach to studying outcomes of patients with chronic kidney disease and end-stage renal disease (ESRD). The objective of this study is to determine the validity of outpatient physician billing derived algorithms for defining chronic dialysis compared to a reference standard ESRD registry. A cohort of incident dialysis patients (Jan. 1-Dec. 31, 2008) and prevalent chronic dialysis patients (Jan 1, 2008) was selected from a geographically inclusive ESRD registry and administrative database. Four administrative data definitions were considered: at least 1 outpatient claim, at least 2 outpatient claims, at least 2 outpatient claims at least 90 days apart, and continuous outpatient claims at least 90 days apart with no gap in claims greater than 21 days. Measures of agreement of the four administrative data definitions were compared to a reference standard (ESRD registry). Basic patient characteristics are compared between all 5 patient groups. 1,118,097 individuals formed the overall population and 2,227 chronic dialysis patients were included in the ESRD registry. The three definitions requiring at least 2 outpatient claims resulted in kappa statistics between 0.60-0.80 indicating "substantial" agreement. "At least 1 outpatient claim" resulted in "excellent" agreement with a kappa statistic of 0.81. Of the four definitions, the simplest (at least 1 outpatient claim) performed comparatively to other definitions. The limitations of this work are the billing codes used are developed in Canada, however, other countries use similar billing practices and thus the codes could easily be mapped to other systems. Our reference standard ESRD registry may not capture all dialysis patients resulting in some misclassification. The registry is linked to on-going care so this is likely to be minimal. The definition utilized will vary with the research objective.

  16. Validation of a case definition to define chronic dialysis using outpatient administrative data

    Directory of Open Access Journals (Sweden)

    Klarenbach Scott W

    2011-03-01

    Full Text Available Abstract Background Administrative health care databases offer an efficient and accessible, though as-yet unvalidated, approach to studying outcomes of patients with chronic kidney disease and end-stage renal disease (ESRD. The objective of this study is to determine the validity of outpatient physician billing derived algorithms for defining chronic dialysis compared to a reference standard ESRD registry. Methods A cohort of incident dialysis patients (Jan. 1 - Dec. 31, 2008 and prevalent chronic dialysis patients (Jan 1, 2008 was selected from a geographically inclusive ESRD registry and administrative database. Four administrative data definitions were considered: at least 1 outpatient claim, at least 2 outpatient claims, at least 2 outpatient claims at least 90 days apart, and continuous outpatient claims at least 90 days apart with no gap in claims greater than 21 days. Measures of agreement of the four administrative data definitions were compared to a reference standard (ESRD registry. Basic patient characteristics are compared between all 5 patient groups. Results 1,118,097 individuals formed the overall population and 2,227 chronic dialysis patients were included in the ESRD registry. The three definitions requiring at least 2 outpatient claims resulted in kappa statistics between 0.60-0.80 indicating "substantial" agreement. "At least 1 outpatient claim" resulted in "excellent" agreement with a kappa statistic of 0.81. Conclusions Of the four definitions, the simplest (at least 1 outpatient claim performed comparatively to other definitions. The limitations of this work are the billing codes used are developed in Canada, however, other countries use similar billing practices and thus the codes could easily be mapped to other systems. Our reference standard ESRD registry may not capture all dialysis patients resulting in some misclassification. The registry is linked to on-going care so this is likely to be minimal. The definition

  17. Enhancing case definitions for surveillance of human monkeypox in the Democratic Republic of Congo.

    Directory of Open Access Journals (Sweden)

    Lynda Osadebe

    2017-09-01

    Full Text Available Human monkeypox (MPX occurs at appreciable rates in the Democratic Republic of Congo (DRC. Infection with varicella zoster virus (VZV has a similar presentation to that of MPX, and in areas where MPX is endemic these two illnesses are commonly mistaken. This study evaluated the diagnostic utility of two surveillance case definitions for MPX and specific clinical characteristics associated with laboratory-confirmed MPX cases.Data from a cohort of suspect MPX cases (identified by surveillance over the course of a 42 month period during 2009-2014 from DRC were used; real-time PCR diagnostic test results were used to establish MPX and VZV diagnoses. A total of 333 laboratory-confirmed MPX cases, 383 laboratory-confirmed VZV cases, and 36 cases that were determined to not be either MPX or VZV were included in the analyses. Significant (p<0.05 differences between laboratory-confirmed MPX and VZV cases were noted for several signs/symptoms including key rash characteristics. Both surveillance case definitions had high sensitivity and low specificities for individuals that had suspected MPX virus infections. Using 12 signs/symptoms with high sensitivity and/or specificity values, a receiver operator characteristic analysis showed that models for MPX cases that had the presence of 'fever before rash' plus at least 7 or 8 of the 12 signs/symptoms demonstrated a more balanced performance between sensitivity and specificity.Laboratory-confirmed MPX and VZV cases presented with many of the same signs and symptoms, and the analysis here emphasized the utility of including 12 specific signs/symptoms when investigating MPX cases. In order to document and detect endemic human MPX cases, a surveillance case definition with more specificity is needed for accurate case detection. In the absence of a more specific case definition, continued emphasis on confirmatory laboratory-based diagnostics is warranted.

  18. Generic project definitions for improvement of health care delivery: a case-based approach.

    Science.gov (United States)

    Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

    2011-01-01

    The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

  19. Validation of a case definition to define hypertension using administrative data.

    Science.gov (United States)

    Quan, Hude; Khan, Nadia; Hemmelgarn, Brenda R; Tu, Karen; Chen, Guanmin; Campbell, Norm; Hill, Michael D; Ghali, William A; McAlister, Finlay A

    2009-12-01

    We validated the accuracy of case definitions for hypertension derived from administrative data across time periods (year 2001 versus 2004) and geographic regions using physician charts. Physician charts were randomly selected in rural and urban areas from Alberta and British Columbia, Canada, during years 2001 and 2004. Physician charts were linked with administrative data through unique personal health number. We reviewed charts of approximately 50 randomly selected patients >35 years of age from each clinic within 48 urban and 16 rural family physician clinics to identify physician diagnoses of hypertension during the years 2001 and 2004. The validity indices were estimated for diagnosed hypertension using 3 years of administrative data for the 8 case-definition combinations. Of the 3,362 patient charts reviewed, the prevalence of hypertension ranged from 18.8% to 33.3%, depending on the year and region studied. The administrative data hypertension definition of "2 claims within 2 years or 1 hospitalization" had the highest validity relative to the other definitions evaluated (sensitivity 75%, specificity 94%, positive predictive value 81%, negative predictive value 92%, and kappa 0.71). After adjustment for age, sex, and comorbid conditions, the sensitivities between regions, years, and provinces were not significantly different, but the positive predictive value varied slightly across geographic regions. These results provide evidence that administrative data can be used as a relatively valid source of data to define cases of hypertension for surveillance and research purposes.

  20. What is "grazing"? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition.

    Science.gov (United States)

    Conceição, Eva M; Mitchell, James E; Engel, Scott G; Machado, Paulo P P; Lancaster, Kathryn; Wonderlich, Stephen A

    2014-01-01

    Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies. To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work. University and Clinical Research Institute. Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of nonbariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing. Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and noncompulsive subtypes. Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations. Copyright © 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.

  1. Evaluation of an expanded case definition for vaccine-modified measles in a school outbreak in South Korea in 2010.

    Science.gov (United States)

    Choe, Young June; Hu, Jae Kyung; Song, Kyung Min; Cho, Heeyeon; Yoon, Hee Sook; Kim, Seung Tae; Lee, Han Jung; Kim, Kisoon; Bae, Geun-Ryang; Lee, Jong-Koo

    2012-01-01

    In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73% (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%. The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.

  2. Aggressive periodontitis: case definition and diagnostic criteria.

    Science.gov (United States)

    Albandar, Jasim M

    2014-06-01

    Aggressive periodontitis is a destructive disease characterized by the following: the involvement of multiple teeth with a distinctive pattern of periodontal tissue loss; a high rate of disease progression; an early age of onset; and the absence of systemic diseases. In some patients periodontal tissue loss may commence before puberty, whereas in most patients the age of onset is during or somewhat after the circumpubertal period. Besides infection with specific microorganisms, a host predisposition seems to play a key role in the pathogenesis of aggressive periodontitis, as evidenced by the familial aggregation of the disease. In this article we review the historical background of the diagnostic criteria of aggressive periodontitis, present a contemporary case definition and describe the clinical parameters of the disease. At present, the diagnosis of aggressive periodontitis is achieved using case history, clinical examination and radiographic evaluation. The data gathered using these methods are prone to relatively high measurement errors. Besides, this diagnostic approach measures past disease history and may not reliably measure existing disease activity or accurately predict future tissue loss. A diagnosis is often made years after the onset of the disease, partly because current assessment methods detect established disease more readily and reliably than they detect incipient or initial lesions where the tissue loss is minimal and usually below the detection threshold of present examination methods. Future advancements in understanding the pathogenesis of this disease may contribute to an earlier diagnosis. Insofar, future case definitions may involve the identification of key etiologic and risk factors, combined with high-precision methodologies that enable the early detection of initial lesions. This may significantly enhance the predictive value of these tests and detect cases of aggressive periodontitis before significant tissue loss develops. © 2014

  3. Proposed clinical case definition for cytomegalovirus-immune recovery retinitis.

    Science.gov (United States)

    Ruiz-Cruz, Matilde; Alvarado-de la Barrera, Claudia; Ablanedo-Terrazas, Yuria; Reyes-Terán, Gustavo

    2014-07-15

    Cytomegalovirus (CMV) retinitis has been extensively described in patients with advanced or late human immunodeficiency virus (HIV) disease under ineffective treatment of opportunistic infection and antiretroviral therapy (ART) failure. However, there is limited information about patients who develop active cytomegalovirus retinitis as an immune reconstitution inflammatory syndrome (IRIS) after successful initiation of ART. Therefore, a case definition of cytomegalovirus-immune recovery retinitis (CMV-IRR) is proposed here. We reviewed medical records of 116 HIV-infected patients with CMV retinitis attending our institution during January 2003-June 2012. We retrospectively studied HIV-infected patients who had CMV retinitis on ART initiation or during the subsequent 6 months. Clinical and immunological characteristics of patients with active CMV retinitis were described. Of the 75 patients under successful ART included in the study, 20 had improvement of CMV retinitis. The remaining 55 patients experienced CMV-IRR; 35 of those developed CMV-IRR after ART initiation (unmasking CMV-IRR) and 20 experienced paradoxical clinical worsening of retinitis (paradoxical CMV-IRR). Nineteen patients with CMV-IRR had a CD4 count of ≥50 cells/µL. Six patients with CMV-IRR subsequently developed immune recovery uveitis. There is no case definition for CMV-IRR, although this condition is likely to occur after successful initiation of ART, even in patients with high CD4 T-cell counts. By consequence, we propose the case definitions for paradoxical and unmasking CMV-IRR. We recommend close follow-up of HIV-infected patients following ART initiation. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Alfredo Pereira Leite de Albuquerque Filho

    2011-12-01

    Full Text Available INTRODUCTION: Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. METHODS: Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture. Test properties were determined for each cutoff number of the criteria from the case definition. RESULTS: Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (p<0.0001. Best sensitivity (85.3% and specificity (68.2% combination was found with a cutoff of 7 or more criteria, reaching positive and negative predictive values of 90.1% and 57.7%, respectively; accuracy was 81.4%. CONCLUSIONS: The case definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

  5. Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition.

    Science.gov (United States)

    Harduar Morano, Laurel; Waller, Anna E

    To improve heat-related illness surveillance, we evaluated and refined North Carolina's heat syndrome case definition. We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: "heat ex" (n = 1674, 41.8%), "overheat" (n = 646, 16.1%), "too hot" (n = 594, 14.8%), and "heatstroke" (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: "burn," "grease," "liquid," "oil," "radiator," "antifreeze," "hot tub," "hot spring," and "sauna." After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.

  6. An automated database case definition for serious bleeding related to oral anticoagulant use.

    Science.gov (United States)

    Cunningham, Andrew; Stein, C Michael; Chung, Cecilia P; Daugherty, James R; Smalley, Walter E; Ray, Wayne A

    2011-06-01

    Bleeding complications are a serious adverse effect of medications that prevent abnormal blood clotting. To facilitate epidemiologic investigations of bleeding complications, we developed and validated an automated database case definition for bleeding-related hospitalizations. The case definition utilized information from an in-progress retrospective cohort study of warfarin-related bleeding in Tennessee Medicaid enrollees 30 years of age or older. It identified inpatient stays during the study period of January 1990 to December 2005 with diagnoses and/or procedures that indicated a current episode of bleeding. The definition was validated by medical record review for a sample of 236 hospitalizations. We reviewed 186 hospitalizations that had medical records with sufficient information for adjudication. Of these, 165 (89%, 95%CI: 83-92%) were clinically confirmed bleeding-related hospitalizations. An additional 19 hospitalizations (10%, 7-15%) were adjudicated as possibly bleeding-related. Of the 165 clinically confirmed bleeding-related hospitalizations, the automated database and clinical definitions had concordant anatomical sites (gastrointestinal, cerebral, genitourinary, other) for 163 (99%, 96-100%). For those hospitalizations with sufficient information to distinguish between upper/lower gastrointestinal bleeding, the concordance was 89% (76-96%) for upper gastrointestinal sites and 91% (77-97%) for lower gastrointestinal sites. A case definition for bleeding-related hospitalizations suitable for automated databases had a positive predictive value of between 89% and 99% and could distinguish specific bleeding sites. Copyright © 2011 John Wiley & Sons, Ltd.

  7. Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases.

    Science.gov (United States)

    Raebel, Marsha A; Schmittdiel, Julie; Karter, Andrew J; Konieczny, Jennifer L; Steiner, John F

    2013-08-01

    To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies. We reviewed recent literature to identify definitions in electronic database studies of prescription-filling patterns for chronic oral medications. We then develop a conceptual model and propose standardized terminology and definitions to describe prescription-filling behavior from electronic databases. The conceptual model we propose defines 2 separate constructs: medication adherence and persistence. We define primary and secondary adherence as distinct subtypes of adherence. Metrics for estimating secondary adherence are discussed and critiqued, including a newer metric (New Prescription Medication Gap measure) that enables estimation of both primary and secondary adherence. Terminology currently used in prescription adherence research employing electronic databases lacks consistency. We propose a clear, consistent, broadly applicable conceptual model and terminology for such studies. The model and definitions facilitate research utilizing electronic medication prescribing, dispensing, and/or claims databases and encompasses the entire continuum of prescription-filling behavior. Employing conceptually clear and consistent terminology to define medication adherence and persistence will facilitate future comparative effectiveness research and meta-analytic studies that utilize electronic prescription and dispensing records.

  8. Impact of the Definition of Peak Standardized Uptake Value on Quantification of Treatment Response

    Science.gov (United States)

    Vanderhoek, Matt; Perlman, Scott B.; Jeraj, Robert

    2012-01-01

    PET-based treatment response assessment typically measures the change in maximum standardized uptake value (SUVmax), which is adversely affected by noise. Peak SUV (SUVpeak) has been recommended as a more robust alternative, but its associated region of interest (ROIpeak) is not uniquely defined. We investigated the impact of different ROIpeak definitions on quantification of SUVpeak and tumor response. Methods Seventeen patients with solid malignancies were treated with a multitargeted receptor tyrosine kinase inhibitor resulting in a variety of responses. Using the cellular proliferation marker 3′-deoxy-3′-18F-fluorothymidine (18F-FLT), whole-body PET/CT scans were acquired at baseline and during treatment. 18F-FLT–avid lesions (~2/patient) were segmented on PET images, and tumor response was assessed via the relative change in SUVpeak. For each tumor, 24 different SUVpeaks were determined by changing ROIpeak shape (circles vs. spheres), size (7.5–20 mm), and location (centered on SUVmax vs. placed in highest-uptake region), encompassing different definitions from the literature. Within each tumor, variations in the 24 SUVpeaks and tumor responses were measured using coefficient of variation (CV), standardized deviation (SD), and range. For each ROIpeak definition, a population average SUVpeak and tumor response were determined over all tumors. Results A substantial variation in both SUVpeak and tumor response resulted from changing the ROIpeak definition. The variable ROIpeak definition led to an intratumor SUVpeak variation ranging from 49% above to 46% below the mean (CV, 17%) and an intratumor SUVpeak response variation ranging from 49% above to 35% below the mean (SD, 9%). The variable ROIpeak definition led to a population average SUVpeak variation ranging from 24% above to 28% below the mean (CV, 14%) and a population average SUVpeak response variation ranging from only 3% above to 3% below the mean (SD, 2%). The size of ROIpeak caused more

  9. Should clinical case definitions of influenza in hospitalized older adults include fever?

    Science.gov (United States)

    Falsey, Ann R; Baran, Andrea; Walsh, Edward E

    2015-08-01

    Influenza is a major cause of morbidity and mortality in elderly persons. Fever is included in all standard definitions of influenza-like illness (ILI), yet older patients may have diminished febrile response to infection. Therefore, we examined the utility of various thresholds to define fever for case definitions of influenza in persons ≥ 65 years of age. Data from two prospective surveillance studies for respiratory viral infection in adults hospitalized with acute cardiopulmonary illnesses with or without fever were examined. The highest temperature reported prior to admission or measured during the first 24 h after admission was recorded. The diagnosis of influenza was made by a combination of viral culture, reverse-transcription polymerase chain reaction, antigen testing, and serology. A total of 2410 subjects (66% ≥ 65 years of age) were enrolled; 281 had influenza (261 influenza A, 19 influenza B, and one mixed influenza A and B). The commonly used definition of ILI (fever ≥ 37·8°C and cough) resulted in 57% sensitivity and 71% specificity in older adults. Receiver operating characteristic curves examining the various temperature thresholds combined with cough and/or sore throat showed the optimal balance between sensitivity and specificity to be 37·9°C (AUC 0·71) and 37·3°C (AUC 0·66), in younger and older persons, respectively. Clinical decision rules using the presence of cough and fever may be helpful when screening for influenza or empiric antiviral treatment when rapid influenza testing is not available; however, lower fever thresholds may be considered for elderly subjects. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

  10. Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance

    Directory of Open Access Journals (Sweden)

    Alejandro Ferreiro

    Full Text Available ABSTRACT Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts.

  11. Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance.

    Science.gov (United States)

    Ferreiro, Alejandro; Álvarez-Estévez, Guillermo; Cerdas-Calderón, Manuel; Cruz-Trujillo, Zulma; Mena, Elio; Reyes, Marina; Sandoval-Diaz, Mabel; Sánchez-Polo, Vicente; Valdés, Régulo; Ordúnez, Pedro

    2016-11-01

    Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts.

  12. Nuclear technology terms and definitions

    International Nuclear Information System (INIS)

    1979-02-01

    The terms and definitions in this standard are part of the catalogue of definitions 'Nuclear technology, terms and definitions', in eight parts; they are the latest version of the standards and draft standards of DIN 25 401, part 10 to 19, published at irregular intervals until now. (orig.) [de

  13. Case definitions for human poisonings postulated to palytoxins exposure.

    Science.gov (United States)

    Tubaro, A; Durando, P; Del Favero, G; Ansaldi, F; Icardi, G; Deeds, J R; Sosa, S

    2011-03-01

    A series of case reports and anecdotal references describe the adverse effects on human health ascribed to the marine toxin palytoxin (PLTX) after different exposure routes. They include poisonings after oral intake of contaminated seafood, but also inhalation and cutaneous/systemic exposures after direct contact with aerosolized seawater during Ostreopsis blooms and/or through maintaining aquaria containing cnidarian zoanthids. The symptoms commonly recorded during PLTX intoxication are general malaise and weakness, associated with myalgia, respiratory effects, impairment of the neuromuscular apparatus and abnormalities in cardiac function. Systemic symptoms are often recorded together with local damages whose intensity varies according to the route and length of exposure. Gastrointestinal malaise or respiratory distress is common for oral and inhalational exposure, respectively. In addition, irritant properties of PLTX probably account for the inflammatory reactions typical of cutaneous and inhalational contact. Unfortunately, the toxin identification and/or quantification are often incomplete or missing and cases of poisoning are indirectly ascribed to PLTXs, according only to symptoms, anamnesis and environmental/epidemiological investigations (i.e. zoanthid handling or ingestion of particular seafood). Based on the available literature, we suggest a "case definition of PLTX poisonings" according to the main exposure routes, and, we propose the main symptoms to be checked, as well as, hemato-clinical analysis to be carried out. We also suggest the performance of specific analyses both on biological specimens of patients, as well as, on the contaminated materials responsible for the poisoning. A standardized protocol for data collection could provide a more rapid and reliable diagnosis of palytoxin-poisoning, but also the collection of necessary data for the risk assessment for this family of toxins. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. The case for expanding the definition of 'key populations' to include ...

    African Journals Online (AJOL)

    The case for expanding the definition of 'key populations' to include high-risk groups in the general population ... South African Medical Journal ... to formal housing and services, access to higher education, and broad economic transformation.

  15. Natural history of benign prostatic hyperplasia: Appropriate case definition and estimation of its prevalence in the community

    NARCIS (Netherlands)

    J.L.H.R. Bosch (Ruud); W.C.J. Hop (Wim); W.J. Kirkels (Wim); F.H. Schröder (Fritz)

    1995-01-01

    textabstractThere is no consensus about a case definition of benign prostatic hyperplasia (BPH). In the present study, BPH prevalence rates were determined using various case definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism,

  16. High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomography.

    Science.gov (United States)

    Min, James K; Swaminathan, Rajesh V; Vass, Melissa; Gallagher, Scott; Weinsaft, Jonathan W

    2009-01-01

    The assessment of coronary stents with present-generation 64-detector row computed tomography scanners that use filtered backprojection and operating at standard definition of 0.5-0.75 mm (standard definition, SDCT) is limited by imaging artifacts and noise. We evaluated the performance of a novel, high-definition 64-slice CT scanner (HDCT), with improved spatial resolution (0.23 mm) and applied statistical iterative reconstruction (ASIR) for evaluation of coronary artery stents. HDCT and SDCT stent imaging was performed with the use of an ex vivo phantom. HDCT was compared with SDCT with both smooth and sharp kernels for stent intraluminal diameter, intraluminal area, and image noise. Intrastent visualization was assessed with an ASIR algorithm on HDCT scans, compared with the filtered backprojection algorithms by SDCT. Six coronary stents (2.5, 2.5, 2.75, 3.0, 3.5, 4.0mm) were analyzed by 2 independent readers. Interobserver correlation was high for both HDCT and SDCT. HDCT yielded substantially larger luminal area visualization compared with SDCT, both for smooth (29.4+/-14.5 versus 20.1+/-13.0; P<0.001) and sharp (32.0+/-15.2 versus 25.5+/-12.0; P<0.001) kernels. Stent diameter was higher with HDCT compared with SDCT, for both smooth (1.54+/-0.59 versus1.00+/-0.50; P<0.0001) and detailed (1.47+/-0.65 versus 1.08+/-0.54; P<0.0001) kernels. With detailed kernels, HDCT scans that used algorithms showed a trend toward decreased image noise compared with SDCT-filtered backprojection algorithms. On the basis of this ex vivo study, HDCT provides superior detection of intrastent luminal area and diameter visualization, compared with SDCT. ASIR image reconstruction techniques for HDCT scans enhance the in-stent assessment while decreasing image noise.

  17. Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia.

    Science.gov (United States)

    Bines, Julie E; Liem, Nguyen Thanh; Justice, Frances; Son, Tran Ngoc; Carlin, John B; de Campo, Margaret; Jamsen, Kris; Mulholland, Kim; Barnett, Peter; Barnes, Graeme L

    2006-07-01

    To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants agedclinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely.

  18. Uniform research case definition criteria differentiate tuberculous and bacterial meningitis in children.

    Science.gov (United States)

    Solomons, Regan S; Wessels, Marie; Visser, Douwe H; Donald, Peter R; Marais, Ben J; Schoeman, Johan F; van Furth, Anne M

    2014-12-01

    Tuberculous meningitis (TBM) research is hampered by low numbers of microbiologically confirmed TBM cases and the fact that they may represent a select part of the disease spectrum. A uniform TBM research case definition was developed to address these limitations, but its ability to differentiate TBM from bacterial meningitis has not been evaluated. We assessed all children treated for TBM from 1985 to 2005 at Tygerberg Children's Hospital, Cape Town, South Africa. For comparative purposes, a group of children with culture-confirmed bacterial meningitis, diagnosed between 2003 and 2009, was identified from the National Health Laboratory Service database. The performance of the proposed case definition was evaluated in culture-confirmed TBM and bacterial meningitis cases. Of 554 children treated for TBM, 66 (11.9%) were classified as "definite TBM," 408 (73.6%) as "probable TBM," and 72 (13.0%) as "possible TBM." "Probable TBM" criteria identified culture-confirmed TBM with a sensitivity of 86% and specificity of 100%; sensitivity was increased but specificity reduced when using "possible TBM" criteria (sensitivity 100%, specificity 56%). "Probable TBM" criteria accurately differentiated TBM from bacterial meningitis and could be considered for use in clinical trials; reduced sensitivity in children with early TBM (stage 1 disease) remains a concern. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  19. Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia.

    OpenAIRE

    Bines, JE; Liem, NT; Justice, F; Son, TN; Carlin, JB; de Campo, M; Jamsen, K; Mulholland, K; Barnett, P; Barnes, GL

    2006-01-01

    OBJECTIVE: To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. METHODS: Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition ...

  20. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use

    DEFF Research Database (Denmark)

    Kraus, V B; Blanco, F J; Englund, M

    2015-01-01

    Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and ...... sophisticated definitions, terminology and tools....

  1. 76 FR 38051 - Defense Federal Acquisition Regulation Supplement; Definition of Sexual Assault (DFARS Case 2010...

    Science.gov (United States)

    2011-06-29

    ... Sexual Assault/Harassment Involving DoD Contractors During Contingency Operations,'' dated April 16, 2010... Federal Acquisition Regulation Supplement; Definition of Sexual Assault (DFARS Case 2010-D023) AGENCY... employees accompanying U.S. Armed Forces are made aware of the DoD definition of sexual assault as defined...

  2. Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data

    Science.gov (United States)

    Jolley, Rachel J; Jetté, Nathalie; Sawka, Keri Jo; Diep, Lucy; Goliath, Jade; Roberts, Derek J; Yipp, Bryan G; Doig, Christopher J

    2015-01-01

    Objective Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients. Setting and participants All adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included. Research design Patient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis. Measures Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Sepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly. Conclusions This study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes. PMID:26700284

  3. Guillain-Barré syndrome following receipt of influenza A (H1N1) 2009 monovalent vaccine in Korea with an emphasis on Brighton Collaboration case definition.

    Science.gov (United States)

    Choe, Young June; Cho, Heeyeon; Bae, Geun-Ryang; Lee, Jong-Koo

    2011-03-03

    In 2009-2010 season, with ongoing of influenza A (H1N1), employment of mass vaccination has generated concerns in issue of adverse events following immunization (AEFI). This study investigates the clinical and laboratory data of reported cases of Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) following receipt of influenza A (H1N1) 2009 monovalent vaccine to the National Vaccine Injury Compensation Program (NVICP) in Korea, with all cases reviewed under case definition developed by Brighton Collaboration GBS Working Group. Retrospective review of medical records for all suspected cases of GBS ad FS following receipt of influenza A (H1N1) monovalent vaccine reported to NVICP from December 1, 2009, through April 28, 2010 was conducted. Additional analyses were performed for identification of levels of diagnostic certainty according to Brighton Collaboration case definition. Of 29 reported cases, 22 were confirmed to meet Brighton criteria level 1, 2, or 3 for GBS (21) or FS (1). Of those, 2 (9.1%) met level 1, 9 (40.9%) met level 2, and 11 (50.0%) met level 3. The male to female ratio was 2:0 in cases with level 1, 8:1 in cases with level 2, and 3:8 in cases with level 3. The mean age was older in cases with level 1 (54.0 ± 26.9) than that of cases with level 2 (25.6 ± 22.8), and level 3 (13.6 ± 2.4, P=0.005). The median onset interval was longer in cases with level 1 (16 days) than that of cases that met level 2 (12.44 days), and 3 (1.09 days, P=0.019). The Brighton case definition was used to improve the quality of AEFI data in Korea, and was applicable in retrospective review of medical records in cases with GBS and FS after influenza A (H1N1) vaccination. These findings suggest that standardized case definition was feasible in clarifying the AEFI data, and to further increase the understanding of possible relationship of influenza vaccine and GBS. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Evaluation of surveillance case definition in the diagnosis of leptospirosis, using the Microscopic Agglutination Test: a validation study.

    Science.gov (United States)

    Dassanayake, Dinesh L B; Wimalaratna, Harith; Agampodi, Suneth B; Liyanapathirana, Veranja C; Piyarathna, Thibbotumunuwe A C L; Goonapienuwala, Bimba L

    2009-04-22

    Leptospirosis is endemic in both urban and rural areas of Sri Lanka and there had been many out breaks in the recent past. This study was aimed at validating the leptospirosis surveillance case definition, using the Microscopic Agglutination Test (MAT). The study population consisted of patients with undiagnosed acute febrile illness who were admitted to the medical wards of the Teaching Hospital Kandy, from 1st July 2007 to 31st July 2008. The subjects were screened to diagnose leptospirosis according to the leptospirosis case definition. MAT was performed on blood samples taken from each patient on the 7th day of fever. Leptospirosis case definition was evaluated in regard to sensitivity, specificity and predictive values, using a MAT titre >or= 1:800 for confirming leptospirosis. A total of 123 patients were initially recruited of which 73 had clinical features compatible with the surveillance case definition. Out of the 73 only 57 had a positive MAT result (true positives) leaving 16 as false positives. Out of the 50 who didn't have clinical features compatible with the case definition 45 had a negative MAT as well (true negatives), therefore 5 were false negatives. Total number of MAT positives was 62 out of 123. According to these results the test sensitivity was 91.94%, specificity 73.77%, positive predictive value and negative predictive values were 78.08% and 90% respectively. Diagnostic accuracy of the test was 82.93%. This study confirms that the surveillance case definition has a very high sensitivity and negative predictive value with an average specificity in diagnosing leptospirosis, based on a MAT titre of >or= 1: 800.

  5. 75 FR 73997 - Defense Federal Acquisition Regulation Supplement; Definition of Sexual Assault (DFARS Case 2010...

    Science.gov (United States)

    2010-11-30

    ... Inspector General audit D-2010-052, entitled ``Efforts to Prevent Sexual Assault/Harassment Involving DoD... Acquisition Regulation Supplement; Definition of Sexual Assault (DFARS Case 2010-D023) AGENCY: Defense..., to ensure contractor employees are aware of the DoD definition of ``sexual assault'' as defined in Do...

  6. Puffy skin disease (PSD) in rainbow trout, Oncorhynchus mykiss (Walbaum): a case definition.

    Science.gov (United States)

    Maddocks, C E; Nolan, E T; Feist, S W; Crumlish, M; Richards, R H; Williams, C F

    2015-07-01

    Puffy skin disease (PSD) is a disease that causes skin pathology in rainbow trout, Oncorhynchus mykiss (Walbaum). Incidence of PSD in UK fish farms and fisheries has increased sharply in the last decade, with growing concern from both industry sectors. This paper provides the first comprehensive case definition of PSD, combining clinical and pathological observations of diseased rainbow trout from both fish farms and fisheries. The defining features of PSD, as summarized in the case definition, were focal lateral flank skin lesions that appeared as cutaneous swelling with pigment loss and petechiae. These were associated with lethargy, poor body condition, inappetance and low level mortality. Epidermal hyperplasia and spongiosis, oedema of the dermis stratum spongiosum and a mild diffuse inflammatory cellularity were typical in histopathology of skin. A specific pathogen or aetiology was not identified. Prevalence and severity of skin lesions was greatest during late summer and autumn, with the highest prevalence being 95%. Atypical lesions seen in winter and spring were suggestive of clinical resolution. PSD holds important implications for both trout aquaculture and still water trout fisheries. This case definition will aid future diagnosis, help avoid confusion with other skin conditions and promote prompt and consistent reporting. © 2014 John Wiley & Sons Ltd.

  7. The use of high definition colonoscopy versus standard definition: does it affect polyp detection rate?

    Science.gov (United States)

    Richardson, John; Thaventhiran, Anthony; Mackenzie, Hugh; Stubbs, Benjamin

    2017-11-03

    Polyp detection rate (PDR) during lower gastrointestinal endoscopy (LGIE) is of clinical importance. Detecting adenomatous polyps early in the adenoma-carcinoma sequence can halt disease progression, enabling treatment at a favourable stage. High definition colonoscopy (HDC) has been used in our hospital alongside standard definition equipment since 2011. We aim to determine what affect the use of HDC has on PDR. Post-hoc analysis of a prospectively maintained database on all patients undergoing LGIE was performed (01/01/2012-31/12/2015), n = 15,448. Analysis tested the primary outcome of HD's effect on PDR across LGIE and secondary outcome stratified this by endoscopist group (Physician (PE), Surgeon (SE) and Nurse Endoscopist (NE)). Of 15,448 patients, 1353 underwent HDC. Unmatched analysis showed PDR increased by 5.3% in this group (p < 0.001). Matched analysis considered 2288 patients from the total cohort (1144 HDC) and showed an increase of 1% in PDR with HDC (p = 0.578). Further unmatched analysis stratified by endoscopist groups showed a PDR increase of 1.8% (p = 0.375), 5.4% (p = 0.008) and 4.6% (p = 0.021) by PE, SE and NE respectively. Matched analysis demonstrated an increase of 1% (p = 0.734) and 1.5% (p = 0.701) amongst PE and NE, with a decrease of 0.6% (p = 0.883) by SE. The introduction of HDC increased PDR across all LGIE in our hospital, though this was not clinically significant. This marginal benefit was present across all endoscopist groups with no group benefiting over another in matched analysis.

  8. Hantavirus pulmonary syndrome clinical findings: evaluating a surveillance case definition.

    Science.gov (United States)

    Knust, Barbara; Macneil, Adam; Rollin, Pierre E

    2012-05-01

    Clinical cases of hantavirus pulmonary syndrome (HPS) can be challenging to differentiate from other acute respiratory diseases, which can lead to delays in diagnosis, treatment, and disease reporting. Rapid onset of severe disease occurs, at times before diagnostic test results are available. This study's objective was to examine the clinical characteristics of patients that would indicate HPS to aid in detection and reporting. Test results of blood samples from U.S. patients suspected of having HPS submitted to the Centers for Disease Control and Prevention from 1998-2010 were reviewed. Patient information collected by case report forms was compared between HPS-confirmed and test-negative patients. Diagnostic sensitivity, specificity, predictive values, and likelihood ratios were calculated for individual clinical findings and combinations of variables. Of 567 patients included, 36% were HPS-confirmed. Thrombocytopenia, chest x-rays with suggestive signs, and receiving supplemental oxygenation were highly sensitive (>95%), while elevated hematocrit was highly specific (83%) in detecting HPS. Combinations that maximized sensitivity required the presence of thrombocytopenia. Using a national sample of suspect patients, we found that thrombocytopenia was a highly sensitive indicator of HPS and should be included in surveillance definitions for suspected HPS. Using a sensitive suspect case definition to identify potential HPS patients that are confirmed by highly specific diagnostic testing will ensure accurate reporting of this disease.

  9. Measuring elimination of podoconiosis, endemicity classifications, case definition and targets: an international Delphi exercise.

    Science.gov (United States)

    Deribe, Kebede; Wanji, Samuel; Shafi, Oumer; Muheki Tukahebwa, Edridah; Umulisa, Irenee; Davey, Gail

    2015-09-01

    Podoconiosis is one of the major causes of lymphoedema in the tropics. Nonetheless, currently there are no endemicity classifications or elimination targets to monitor the effects of interventions. This study aimed at establishing case definitions and indicators that can be used to assess endemicity, elimination and clinical outcomes of podoconiosis. This paper describes the result of a Delphi technique used among 28 experts. A questionnaire outlining possible case definitions, endemicity classifications, elimination targets and clinical outcomes was developed. The questionnaire was distributed to experts working on podoconiosis and other neglected tropical diseases in two rounds. The experts rated the importance of case definitions, endemic classifications, elimination targets and the clinical outcome measures. Median and mode were used to describe the central tendency of expert responses. The coefficient of variation was used to describe the dispersals of expert responses. Consensus on definitions and indicators for assessing endemicity, elimination and clinical outcomes of podoconiosis directed at policy makers and health workers was achieved following the two rounds of Delphi approach among the experts. Based on the two Delphi rounds we discuss potential indicators and endemicity classification of this disabling disease, and the ongoing challenges to its elimination in countries with the highest prevalence. Consensus will help to increase effectiveness of podoconiosis elimination efforts and ensure comparability of outcome data. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  10. 21 CFR 130.20 - Food additives proposed for use in foods for which definitions and standards of identity are...

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Food additives proposed for use in foods for which...: GENERAL Food Additives in Standardized Foods § 130.20 Food additives proposed for use in foods for which... the act, which proposes the inclusion of a food additive in such definition and standard of identity...

  11. ORAL CLINICAL LONG CASE PRESENTATION, THE NEED FOR STANDARDIZATION AND DOCUMENTATION.

    Science.gov (United States)

    Agodirin, S O; Olatoke, S A; Rahman, G A; Agbakwuru, E A; Kolawole, O A

    2015-01-01

    The oral presentation of the clinical long case is commonly an implied knowledge. The challenge of the presentation is compounded by the examiners' preferences and sometimes inadequate understanding of what should be assessed. To highlight the different opinions and misconceptions of trainers as the basis for improving our understanding and assessment of oral presentation of the clinical long case. Questionnaire was administered during the West African College of Surgeons fellowship clinical examinations and at their workplaces. Eligibility criteria included being a surgeon, a trainer and responding to all questions. Of the 72 questionnaires that were returned, 36(50%) were eligible for the analysis. The 36 respondents were from 14 centers in Nigeria and Ghana. Fifty-two percent were examiners at the postgraduate medical colleges and 9(25%) were professors. Eight(22.2%) indicated they were unaware of the separate methods of oral presentation for different occasions while 21( 58.3%) respondents were aware that candidate used the "5Cs" method and the traditional compartmentalized method in long case oral presentation. Eleven(30.6%) wanted postgraduates to present differently on a much higher level than undergraduate despite not encountering same in literature and 21(58.3%) indicated it was an unwritten rule. Seventeen (47.2%) had not previously encountered the "5Cs" of history of presenting complaint in literature also 17(47.2%) teach it to medical students and their junior residents. This study has shown that examiners definitely have varying opinions on what form the oral presentation of the clinical long case at surgery fellowship/professional examination should be and it translates to their expectations of the residents or clinical students. This highlights the need for standardization and consensus of what is expected at a formal oral presentation during the clinical long case examination in order to avoid subjectivity and bias.

  12. Standard of care: the legal view.

    Science.gov (United States)

    Curley, Arthur W; Peltier, Bruce

    2014-01-01

    The standard of care is a legal construct, a line defined by juries, based on expert testimony, marking a point where treatment failed to meet expectations for what a reasonable professional would have done. There is no before-the-fact objective definition of this standard, except for cases of law and regulation, such as the Occupational Safety and Health Admintration (OSHA). Practitioners must use their judgment in determining what would be acceptable should a case come to trial. Professional codes of conduct and acting in the patient's best interests are helpful guides to practicing within the standard of care. Continuing education credit is available for this and the following article together online at www.dentalethics.org for those who wish to complete the quiz and exercises associated with them (see Course 22).

  13. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group.

    Science.gov (United States)

    Rodeghiero, Francesco; Stasi, Roberto; Gernsheimer, Terry; Michel, Marc; Provan, Drew; Arnold, Donald M; Bussel, James B; Cines, Douglas B; Chong, Beng H; Cooper, Nichola; Godeau, Bertrand; Lechner, Klaus; Mazzucconi, Maria Gabriella; McMillan, Robert; Sanz, Miguel A; Imbach, Paul; Blanchette, Victor; Kühne, Thomas; Ruggeri, Marco; George, James N

    2009-03-12

    Diagnosis and management of immune thrombocytopenic purpura (ITP) remain largely dependent on clinical expertise and observations more than on evidence derived from clinical trials of high scientific quality. One major obstacle to the implementation of such studies and in producing reliable meta-analyses of existing data is a lack of consensus on standardized critical definitions, outcome criteria, and terminology. Moreover, the demand for comparative clinical trials has dramatically increased since the introduction of new classes of therapeutic agents, such as thrombopoietin receptor agonists, and innovative treatment modalities, such as anti-CD 20 antibodies. To overcome the present heterogeneity, an International Working Group of recognized expert clinicians convened a 2-day structured meeting (the Vicenza Consensus Conference) to define standard terminology and definitions for primary ITP and its different phases and criteria for the grading of severity, and clinically meaningful outcomes and response. These consensus criteria and definitions could be used by investigational clinical trials or cohort studies. Adoption of these recommendations would serve to improve communication among investigators, to enhance comparability among clinical trials, to facilitate meta-analyses and development of therapeutic guidelines, and to provide a standardized framework for regulatory agencies.

  14. 48 CFR 9904.410-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.410-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.410-30 Definitions. (a) The following are definitions of terms...

  15. 48 CFR 9904.408-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.408-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.408-30 Definitions. (a) The following are definitions of terms...

  16. 48 CFR 9904.404-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.404-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.404-30 Definitions. (a) The following are definitions of terms...

  17. 48 CFR 9904.405-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.405-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.405-30 Definitions. (a) The following are definitions of terms...

  18. 48 CFR 9904.406-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.406-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.406-30 Definitions. (a) The following are definitions of terms...

  19. 48 CFR 9904.402-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.402-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402-30 Definitions. (a) The following are definitions of terms...

  20. 48 CFR 9904.401-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.401-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.401-30 Definitions. (a) The following are definitions of terms...

  1. 48 CFR 9904.409-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.409-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.409-30 Definitions. (a) The following are definitions of terms...

  2. 48 CFR 9904.407-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.407-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.407-30 Definitions. (a) The following are definitions of terms...

  3. 48 CFR 9904.403-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Section 9904.403-30 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403-30 Definitions. (a) The following are definitions of terms...

  4. The analysis and rationale behind the upgrading of existing standard definition thermal imagers to high definition

    Science.gov (United States)

    Goss, Tristan M.

    2016-05-01

    With 640x512 pixel format IR detector arrays having been on the market for the past decade, Standard Definition (SD) thermal imaging sensors have been developed and deployed across the world. Now with 1280x1024 pixel format IR detector arrays becoming readily available designers of thermal imager systems face new challenges as pixel sizes reduce and the demand and applications for High Definition (HD) thermal imaging sensors increases. In many instances the upgrading of existing under-sampled SD thermal imaging sensors into more optimally sampled or oversampled HD thermal imaging sensors provides a more cost effective and reduced time to market option than to design and develop a completely new sensor. This paper presents the analysis and rationale behind the selection of the best suited HD pixel format MWIR detector for the upgrade of an existing SD thermal imaging sensor to a higher performing HD thermal imaging sensor. Several commercially available and "soon to be" commercially available HD small pixel IR detector options are included as part of the analysis and are considered for this upgrade. The impact the proposed detectors have on the sensor's overall sensitivity, noise and resolution is analyzed, and the improved range performance is predicted. Furthermore with reduced dark currents due to the smaller pixel sizes, the candidate HD MWIR detectors are operated at higher temperatures when compared to their SD predecessors. Therefore, as an additional constraint and as a design goal, the feasibility of achieving upgraded performance without any increase in the size, weight and power consumption of the thermal imager is discussed herein.

  5. Practical support for Lean Six Sigma software process definition using IEEE software engineering standards

    CERN Document Server

    Land, Susan K; Walz, John W

    2012-01-01

    Practical Support for Lean Six Sigma Software Process Definition: Using IEEE Software Engineering Standards addresses the task of meeting the specific documentation requirements in support of Lean Six Sigma. This book provides a set of templates supporting the documentation required for basic software project control and management and covers the integration of these templates for their entire product development life cycle. Find detailed documentation guidance in the form of organizational policy descriptions, integrated set of deployable document templates, artifacts required in suppo

  6. Natural history of benign prostatic hyperplasia: Appropriate case definition and estimation of its prevalence in the community

    OpenAIRE

    Bosch, Ruud; Hop, Wim; Kirkels, Wim; Schröder, Fritz

    1995-01-01

    textabstractThere is no consensus about a case definition of benign prostatic hyperplasia (BPH). In the present study, BPH prevalence rates were determined using various case definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, prostate volume increase, and bladder outflow obstruction. The aim of this study—in a community-based population of 502 men (55–74 years of age) without prostate cancer—was to determine the relative i...

  7. Nuclear engineering terms and definitions

    International Nuclear Information System (INIS)

    1981-01-01

    The most important nuclear engineering's terms and definitions are given in this standard. The definitions take into account the Austrian Regulations for Radiation Protection, for and pertinent ISO and DIN-Standards as also the OENORM A7006 and OENORM A6601. (M.T.)

  8. A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique.

    Science.gov (United States)

    East, J E; Stavrindis, M; Thomas-Gibson, S; Guenther, T; Tekkis, P P; Saunders, B P

    2008-09-15

    Colonoscopy has a known miss rate for polyps and adenomas. High definition (HD) colonoscopes may allow detection of subtle mucosal change, potentially aiding detection of adenomas and hyperplastic polyps. To compare detection rates between HD and standard definition (SD) colonoscopy. Prospective, cohort study with optimized withdrawal technique (withdrawal time >6 min, antispasmodic, position changes, re-examining flexures and folds). One hundred and thirty patients attending for routine colonoscopy were examined with either SD (n = 72) or HD (n = 58) colonoscopes. Groups were well matched. Sixty per cent of patients had at least one adenoma detected with SD vs. 71% with HD, P = 0.20, relative risk (benefit) 1.32 (95% CI 0.85-2.04). Eighty-eight adenomas (mean +/- standard deviation 1.2 +/- 1.4) were detected using SD vs. 93 (1.6 +/- 1.5) with HD, P = 0.12; however more nonflat, diminutive (9 mm) hyperplastic polyps was 7% (0.09 +/- 0.36). High definition did not lead to a significant increase in adenoma or hyperplastic polyp detection, but may help where comprehensive lesion detection is paramount. High detection rates appear possible with either SD or HD, when using an optimized withdrawal technique.

  9. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document.

    Science.gov (United States)

    Garcia-Garcia, Hector M; McFadden, Eugène P; Farb, Andrew; Mehran, Roxana; Stone, Gregg W; Spertus, John; Onuma, Yoshinobu; Morel, Marie-Angèle; van Es, Gerrit-Anne; Zuckerman, Bram; Fearon, William F; Taggart, David; Kappetein, Arie-Pieter; Krucoff, Mitchell W; Vranckx, Pascal; Windecker, Stephan; Cutlip, Donald; Serruys, Patrick W

    2018-06-14

    The Academic Research Consortium (ARC)-2 initiative revisited the clinical and angiographic end point definitions in coronary device trials, proposed in 2007, to make them more suitable for use in clinical trials that include increasingly complex lesion and patient populations and incorporate novel devices such as bioresorbable vascular scaffolds. In addition, recommendations for the incorporation of patient-related outcomes in clinical trials are proposed. Academic Research Consortium-2 is a collaborative effort between academic research organizations in the United States and Europe, device manufacturers, and European, US, and Asian regulatory bodies. Several in-person meetings were held to discuss the changes that have occurred in the device landscape and in clinical trials and regulatory pathways in the last decade. The consensus-based end point definitions in this document are endorsed by the stakeholders of this document and strongly advocated for clinical trial purposes. This Academic Research Consortium-2 document provides further standardization of end point definitions for coronary device trials, incorporating advances in technology and knowledge. Their use will aid interpretation of trial outcomes and comparison among studies, thus facilitating the evaluation of the safety and effectiveness of these devices.

  10. Development of a validated clinical case definition of generalized tonic-clonic seizures for use by community-based health care providers.

    Science.gov (United States)

    Anand, Krishnan; Jain, Satish; Paul, Eldho; Srivastava, Achal; Sahariah, Sirazul A; Kapoor, Suresh K

    2005-05-01

    To develop and test a clinical case definition for identification of generalized tonic-clonic seizures (GTCSs) by community-based health care providers. To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects. In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1-41.3), presence of frothing (13.7; 4.0-47.3), and occurrence in sleep (8.3; 2.0-34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4-66.0) and specificity, 96.3 (86.2-99.4). Among the 197 GTCS

  11. Course and Outcome of Bacteremia Due to Staphylococcus Aureus: Evaluation of Different Clinical Case Definitions

    NARCIS (Netherlands)

    S. Lautenschlager (Stephan); C. Herzog (Christian); W. Zimmerli (Werner)

    1993-01-01

    textabstractIn a retrospective survey of patients hospitalized in the University Hospital of Basel, Switzerland, the course and outcome of 281 cases of true bacteremia due to Staphylococcus aureus over a 7-year period were analyzed. The main purpose was to evaluate different case definitions. In 78%

  12. Case management.

    Science.gov (United States)

    Woodward, Judy; Rice, Eve

    2015-03-01

    Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. The application of standard definitions of sound to the fields of underwater acoustics and acoustical oceanography

    Science.gov (United States)

    Carey, William M.

    2004-05-01

    Recent societal concerns have focused attention on the use of sound as a probe to investigate the oceans and its use in naval sonar applications. The concern is the impact the use of sound may have on marine mammals and fishes. The focus has changed the fields of acoustical oceanography (AO) and underwater acoustics (UW) because of the requirement to communicate between disciplines. Multiple National Research Council publications, Dept. of Navy reports, and several monographs have been written on this subject, and each reveals the importance as well as the misapplication of ASA standards. The ANSI-ASA standards are comprehensive, however not widely applied. The clear definition of standards and recommendations of their use is needed for both scientists and government agencies. Traditionally the U.S. Navy has been responsible for UW standards and calibration; the ANSI-ASA standards have been essential. However, recent changes in the Navy and its laboratory structure may necessitate a more formal recognition of ANSI-ASA standards and perhaps incorporation of UW-AO in the Bureau of Standards. A separate standard for acoustical terminology, reference levels, and notation used in the UW-AO is required. Since the problem is global, a standard should be compatible and cross referenced with the International Standard (CEI/IEC 27-3).

  14. Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study.

    Science.gov (United States)

    Golder, Vera; Huq, Molla; Franklyn, Kate; Calderone, Alicia; Lateef, Aisha; Lau, Chak Sing; Lee, Alfred Lok Hang; Navarra, Sandra Teresa V; Godfrey, Timothy; Oon, Shereen; Hoi, Alberta Yik Bun; Morand, Eric Francis; Nikpour, Mandana

    2017-06-01

    To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Influence of the lack of a standard definition of “family business” on research into their international strategies☆

    Directory of Open Access Journals (Sweden)

    Myriam Cano-Rubio

    2017-09-01

    Full Text Available Research into the internationalisation strategies of family businesses is plagued by the excessive use of many and varied concepts to define these companies, and often leads to diverse and disparate results. The conceptual spectrum used by researchers is very broad, ranging from the simplest definition, in which a company is classified as a family business on the basis of the perception of its owners and/or managers, to others which consider variables such as ownership, management, involvement of the family in the business, continuity and combinations thereof. The results obtained highlight the need for those researching family business internationalisation strategies to use a standard definition of family business, so enabling us to continue advancing in our knowledge of this topic and avoid coming to different conclusions merely as a result of having based our research on different definitions.

  16. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.

    2011-01-01

    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning

  17. Influenza outbreak during Sydney World Youth Day 2008: the utility of laboratory testing and case definitions on mass gathering outbreak containment.

    Directory of Open Access Journals (Sweden)

    Sebastiaan J van Hal

    Full Text Available BACKGROUND: Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown. METHODS AND RESULTS: An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy. CONCLUSIONS: Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings.

  18. An evaluation of modified case definitions for the detection of dengue hemorrhagic fever. Puerto Rico Association of Epidemiologists.

    Science.gov (United States)

    Rigau-Pérez, J G; Bonilla, G L

    1999-12-01

    The case definition for dengue hemorrhagic fever (DHF) requires fever, platelets plasma leakage evidenced by hemoconcentration > or = 20%, pleural or abdominal effusions, hypoproteinemia or hypoalbuminemia. We evaluated the specificity and yield of modified DHF case definitions and the recently proposed World Health Organization criteria for a provisional diagnosis of DHF, using a data base of laboratory-positive and laboratory-negative reports of hospitalizations for suspected dengue in Puerto Rico, 1994 to 1996. By design, all modifications had 100% sensitivity. More liberal criteria for plasma leakage were examined: 1) adding as evidence a single hematocrit > or = 50% (specificity 97.4%); 2) accepting hemoconcentration > or = 10% (specificity 90.1%); and 3) accepting either hematocrit > or = 50% or hemoconcentration > or = 10% (specificity 88.8%). The new DHF cases identified by these definitions (and percent laboratory positive) were 25 (100.0%), 95 (90.5%), and 107 (91.6%), respectively. In contrast, the provisional diagnosis of DHF (fever and hemorrhage, and one or more of platelets or = 20%, or at least a rising hematocrit [redefined quantitatively as a 5% or greater relative change]) showed a specificity of 66.8%, and identified 318 new DHF cases, of which 282 (88.7%) were laboratory-positive. Very small changes in the criteria may result in a large number of new cases. The modification that accepted either hematocrit > or = 50% or hemoconcentration > or = 10% had acceptable specificity, while doubling the detection of DHF-compatible, laboratory-positive severe cases, but "provisional diagnosis" showed even lower specificity, and may produce inflated DHF incidence figures. Modified case definitions should be prospectively evaluated with patients in a health-care facility before they are recommended for widespread use.

  19. Reviewing the definition of crisis in dementia care

    NARCIS (Netherlands)

    MacNeil-Vroomen, J.L.; Bosmans, J.E.; van Hout, H.P.J.; de Rooij, S.E.

    2013-01-01

    Background: Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice.

  20. Modern standardization case studies at the crossroads of technology, economics, and politics

    CERN Document Server

    Schneiderman, R

    2015-01-01

    Modern Standardization -- Case Studies at the Crossroads of Technology, Economics, and Politics covers the development of new technical standards, how these standards are typically triggered, and how they are submitted to standards development organizations (SDOs) for review and evaluation. It fills the gap in the shortage of reference material in the development of real-world standards. The increasing pace of innovation in technology has accelerated the competitive nature of standardization, particularly in emerging markets. Modern Standardization addresses these and other issues through a series of case studies in a format designed for academics and their engineering, business, and law school students.

  1. Sputum, sex and scanty smears: new case definition may reduce sex disparities in smear-positive tuberculosis.

    Science.gov (United States)

    Ramsay, A; Bonnet, M; Gagnidze, L; Githui, W; Varaine, F; Guérin, P J

    2009-05-01

    Urban clinic, Nairobi. To evaluate the impact of specimen quality and different smear-positive tuberculosis (TB) case (SPC) definitions on SPC detection by sex. Prospective study among TB suspects. A total of 695 patients were recruited: 644 produced > or =1 specimen for microscopy. The male/female sex ratio was 0.8. There were no significant differences in numbers of men and women submitting three specimens (274/314 vs. 339/380, P = 0.43). Significantly more men than women produced a set of three 'good' quality specimens (175/274 vs. 182/339, P = 0.01). Lowering thresholds for definitions to include scanty smears resulted in increases in SPC detection in both sexes; the increase was significantly higher for women. The revised World Health Organization (WHO) case definition was associated with the highest detection rates in women. When analysis was restricted only to patients submitting 'good' quality specimen sets, the difference in detection between sexes was on the threshold for significance (P = 0.05). Higher SPC notification rates in men are commonly reported by TB control programmes. The revised WHO SPC definition may reduce sex disparities in notification. This should be considered when evaluating other interventions aimed at reducing these. Further study is required on the effects of the human immuno-deficiency virus and instructed specimen collection on sex-specific impact of new SPC definition.

  2. Definition and denomination of occupations in libraries

    Directory of Open Access Journals (Sweden)

    Jelka Gazvoda

    1998-01-01

    Full Text Available In the first part of the article, the author presents the modern definition of occupation as defined in the ISCO-88 standard, and consecutively in the Slovenian Standard Classification of Occupations; occupations in the field of library and information science are then placed in a wider frame of information occupations which are present in ali spheres of activities. The following part of the article is focused on information occupations in libraries, especially on their contents definitions and denominations.Based on the analysis of job descriptions in three Slovenian libraries (National and University Library, University Library of Maribor and Central Technical Library,the author came to the following conclusion: the existent practice in libraries shows that the contents and denominations of occupations in library and information jobs are defined too loosely. In most cases, the contents of occupation is defined by the contents of the job, while for its denomination the required educational title of the employee is often used. Therefore, the author proposes the establishment of a work force which would define the contents and design denominations to library and information occupations according to the principles contained in the Standard Classification of Occupations.

  3. Intellectual property rights and standardization. The case of GSM

    NARCIS (Netherlands)

    Bekkers, R.N.A.; Verspagen, B.; Smits, J.M.

    2002-01-01

    This paper investigates the role of intellectual property rights (IPRs) in the process of standardization in the telecommunications industry. We take the global system for mobile communications (GSM) case as a highly relevant example, being part of a high-tech industry in which standards play a

  4. Reviewing the definition of crisis in dementia care

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Bosmans, Judith E.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2013-01-01

    Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice. We systematically

  5. The definition of cross polarization

    DEFF Research Database (Denmark)

    Ludwig, Arthur

    1973-01-01

    There are at least three different definitions of cross polarization used in the literature. The alternative definitions are discussed with respect to several applications, and the definition which corresponds to one standard measurement practice is proposed as the best choice....

  6. The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study

    NARCIS (Netherlands)

    Scott, J. Anthony G.; Wonodi, Chizoba; Moïsi, Jennifer C.; Deloria-Knoll, Maria; DeLuca, Andrea N.; Karron, Ruth A.; Bhat, Niranjan; Murdoch, David R.; Crawley, Jane; Levine, Orin S.; O'Brien, Katherine L.; Feikin, Daniel R.; Black, Robert E.; Bhutta, Zulfiqar A.; Campbell, Harry; Cherian, Thomas; Crook, Derrick W.; de Jong, Menno D.; Dowell, Scott F.; Graham, Stephen M.; Klugman, Keith P.; Lanata, Claudio F.; Madhi, Shabir A.; Martin, Paul; Nataro, James P.; Piazza, Franco M.; Qazi, Shamim A.; Zar, Heather J.

    2012-01-01

    To develop a case definition for the Pneumonia Etiology Research for Child Health (PERCH) project, we sought a widely acceptable classification that was linked to existing pneumonia research and focused on very severe cases. We began with the World Health Organization's classification of severe/very

  7. Validation of an algorithm-based definition of treatment resistance in patients with schizophrenia.

    Science.gov (United States)

    Ajnakina, Olesya; Horsdal, Henriette Thisted; Lally, John; MacCabe, James H; Murray, Robin M; Gasse, Christiane; Wimberley, Theresa

    2018-02-19

    Large-scale pharmacoepidemiological research on treatment resistance relies on accurate identification of people with treatment-resistant schizophrenia (TRS) based on data that are retrievable from administrative registers. This is usually approached by operationalising clinical treatment guidelines by using prescription and hospital admission information. We examined the accuracy of an algorithm-based definition of TRS based on clozapine prescription and/or meeting algorithm-based eligibility criteria for clozapine against a gold standard definition using case notes. We additionally validated a definition entirely based on clozapine prescription. 139 schizophrenia patients aged 18-65years were followed for a mean of 5years after first presentation to psychiatric services in South-London, UK. The diagnostic accuracy of the algorithm-based measure against the gold standard was measured with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). A total of 45 (32.4%) schizophrenia patients met the criteria for the gold standard definition of TRS; applying the algorithm-based definition to the same cohort led to 44 (31.7%) patients fulfilling criteria for TRS with sensitivity, specificity, PPV and NPV of 62.2%, 83.0%, 63.6% and 82.1%, respectively. The definition based on lifetime clozapine prescription had sensitivity, specificity, PPV and NPV of 40.0%, 94.7%, 78.3% and 76.7%, respectively. Although a perfect definition of TRS cannot be derived from available prescription and hospital registers, these results indicate that researchers can confidently use registries to identify individuals with TRS for research and clinical practices. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Dual, use-based definition of "system"

    CSIR Research Space (South Africa)

    Gonçalves, DP

    2015-09-01

    Full Text Available The standard definition (ISO 15288, 2008) of the concept of a system is not complete and is the definition of a closed system. Such a definition is inadequate for systems engineering. A use-based definition is proposed which spans the open...

  9. 40 CFR 51.1000 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Definitions. 51.1000 Section 51.1000 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS REQUIREMENTS FOR... Ambient Air Quality Standards § 51.1000 Definitions. The following definitions apply for purposes of this...

  10. Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients.

    Science.gov (United States)

    Grote Beverborg, Niels; Klip, IJsbrand T; Meijers, Wouter C; Voors, Adriaan A; Vegter, Eline L; van der Wal, Haye H; Swinkels, Dorine W; van Pelt, Joost; Mulder, Andre B; Bulstra, Sjoerd K; Vellenga, Edo; Mariani, Massimo A; de Boer, Rudolf A; van Veldhuisen, Dirk J; van der Meer, Peter

    2018-02-01

    The most commonly used definition of iron deficiency (ID; ferritin the biomarker-based definition of ID in HF, using bone marrow iron staining as the gold standard. Second, we aimed to assess the prognostic value of the optimized definition. Bone marrow aspiration with iron staining was performed in 42 patients with HF and a reduced left ventricular ejection fraction (≤45%) undergoing median sternotomy for coronary artery bypass grafting. Patients were mostly male (76%) with mild-to-moderate HF and a mean age of 68±10 years. Bone marrow ID was found in 17 (40%) of the HF patients. The most commonly used definition of ID had a sensitivity of 82% and a specificity of 72%. A definition solely based on TSAT ≤19.8% or serum iron ≤13 µmol/L had a sensitivity of 94% and specificity of 84% and 88%, respectively ( P the former definition). Subsequently, we assessed the incidence of all-cause mortality in 387 consecutive outpatient HF patients (left ventricular ejection fraction ≤45%). In these patients, TSAT ≤19.8% and serum iron ≤13 µmol/L, and not ferritin, were independently associated with mortality. A TSAT ≤19.8% or a serum iron ≤13 µmol/L shows the best performance in selecting patients with ID and identifies HF patients at the highest risk of death. Our findings validate the currently used TSAT cutoff of the identification of ID in HF patients, but question the diagnostic value of ferritin. © 2018 American Heart Association, Inc.

  11. Validity of Health Administrative Database Definitions for Hypertension: A Systematic Review.

    Science.gov (United States)

    Pace, Romina; Peters, Tricia; Rahme, Elham; Dasgupta, Kaberi

    2017-08-01

    Health administrative data are frequently used for hypertension surveillance. The aim of this systematic review was to determine the sensitivity and specificity of the commonly used hypertension case definition of 2 physician outpatient claims within a 2-year period or 1 hospital discharge abstract record. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE (from 1946) and EMBASE (from 1947) for relevant studies through September 2016 (keywords: "hypertension," "administrative databases," "validation studies"). Data with standardized forms and assessed quality using Quality Assessment of Diagnostic Accuracy Studies criteria were reviewed by 2 reviewers. Pooled sensitivity and specificity were estimated using a generalized linear-model approach to random-effects bivariate regression meta-analysis. The search strategy identified 1732 abstracts, among which 3 articles were deemed relevant. One of the articles incorporated 2 studies with differing reference standards and study populations; thus, we considered each separately. The quality scores of the retained studies ranged from 10-12 of a maximum 14. The sensitivity of the definition investigated to identify hypertension using administrative health databases was 71.2% (95% confidence interval [CI], 68.3-73.7) and the specificity was 94.5% (95% CI, 93.2-95.6) when compared with surveys or medical records. The 2 physician outpatient claims within a 2-year period or 1 hospital discharge abstract record hypertension case definition accurately classifies individuals as hypertensive in approximately 70% of cases and correctly identifies persons as nonhypertensive in approximately 95% of cases. This is likely sufficiently sensitive and specific for most research and surveillance purposes. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet): case definition in surveillance for childhood-onset Duchenne/Becker muscular dystrophy.

    Science.gov (United States)

    Mathews, Katherine D; Cunniff, Chris; Kantamneni, Jiji R; Ciafaloni, Emma; Miller, Timothy; Matthews, Dennis; Cwik, Valerie; Druschel, Charlotte; Miller, Lisa; Meaney, F John; Sladky, John; Romitti, Paul A

    2010-09-01

    The Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) is a multisite collaboration to determine the prevalence of childhood-onset Duchenne/Becker muscular dystrophy and to characterize health care and health outcomes in this population. MD STARnet uses medical record abstraction to identify patients with Duchenne/Becker muscular dystrophy born January 1, 1982 or later who resided in 1 of the participating sites. Critical diagnostic elements of each abstracted record are reviewed independently by >4 clinicians and assigned to 1 of 6 case definition categories (definite, probable, possible, asymptomatic, female, not Duchenne/Becker muscular dystrophy) by consensus. As of November 2009, 815 potential cases were reviewed. Of the cases included in analysis, 674 (82%) were either ''definite'' or ''probable'' Duchenne/Becker muscular dystrophy. These data reflect a change in diagnostic testing, as case assignment based on genetic testing increased from 67% in the oldest cohort (born 1982-1987) to 94% in the cohort born 2004 to 2009.

  13. Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach - a review of the literature and discussion.

    Science.gov (United States)

    Waltho, Daniel; Rockwell, Gloria

    2016-09-01

    Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements. We searched PubMed to retrieve all studies and case reports on PMPS, and we analyzed definitions of PMPS, inclusion/exclusion criteria, and methods of measuring PMPS. Twenty-three studies were included in this review. We identified 7 independent domains for defining PMPS: surgical breast procedure, neuropathic nature, pain of at least moderate intensity, protracted duration, frequent symptoms, appropriate location of the symptoms and exacerbation with movement. These domains were used with varying frequency. Inclusion/exclusion criteria and methods for assessing PMPS also varied markedly. To prevent future discrepancies in both the clinical and research settings, we propose a new and complete definition based on the results of our review: PMPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50% of the time; and may be exacerbated by movements of the shoulder girdle.

  14. 45 CFR 1609.2 - Definition.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Definition. 1609.2 Section 1609.2 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION FEE-GENERATING CASES § 1609.2 Definition. (a) Fee-generating case means any case or matter which, if undertaken on behalf of an eligible...

  15. Computing tools for implementing standards for single-case designs.

    Science.gov (United States)

    Chen, Li-Ting; Peng, Chao-Ying Joanne; Chen, Ming-E

    2015-11-01

    In the single-case design (SCD) literature, five sets of standards have been formulated and distinguished: design standards, assessment standards, analysis standards, reporting standards, and research synthesis standards. This article reviews computing tools that can assist researchers and practitioners in meeting the analysis standards recommended by the What Works Clearinghouse: Procedures and Standards Handbook-the WWC standards. These tools consist of specialized web-based calculators or downloadable software for SCD data, and algorithms or programs written in Excel, SAS procedures, SPSS commands/Macros, or the R programming language. We aligned these tools with the WWC standards and evaluated them for accuracy and treatment of missing data, using two published data sets. All tools were tested to be accurate. When missing data were present, most tools either gave an error message or conducted analysis based on the available data. Only one program used a single imputation method. This article concludes with suggestions for an inclusive computing tool or environment, additional research on the treatment of missing data, and reasonable and flexible interpretations of the WWC standards. © The Author(s) 2015.

  16. Differences in Approach between Nuclear and Conventional Seismic Standards with regard to Hazard Definition - CSNI Integrity And Ageing Working Group

    International Nuclear Information System (INIS)

    Djaoudi, Ali; Labbe, Pierre; Murphy, Andrew; Kitada, Yoshio

    2008-01-01

    The Committee on the safety of Nuclear Installations (CSNI) of the OECD-NEA co-ordinates the NEA activities related to maintaining and advancing the scientific and technological knowledge base of the safety of nuclear installations. The Integrity and Ageing of Components and Structures Working Group of the CSNI is responsible for work related to the development and use of methods, data and information to assess the behaviour of materials and structures. It has three sub-groups, dealing with the integrity of metal components and structures, ageing of concrete structures, and the seismic behaviour of structures. The CSNI, at its meeting in June 2003, agreed to initiate an activity aimed to identify any difference between nuclear and non-nuclear conventional standards and their potential significance with regard to seismic hazards and design methods. There was a perception, mainly in some of the European countries that nuclear seismic hazard and design standards may be lagging behind developments in similar standards for conventional facilities. Adequate answer to such perception, need the examination of the following aspects and their significance on the seismic assessment of structures and components: - The safety philosophy behind the seismic nuclear and conventional standards. - The differences in approach regarding the seismic hazard definition. - The difference in approach regarding the design and the methods of analysis. These topics are examined in this report. Appendices A to H of this report contain a brief description of the conventional and the nuclear approaches in the NEA member countries: Belgium, Canada, Czech Republic, Germany, Japan, South Korea, Spain,and USA. The following general conclusions can be drawn: - The approach adopted by the nuclear seismic standards is more conservative and more reliable (in particular for meeting the continued operation criteria) than the recommended by the currently applicable force based conventional seismic codes

  17. Standardization and Green Economic Change - the Case of Energy Efficiency in Buildings

    DEFF Research Database (Denmark)

    Andersen, Maj Munch; Faria, Lourenco

    2015-01-01

    This paper investigates the role of standardization for green economic change using energy efficiency in buildings as a case. Innovation research on standards tends to focus on the competition between competing emerging standards as well as the economic impacts of these. The idea pursued here...... energy efficiency becomes an issue in standardization work using buildings as a case. The paper seeks more specifically to investigate the rise of building related standards generally over time as well as in different technical areas and geographic regions. The hypothesis pursued in this paper...... is that the rise of the green economy can only take place accompanied by considerable institution formation in the form of standards. In this sense, the presence of standards may be seen as an important indicator on the maturity of the greening of the economy. The paper presents early empirical work...

  18. Clinical Criteria Versus a Possible Research Case Definition in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

    Science.gov (United States)

    Jason, Leonard A; McManimen, Stephanie; Sunnquist, Madison; Newton, Julia L; Strand, Elin Bolle

    2017-01-01

    The Institute of Medicine (IOM) recently developed clinical criteria for what had been known as chronic fatigue syndrome (CFS). Given the broad nature of the clinical IOM criteria, there is a need for a research definition that would select a more homogenous and impaired group of patients than the IOM clinical criteria. At the present time, it is unclear what will serve as the research definition. The current study focused on a research definition which selected homebound individuals who met the four IOM criteria, excluding medical and psychiatric co-morbidities. Our research criteria were compared to those participants meeting the IOM criteria. Those not meeting either of these criteria sets were placed in a separate group defined by 6 or more months of fatigue. Data analyzed were from the DePaul Symptom Questionnaire and the SF-36. Due to unequal sample sizes and variances, Welch's F tests and Games-Howell post hoc tests were conducted. Using a large database of over 1,000 patients from several countries, we found that those meeting a more restrictive research definition were even more impaired and more symptomatic than those meeting criteria for the other two groups. Deciding on a particular research case definition would allow researchers to select more comparable patient samples across settings, and this would represent one of the most significant methodologic advances for this field of study.

  19. Of Atkins and men: deviations from clinical definitions of mental retardation in death penalty cases.

    Science.gov (United States)

    Blume, John H; Johnson, Sheri Lynn; Seeds, Christopher

    2009-01-01

    Under Atkins v. Virginia, the Eighth Amendment exempts from execution individuals who meet the clinical definitions of mental retardation set forth by the American Association on Intellectual and Developmental Disabilities and the American Psychiatric Association. Both define mental retardation as significantly subaverage intellectual functioning accompanied by significant limitations in adaptive functioning, originating before the age of 18. Since Atkins, most jurisdictions have adopted definitions of mental retardation that conform to those definitions. But some states, looking often to stereotypes of persons with mental retardation, apply exclusion criteria that deviate from and are more restrictive than the accepted scientific and clinical definitions. These state deviations have the effect of excluding from Atkins's reach some individuals who plainly fall within the class it protects. This article focuses on the cases of Roger Cherry, Jeffrey Williams, Michael Stallings, and others, who represent an ever-growing number of individuals inappropriately excluded from Atkins. Left unaddressed, the state deviations discussed herein permit what Atkins does not: the death-sentencing and execution of some capital defendants who have mental retardation.

  20. DOE technical standards list: Department of Energy standards index

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    This technical standards list (TSL) was prepared for use by personnel involved in the selection and use of US DOE technical standards and other government and non-government standards. This TSL provides listings of current DOE technical standards, non-government standards that have been adopted by DOE, other government documents in which DOE has a recorded interest, and cancelled DOE technical standards. Standards are indexed by type in the appendices to this document. Definitions of and general guidance for the use of standards are also provided.

  1. 16 CFR 1031.10 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION PARTICIPATION AND COMMISSION EMPLOYEE INVOLVEMENT IN VOLUNTARY STANDARDS ACTIVITIES Employee Involvement § 1031.10 Definitions. For... employees may be authorized, the following definitions apply: (a) Membership. Membership is the status of an...

  2. Nuclear technology terms and definitions. Radiation protection. Draft. Kerntechnik. Begriffe. Strahlenschutz. Entwurf

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The terms and definitions in this standard are part of the catalogue of definitions 'Nuclear technology, terms and definitions', in eight parts; they are the latest version of the standards and draft standards of DIN 25 401, part 10 to 19, published at irregular intervals until now. (orig.).

  3. Systematic review of validated case definitions for diabetes in ICD-9-coded and ICD-10-coded data in adult populations.

    Science.gov (United States)

    Khokhar, Bushra; Jette, Nathalie; Metcalfe, Amy; Cunningham, Ceara Tess; Quan, Hude; Kaplan, Gilaad G; Butalia, Sonia; Rabi, Doreen

    2016-08-05

    With steady increases in 'big data' and data analytics over the past two decades, administrative health databases have become more accessible and are now used regularly for diabetes surveillance. The objective of this study is to systematically review validated International Classification of Diseases (ICD)-based case definitions for diabetes in the adult population. Electronic databases, MEDLINE and Embase, were searched for validation studies where an administrative case definition (using ICD codes) for diabetes in adults was validated against a reference and statistical measures of the performance reported. The search yielded 2895 abstracts, and of the 193 potentially relevant studies, 16 met criteria. Diabetes definition for adults varied by data source, including physician claims (sensitivity ranged from 26.9% to 97%, specificity ranged from 94.3% to 99.4%, positive predictive value (PPV) ranged from 71.4% to 96.2%, negative predictive value (NPV) ranged from 95% to 99.6% and κ ranged from 0.8 to 0.9), hospital discharge data (sensitivity ranged from 59.1% to 92.6%, specificity ranged from 95.5% to 99%, PPV ranged from 62.5% to 96%, NPV ranged from 90.8% to 99% and κ ranged from 0.6 to 0.9) and a combination of both (sensitivity ranged from 57% to 95.6%, specificity ranged from 88% to 98.5%, PPV ranged from 54% to 80%, NPV ranged from 98% to 99.6% and κ ranged from 0.7 to 0.8). Overall, administrative health databases are useful for undertaking diabetes surveillance, but an awareness of the variation in performance being affected by case definition is essential. The performance characteristics of these case definitions depend on the variations in the definition of primary diagnosis in ICD-coded discharge data and/or the methodology adopted by the healthcare facility to extract information from patient records. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. 48 CFR 30.001 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Definitions. 30.001 Section 30.001 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION 30.001 Definitions. As used in this part— Affected CAS...

  5. Research misconduct definitions adopted by U.S. research institutions.

    Science.gov (United States)

    Resnik, David B; Neal, Talicia; Raymond, Austin; Kissling, Grace E

    2015-01-01

    In 2000, the U.S. federal government adopted a uniform definition of research misconduct as fabrication, falsification, or plagiarism (FFP), which became effective in 2001. Institutions must apply this definition of misconduct to federally-funded research to receive funding. While institutions are free to adopt definitions of misconduct that go beyond the federal standard, it is not known how many do. We analyzed misconduct policies from 183 U.S. research institutions and coded them according to thirteen different types of behavior mentioned in the misconduct definition. We also obtained data on the institution's total research funding and public vs. private status, and the year it adopted the definition. We found that more than half (59%) of the institutions in our sample had misconduct policies that went beyond the federal standard. Other than FFP, the most common behaviors included in definitions were "other serious deviations" (45.4%), "significant or material violations of regulations" (23.0%), "misuse of confidential information" (15.8%), "misconduct related to misconduct" (14.8%), "unethical authorship other than plagiarism" (14.2%), "other deception involving data manipulation" (13.1%), and "misappropriation of property/theft" (10.4%). Significantly more definitions adopted in 2001 or later went beyond the federal standard than those adopted before 2001 (73.2% vs. 26.8%), and significantly more definitions adopted by institutions in the lower quartile of total research funding went beyond the federal standard than those adopted by institutions in the upper quartiles. Public vs. private status was not significantly associated with going beyond the federal standard.

  6. Engineering Definitional Interpreters

    DEFF Research Database (Denmark)

    Midtgaard, Jan; Ramsay, Norman; Larsen, Bradford

    2013-01-01

    A definitional interpreter should be clear and easy to write, but it may run 4--10 times slower than a well-crafted bytecode interpreter. In a case study focused on implementation choices, we explore ways of making definitional interpreters faster without expending much programming effort. We imp...

  7. 7 CFR 51.2339 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946... Standards for Grades of Kiwifruit § 51.2339 Definitions. Similar varietal characteristics means the fruit in...

  8. Empirical Derivation and Validation of a Clinical Case Definition for Neuropsychological Impairment in Children and Adolescents.

    Science.gov (United States)

    Beauchamp, Miriam H; Brooks, Brian L; Barrowman, Nick; Aglipay, Mary; Keightley, Michelle; Anderson, Peter; Yeates, Keith O; Osmond, Martin H; Zemek, Roger

    2015-09-01

    Neuropsychological assessment aims to identify individual performance profiles in multiple domains of cognitive functioning; however, substantial variation exists in how deficits are defined and what cutoffs are used, and there is no universally accepted definition of neuropsychological impairment. The aim of this study was to derive and validate a clinical case definition rule to identify neuropsychological impairment in children and adolescents. An existing normative pediatric sample was used to calculate base rates of abnormal functioning on eight measures covering six domains of neuropsychological functioning. The dataset was analyzed by varying the range of cutoff levels [1, 1.5, and 2 standard deviations (SDs) below the mean] and number of indicators of impairment. The derived rule was evaluated by bootstrap, internal and external clinical validation (orthopedic and traumatic brain injury). Our neuropsychological impairment (NPI) rule was defined as "two or more test scores that fall 1.5 SDs below the mean." The rule identifies 5.1% of the total sample as impaired in the assessment battery and consistently targets between 3 and 7% of the population as impaired even when age, domains, and number of tests are varied. The NPI rate increases in groups known to exhibit cognitive deficits. The NPI rule provides a psychometrically derived method for interpreting performance across multiple tests and may be used in children 6-18 years. The rule may be useful to clinicians and scientists who wish to establish whether specific individuals or clinical populations present within expected norms versus impaired function across a battery of neuropsychological tests.

  9. Definition and specification for PACS. A checklist based on the standard ''IEEE Recommended Practice for Software Requirements Specifications''

    International Nuclear Information System (INIS)

    Koenig, H.; Klose, K.J.

    1999-01-01

    Problem: The formulation of requirements is necessary to control the goals of a PACS project. Furthermore, in this way, the scope of functionality necessary to support radiological working processes becomes clear. Method: Definitions of requirements and specification are formulated independently of systems according to the IEEE standard 'Recommended Practice for Software Requirements Specifications'. Definitions are given in the Request for Information, specifications in the Request for Proposal. Functional and non-functional requirements are distinguished. The solutions are rated with respect to scope, appropriateness and quality of implementation. Results: A PACS checklist was created according to the methods described above. It is published on the homepage of the 'Arbeitsgemeinschaft Informationstechnologie' (AGIT) within the 'Deutsche Roentgengesellschaft' (DRG) (http://www.uni-marburg.de/mzr.agit). Conclusion: The checklist provides a discussion forum which should contribute to an agreement on accepted basic PACS functionalities. (orig.) [de

  10. Exploring Stakeholder Definitions within the Aerospace Industry: A Qualitative Case Study

    Science.gov (United States)

    Hebert, Jonathan R.

    A best practice in the discipline of project management is to identify all key project stakeholders prior to the execution of a project. When stakeholders are properly identified, they can be consulted to provide expert advice on project activities so that the project manager can ensure the project stays within the budget and schedule constraints. The problem addressed by this study is that managers fail to properly identify key project stakeholders when using stakeholder theory because there are multiple conflicting definitions for the term stakeholder. Poor stakeholder identification has been linked to multiple negative project outcomes such as budget and schedules overruns, and this problem is heightened in certain industries such as aerospace. The purpose of this qualitative study was to explore project managers' and project stakeholders' perceptions of how they define and use the term stakeholder within the aerospace industry. This qualitative exploratory single-case study had two embedded units of analysis: project managers and project stakeholders. Six aerospace project managers and five aerospace project stakeholders were purposively selected for this study. Data were collected through individual semi-structured interviews with both project managers and project stakeholders. All data were analyzed using Yin's (2011) five-phased cycle approach for qualitative research. The results indicated that the aerospace project managers and project stakeholder define the term stakeholder as "those who do the work of a company." The participants build upon this well-known concept by adding that, "a company should list specific job titles" that correspond to their company specific-stakeholder definition. Results also indicated that the definition of the term stakeholder is used when management is assigning human resources to a project to mitigate or control project risk. Results showed that project managers tended to include the customer in their stakeholder definitions

  11. Standard software for CAMAC

    International Nuclear Information System (INIS)

    Lenkszus, F.R.

    1978-01-01

    The NIM Committee (National Instrumentation Methods Committee) of the U.S. Department of Energy and the ESONE Committee of European Laboratories have jointly specified standard software for use with CAMAC. Three general approaches were followed: the definition of a language called IML for use in CAMAC systems, the definition of a standard set of subroutine calls, and real-time extensions to the BASIC language. This paper summarizes the results of these efforts. 1 table

  12. 48 CFR 430.070 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Definitions. 430.070 Section 430.070 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION 430.070 Definitions. ACO, as used in this part and in FAR...

  13. Definition of Success after Surgery for Female Stress Incontinence or Voiding Dysfunction: An Attempt at Standardization.

    Science.gov (United States)

    Carmel, Maude E; Deng, Donna Y; Greenwell, Tamsin J; Zimmern, Philippe E

    2016-08-01

    There is currently no standardized definition of success for surgery for stress urinary incontinence (SUI) and voiding dysfunction (VD) in women. To review the use of outcome measures (OMs) and definitions of success in the literature on SUI and VD surgery in women in an attempt to provide recommendations for future publications. A PubMed search of all English language full-text articles on SUI and VD surgery in women published between 2010 and 2015 was performed. A list of randomized trials and prospective and retrospective studies was obtained. Specific objective and subjective OMs used to define success were reviewed. Some 95 articles met the inclusion criteria for SUI surgery outcomes. Most trials reported outcomes at 12 mo after surgery. The majority (n=48) reported their primary outcomes using both objective and subjective success measures, 24 defined success using subjective OMs alone, and 23 using objective OMs alone. The OMs most frequently used for objective success were a negative cough stress test (CST), a negative pad test, and the absence of retreatment for SUI. The definition of subjective success most often involved questionnaires. The questionnaires most frequently used were Patient Global Impression of Improvement (PGI-I), Urinary Distress Inventory (UDI)/UDI-6, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Medical Epidemiologic and Social Aspects of Aging (MESA). Only 11 studies on OMs used for VD surgery were published between 2010 and 2015. The two most common criteria used for success were measurement of postvoid residual urine (PVR) and subjective resolution of VD symptoms. There is great heterogeneity in the definition of success used after surgery for SUI or VD in women. For SUI surgery, we recommend use of the CST and a 1-h pad test for the definition of objective success, and of the UDI/UDI-6, Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ), ICIQ-SF, or PGI-I questionnaire for

  14. A definition of maximal CP-violation

    International Nuclear Information System (INIS)

    Roos, M.

    1985-01-01

    The unitary matrix of quark flavour mixing is parametrized in a general way, permitting a mathematically natural definition of maximal CP violation. Present data turn out to violate this definition by 2-3 standard deviations. (orig.)

  15. 12 CFR 930.1 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... contract means a derivative contract that transfers credit risk. Credit risk means the risk that the market... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this...

  16. Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data.

    Science.gov (United States)

    Parks, Sharyn E; Kegler, Scott R; Annest, Joseph L; Mercy, James A

    2012-06-01

    In March of 2008, an expert panel was convened at the Centers for Disease Control and Prevention to develop code-based case definitions for abusive head trauma (AHT) in children under 5 years of age based on the International Classification of Diseases, 10th Revision (ICD-10) nature and cause of injury codes. This study presents the operational case definition and applies it to US death data. National Center for Health Statistics National Vital Statistics System data on multiple cause-of-death from 2003 to 2007 were examined. Inspection of records with at least one ICD-10 injury/disease code and at least one ICD-10 cause code from the AHT case definition resulted in the identification of 780 fatal AHT cases, with 699 classified as definite/presumptive AHT and 81 classified as probable AHT. The fatal AHT rate was highest among children age definition can help to identify population subgroups at higher risk for AHT defined by year and month of death, age, sex and race/ethnicity. This type of definition may be useful for various epidemiological applications including research and surveillance. These activities can in turn inform further development of prevention activities, including educating parents about the dangers of shaking and strategies for managing infant crying.

  17. [Based on the incidence of Creutzfeldt-Jakob disease in the Lanzarote healthcare area. Description of two definitive cases].

    Science.gov (United States)

    Hernández-Ramos, F J; Martínez Martín, M; Esteban Robayna, M; Jensen Toll, F; Palacios Llopis, S

    2005-01-01

    We present two cases who have been diagnosed of definitive Creutzfeldt-Jakob disease in the health area of Lanzarote in the period January 2002 to January 2004. The two cases are presented with clinical description, complementary tests -- including electroencephalogram, 14-3-3 protein determination -- study of the prionic protein gene, and histopathologic findings. In this article, we try to show the importance of trying to reach a definitive diagnosis with the histopathologic study once there is clinical suspicion (a diagnosis that is probable or possible). In addition our cases show that communication between the clinical and the epidemiological coordinator of the regional community and the National Center of Epidemiology is very important. We refer to the clear growth in the incidence of the disease in the population of Lanzarote in the period above mentioned. Finally, we discuss whether this growth is or is not an isolated event.

  18. Standard Establishment Through Scenarios (SETS): A new technique for occupational fitness standards.

    Science.gov (United States)

    Blacklock, R E; Reilly, T J; Spivock, M; Newton, P S; Olinek, S M

    2015-01-01

    An objective and scientific task analysis provides the basis for establishing legally defensible Physical Employment Standards (PES), based on common and essential occupational tasks. Infrequent performance of these tasks creates challenges when developing PES based on criterion, or content validity. Develop a systematic approach using Subject Matter Experts (SME) to provide tasks with 1) an occupationally relevant scenario considered common to all personnel; 2) a minimum performance standard defined by time, distance, load or work. Examples provided here relate to the development of a new PES for the Canadian Armed Forces (CAF). SME of various experience are selected based on their eligibility criteria. SME are required to define a reasonable scenario for each task from personal experience, provide occupational performance requirements of the scenario in sub-groups, and discuss and agree by consensus vote on the final standard based on the definition of essential. A common and essential task for the CAF is detailed as a case example of process application. Techniques to avoid common SME rating errors are discussed and advantages to the method described. The SETS method was developed as a systematic approach to setting occupational performance standards and qualifying information from SME.

  19. 7 CFR 810.1801 - Definition of sunflower seed.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of sunflower seed. 810.1801 Section 810... STATES STANDARDS FOR GRAIN United States Standards for Sunflower Seed Terms Defined § 810.1801 Definition of sunflower seed. Grain that, before the removal of foreign material, consists of 50.0 percent or...

  20. Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group.

    Science.gov (United States)

    Holtfreter, Birte; Albandar, Jasim M; Dietrich, Thomas; Dye, Bruce A; Eaton, Kenneth A; Eke, Paul I; Papapanou, Panos N; Kocher, Thomas

    2015-05-01

    Periodontal diseases are common and their prevalence varies in different populations. However, prevalence estimates are influenced by the methodology used, including measurement techniques, case definitions, and periodontal examination protocols, as well as differences in oral health status. As a consequence, comparisons between populations are severely hampered and inferences regarding the global variation in prevalence can hardly be drawn. To overcome these limitations, the authors suggest standardized principles for the reporting of the prevalence and severity of periodontal diseases in future epidemiological studies. These principles include the comprehensive reporting of the study design, the recording protocol, and specific subject-related and oral data. Further, a range of periodontal data should be reported in the total population and within specific age groups. Periodontal data include the prevalence and extent of clinical attachment loss (CAL) and probing depth (PD) on site and tooth level according to specific thresholds, mean CAL/PD, the CDC/AAP case definition, and bleeding on probing. Consistent implementation of these standards in future studies will ensure improved reporting quality, permit meaningful comparisons of the prevalence of periodontal diseases across populations, and provide better insights into the determinants of such variation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. 40 CFR 191.02 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... TRANSURANIC RADIOACTIVE WASTES Environmental Standards for Management and Storage § 191.02 Definitions. Unless... process associated with the management and storage of spent nuclear fuel or radioactive waste is conducted... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Definitions. 191.02 Section 191.02...

  2. 29 CFR 1450.20 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... Federal Claims Collection Standards jointly published by the Justice Department and the General Accounting... 29 Labor 4 2010-07-01 2010-07-01 false Definitions. 1450.20 Section 1450.20 Labor Regulations... UNITED STATES Salary Offset § 1450.20 Definitions. For purposes of this subpart— Agency means the Federal...

  3. 5 CFR 179.302 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Definitions. 179.302 Section 179.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.302 Definitions. Administrative offset, as defined in 31 U.S.C. 3701(a)(1), means...

  4. Emergency cesarean section and the 30-minute rule: definitions.

    Science.gov (United States)

    Schauberger, Charles W; Chauhan, Suneet P

    2009-03-01

    We explored the role that lack of a standard definition and heterogeneity in patient selection criteria in the literature might have on the apparent inability to routinely begin an emergency cesarean section in less than 30 minutes. A review of the literature on emergency cesarean delivery was performed. Although there are some similarities in definitions and the criteria used for patient selection in multiple studies, the variability in the definitions could be responsible for some of the apparent timeliness performance deficiency in the literature. A standard definition and directions for future research are suggested.

  5. 40 CFR 92.102 - Definitions and abbreviations.

    Science.gov (United States)

    2010-07-01

    ... the number of carbon atoms in a molecule of that compound. Precision means the standard deviation of... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Definitions and abbreviations. 92.102... Definitions and abbreviations. The definitions and abbreviations of subpart A of this part apply to this...

  6. 40 CFR 264.1031 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... used to separate a mixture of several volatile components of different boiling points in successive... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Definitions. 264.1031 Section 264.1031... Standards for Process Vents § 264.1031 Definitions. As used in this subpart, all terms not defined herein...

  7. Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases.

    Science.gov (United States)

    Suárez-García, Inés; Jarrín, Inmaculada; Iribarren, José Antonio; López-Cortés, Luis Fernando; Lacruz-Rodrigo, José; Masiá, Mar; Gómez-Sirvent, Juan Luis; Hernández-Quero, José; Vidal, Francesc; Alejos-Ferreras, Belén; Moreno, Santiago; Del Amo, Julia

    2013-05-01

    The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  8. Public health implications of using various case definitions in The Netherlands during the worldwide SARS outbreak.

    NARCIS (Netherlands)

    Timen, A.; Doornum, G.J.J. van; Schutten, M.; Conyn-van Spaendonck, M.A.; Meer, J.W.M. van der; Osterhaus, A.D.; Steenbergen, J.E. van

    2006-01-01

    This study analysed the consequences of deviation from the WHO case definition for the assessment of patients with suspected severe acute respiratory syndrome (SARS) in The Netherlands during 2003. Between 17 March and 7 July 2003, as a result of dilemmas in balancing sensitivity and specificity,

  9. 40 CFR 63.361 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... § 63.362 is required to be in compliance with the standard. Deviation means any instance in which an... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Definitions. 63.361 Section 63.361... EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Ethylene Oxide Emissions Standards...

  10. Estimating time-varying exposure-outcome associations using case-control data: logistic and case-cohort analyses.

    Science.gov (United States)

    Keogh, Ruth H; Mangtani, Punam; Rodrigues, Laura; Nguipdop Djomo, Patrick

    2016-01-05

    Traditional analyses of standard case-control studies using logistic regression do not allow estimation of time-varying associations between exposures and the outcome. We present two approaches which allow this. The motivation is a study of vaccine efficacy as a function of time since vaccination. Our first approach is to estimate time-varying exposure-outcome associations by fitting a series of logistic regressions within successive time periods, reusing controls across periods. Our second approach treats the case-control sample as a case-cohort study, with the controls forming the subcohort. In the case-cohort analysis, controls contribute information at all times they are at risk. Extensions allow left truncation, frequency matching and, using the case-cohort analysis, time-varying exposures. Simulations are used to investigate the methods. The simulation results show that both methods give correct estimates of time-varying effects of exposures using standard case-control data. Using the logistic approach there are efficiency gains by reusing controls over time and care should be taken over the definition of controls within time periods. However, using the case-cohort analysis there is no ambiguity over the definition of controls. The performance of the two analyses is very similar when controls are used most efficiently under the logistic approach. Using our methods, case-control studies can be used to estimate time-varying exposure-outcome associations where they may not previously have been considered. The case-cohort analysis has several advantages, including that it allows estimation of time-varying associations as a continuous function of time, while the logistic regression approach is restricted to assuming a step function form for the time-varying association.

  11. Clinical malaria case definition and malaria attributable fraction in the highlands of western Kenya.

    Science.gov (United States)

    Afrane, Yaw A; Zhou, Guofa; Githeko, Andrew K; Yan, Guiyun

    2014-10-15

    In African highland areas where endemicity of malaria varies greatly according to altitude and topography, parasitaemia accompanied by fever may not be sufficient to define an episode of clinical malaria in endemic areas. To evaluate the effectiveness of malaria interventions, age-specific case definitions of clinical malaria needs to be determined. Cases of clinical malaria through active case surveillance were quantified in a highland area in Kenya and defined clinical malaria for different age groups. A cohort of over 1,800 participants from all age groups was selected randomly from over 350 houses in 10 villages stratified by topography and followed for two-and-a-half years. Participants were visited every two weeks and screened for clinical malaria, defined as an individual with malaria-related symptoms (fever [axillary temperature≥37.5°C], chills, severe malaise, headache or vomiting) at the time of examination or 1-2 days prior to the examination in the presence of a Plasmodium falciparum positive blood smear. Individuals in the same cohort were screened for asymptomatic malaria infection during the low and high malaria transmission seasons. Parasite densities and temperature were used to define clinical malaria by age in the population. The proportion of fevers attributable to malaria was calculated using logistic regression models. Incidence of clinical malaria was highest in valley bottom population (5.0% cases per 1,000 population per year) compared to mid-hill (2.2% cases per 1,000 population per year) and up-hill (1.1% cases per 1,000 population per year) populations. The optimum cut-off parasite densities through the determination of the sensitivity and specificity showed that in children less than five years of age, 500 parasites per μl of blood could be used to define the malaria attributable fever cases for this age group. In children between the ages of 5-14, a parasite density of 1,000 parasites per μl of blood could be used to define the

  12. Biopharming, bananas and bureaucracy: the banana vaccine as a case study for products that straddle the definitional food/drug divide.

    Science.gov (United States)

    Birdsall, Margaux

    2011-01-01

    This paper examines the definition of the terms "food" and "drug" as used in the Food, Drug and Cosmetic Act through the lens of biopharmed products. The paper uses the so-called "banana vaccine" as a case study to highlight the problems that occur when attempting to regulate a product that could be safely used as a food or as a drug. Specifically, the examination of this model illustrates the problems in the current definitional scheme. The paper considers how a product that straddles the definitional line between food and drug could be regulated and proposes a reformation to how the definitions are applied to products to better suit new technology in food and drugs.

  13. Maternal mortality in rural South Africa: the impact of case definition on levels and trends

    Directory of Open Access Journals (Sweden)

    Garenne M

    2013-08-01

    Full Text Available Michel Garenne,1–3 Kathleen Kahn,1,4,5 Mark A Collinson,1,4,5 F Xavier Gómez-Olivé,1,5 Stephen Tollman1,4,51MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France; 3Institut de Recherche pour le Développement, UMI Résiliences, Centre Ile de France, Bondy, France; 4Centre for Global Health Research, Umeå University, Umeå, Sweden; 5INDEPTH Network, East Legon, Accra, GhanaBackground: Uncertainty in the levels of global maternal mortality reflects data deficiencies, as well as differences in methods and definitions. This study presents levels and trends in maternal mortality in Agincourt, a rural subdistrict of South Africa, under long-term health and sociodemographic surveillance.Methods: All deaths of women aged 15 years–49 years occurring in the study area between 1992 and 2010 were investigated, and causes of death were assessed by verbal autopsy. Two case definitions were used: “obstetrical” (direct causes, defined as deaths caused by conditions listed under O00-O95 in International Classification of Diseases-10; and “pregnancy-related deaths”, defined as any death occurring during the maternal risk period (pregnancy, delivery, 6 weeks postpartum, irrespective of cause.Results: The case definition had a major impact on levels and trends in maternal mortality. The obstetric mortality ratio averaged 185 per 100,000 live births over the period (60 deaths, whereas the pregnancy-related mortality ratio averaged 423 per 100,000 live births (137 deaths. Results from both calculations increased over the period, with a peak around 2006, followed by a decline coincident with the national roll-out of Prevention of Mother-to-Child Transmission of HIV and antiretroviral treatment programs. Mortality increase from direct causes was

  14. Encrusted cystitis after definitive radiotherapy for cervical cancer: a case report

    Directory of Open Access Journals (Sweden)

    Elisabetta Perrucci

    2016-10-01

    Full Text Available Purpose : Encrusted cystitis is a rare chronic inflammatory disease characterized by calcified plaques of the bladder, previously altered by varies conditions as urological procedures, caused by urea-splitting bacteria. Only one case has been reported on encrusted cystitis occurring after surgery and radiation therapy for a pelvic neoplasm. We report on encrusted cystitis occurred after definitive radiotherapy for bulky uterine cervix cancer, and examine the doses to the bladder wall and the procedure of radiation treatment performed as a possible cause of the onset of the disease. Case presentation : A 52-year-old female developed encrusted cystitis, caused by Corynebacterium spp., after 14 months from definitive chemo-radiotherapy and 2/D brachytherapy treatment for FIGO stage IB2 uterine cervix cancer. For pelvic radiotherapy, the mean bladder dose was 48.47 Gy (range 31.20–51.91; maximal bladder point doses at each brachytherapy insertions were 7.62 Gy, 4.94 Gy and 6.27 Gy at first, second, and third fraction, respectively. Total biological effective dose (BED at bladder point was 140.05 Gy3. The patient was administered antibiotic therapy with linezolid and urine acidification with vitamin C; dietary norms were also suggested. After therapy, complete remission of symptoms and radiological findings were achieved, and the planned surgery for removing the calcified plaques was not completed. After 5 years from the cervical cancer diagnosis, the patient was disease-free without urinary symptoms. Conclusions : The high doses administered to the bladder wall and the repeated catheterizations performed at each brachytherapy insertions may have favored the infection and promoted the occurrence of the encrusted cystitis.

  15. Positive predictive value of a case definition for diabetes mellitus using automated administrative health data in children and youth exposed to antipsychotic drugs or control medications: a Tennessee Medicaid study.

    Science.gov (United States)

    Bobo, William V; Cooper, William O; Stein, C Michael; Olfson, Mark; Mounsey, Jackie; Daugherty, James; Ray, Wayne A

    2012-08-24

    We developed and validated an automated database case definition for diabetes in children and youth to facilitate pharmacoepidemiologic investigations of medications and the risk of diabetes. The present study was part of an in-progress retrospective cohort study of antipsychotics and diabetes in Tennessee Medicaid enrollees aged 6-24 years. Diabetes was identified from diabetes-related medical care encounters: hospitalizations, outpatient visits, and filled prescriptions. The definition required either a primary inpatient diagnosis or at least two other encounters of different types, most commonly an outpatient diagnosis with a prescription. Type 1 diabetes was defined by insulin prescriptions with at most one oral hypoglycemic prescription; other cases were considered type 2 diabetes. The definition was validated for cohort members in the 15 county region geographically proximate to the investigators. Medical records were reviewed and adjudicated for cases that met the automated database definition as well as for a sample of persons with other diabetes-related medical care encounters. The study included 64 cases that met the automated database definition. Records were adjudicated for 46 (71.9%), of which 41 (89.1%) met clinical criteria for newly diagnosed diabetes. The positive predictive value for type 1 diabetes was 80.0%. For type 2 and unspecified diabetes combined, the positive predictive value was 83.9%. The estimated sensitivity of the definition, based on adjudication for a sample of 30 cases not meeting the automated database definition, was 64.8%. These results suggest that the automated database case definition for diabetes may be useful for pharmacoepidemiologic studies of medications and diabetes.

  16. Maintenance Research in SOA Towards a Standard Case Study

    NARCIS (Netherlands)

    Espinha, T.; Chen, C.; Zaidman, A.E.; Gross, H.G.

    2012-01-01

    Preprint of paper published in: 16th European Conference on Software Maintenance and Reengineering (CSMR), 27-30 March 2012; doi:10.1109/CSMR.2012.49 Maintenance research in the context of Service Oriented Architecture (SOA) is currently lacking a suitable standard case study that can be used by

  17. 29 CFR 575.2 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Definitions. 575.2 Section 575.2 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS WAIVER OF CHILD LABOR... § 575.2 Definitions. As used in this part: Act means the Fair Labor Standards Act of 1938, as amended...

  18. 40 CFR 406.21 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 406.21 Section 406.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Corn Dry Milling Subcategory § 406.21 Specialized definitions...

  19. 40 CFR 406.11 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 406.11 Section 406.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Corn Wet Milling Subcategory § 406.11 Specialized definitions...

  20. 40 CFR 406.51 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 406.51 Section 406.51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Normal Rice Milling Subcategory § 406.51 Specialized definitions...

  1. The Epidemiology of Transfusion-related Acute Lung Injury Varies According to the Applied Definition of Lung Injury Onset Time.

    Science.gov (United States)

    Vande Vusse, Lisa K; Caldwell, Ellen; Tran, Edward; Hogl, Laurie; Dinwiddie, Steven; López, José A; Maier, Ronald V; Watkins, Timothy R

    2015-09-01

    Research that applies an unreliable definition for transfusion-related acute lung injury (TRALI) may draw false conclusions about its risk factors and biology. The effectiveness of preventive strategies may decrease as a consequence. However, the reliability of the consensus TRALI definition is unknown. To prospectively study the effect of applying two plausible definitions of acute respiratory distress syndrome onset time on TRALI epidemiology. We studied 316 adults admitted to the intensive care unit and transfused red blood cells within 24 hours of blunt trauma. We identified patients with acute respiratory distress syndrome, and defined acute respiratory distress syndrome onset time two ways: (1) the time at which the first radiographic or oxygenation criterion was met, and (2) the time both criteria were met. We categorized two corresponding groups of TRALI cases transfused in the 6 hours before acute respiratory distress syndrome onset. We used Cohen's kappa to measure agreement between the TRALI cases and implicated blood components identified by the two acute respiratory distress syndrome onset time definitions. In a nested case-control study, we examined potential risk factors for each group of TRALI cases, including demographics, injury severity, and characteristics of blood components transfused in the 6 hours before acute respiratory distress syndrome onset. Forty-two of 113 patients with acute respiratory distress syndrome were TRALI cases per the first acute respiratory distress syndrome onset time definition and 63 per the second definition. There was slight agreement between the two groups of TRALI cases (κ = 0.16; 95% confidence interval, -0.01 to 0.33) and between the implicated blood components (κ = 0.15, 95% confidence interval, 0.11-0.20). Age, Injury Severity Score, high plasma-volume components, and transfused plasma volume were risk factors for TRALI when applying the second acute respiratory distress syndrome onset time definition

  2. 10 CFR 435.302 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... ENERGY ENERGY CONSERVATION ENERGY EFFICIENCY STANDARDS FOR NEW FEDERAL LOW-RISE RESIDENTIAL BUILDINGS Mandatory Energy Efficiency Standards for Federal Residential Buildings § 435.302 Definitions. (a) ANSI... energy consumption and energy costs of a residential building for a particular location, building type...

  3. 7 CFR 28.901 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing..., TESTING, AND STANDARDS Cotton Classification and Market News Service for Producers Definitions § 28.901.... 471-476), unless otherwise noted. (b) Service means the Agricultural Marketing Service of the United...

  4. Clinically significant cardiopulmonary events and the effect of definition standardization on apnea of prematurity management.

    Science.gov (United States)

    Powell, M B F; Ahlers-Schmidt, C R; Engel, M; Bloom, B T

    2017-01-01

    To define the impact of care standardization on caffeine and cardiorespiratory monitoring at neonatal intensive care unit (NICU) discharge. Electronic records were abstracted for infants aged 24-36 weeks gestation with birth weights appropriate for gestational age. Infants who died, transferred prior to discharge, had major pulmonary anomalies, required a home monitor for mechanical ventilation or had a family history of sudden infant death syndrome were excluded. Data and records were used to indicate when the new definition of clinically significant cardiopulmonary events (CSCPEs) and concurrent education was implemented. Preimplementation and postimplementation cohorts were compared. Incidence fell from 74% diagnosed with apnea of prematurity at baseline to 49% diagnosed with CSCPE postimplementation (Pdefinitions and treatments reduced the use of caffeine and cardiorespiratory monitors upon NICU dismissal.

  5. 29 CFR 1910.21 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 5 2010-07-01 2010-07-01 false Definitions. 1910.21 Section 1910.21 Labor Regulations... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Walking-Working Surfaces § 1910.21 Definitions. (a) As used in § 1910... ladder. A through ladder is one from which a man getting off at the top must step through the ladder in...

  6. The impact of alternative diagnoses on the utility of influenza-like illness case definition to detect the 2009 H1N1 pandemic.

    Science.gov (United States)

    Rumoro, Dino P; Bayram, Jamil D; Silva, Julio C; Shah, Shital C; Hallock, Marilyn M; Gibbs, Gillian S; Waddell, Michael J

    2012-01-01

    To investigate the impact of excluding cases with alternative diagnoses on the sensitivity and specificity of the Centers for Disease Control and Prevention's (CDC) influenza-like illness (ILI) case definition in detecting the 2009 H1N1 influenza, using Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification, a disease surveillance system. Retrospective cross-sectional study design. Emergency department of an urban tertiary care academic medical center. 1,233 ED cases, which were tested for respiratory viruses from September 5, 2009 to May 5, 2010. The main outcome measures were positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of the ILI case definition (both including and excluding alternative diagnoses) to detect H1N1. There was a significant decrease in sensitivity (chi2 = 9.09, p < 0.001) and significant improvement in specificity (chi2 = 179, p < 0.001), after excluding cases with alternative diagnoses. When early detection of an influenza epidemic is of prime importance, pursuing alternative diagnoses as part of CDC's ILI case definition may not be warranted for public health reporting due to the significant decrease in sensitivity, in addition to the resources required for detecting these alternative diagnoses.

  7. 48 CFR 1830.7002-1 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION Facilities Capital Employed for Facilities in Use and For Facilities Under Construction 1830.7002-1 Definitions. (a) Cost of money rate is... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Definitions. 1830.7002-1...

  8. Establishing the isolated Standard Model

    International Nuclear Information System (INIS)

    Wells, James D.; Zhang, Zhengkang; Zhao, Yue

    2017-02-01

    The goal of this article is to initiate a discussion on what it takes to claim ''there is no new physics at the weak scale,'' namely that the Standard Model (SM) is ''isolated.'' The lack of discovery of beyond the SM (BSM) physics suggests that this may be the case. But to truly establish this statement requires proving all ''connected'' BSM theories are false, which presents a significant challenge. We propose a general approach to quantitatively assess the current status and future prospects of establishing the isolated SM (ISM), which we give a reasonable definition of. We consider broad elements of BSM theories, and show many examples where current experimental results are not sufficient to verify the ISM. In some cases, there is a clear roadmap for the future experimental program, which we outline, while in other cases, further efforts - both theoretical and experimental - are needed in order to robustly claim the establishment of the ISM in the absence of new physics discoveries.

  9. 76 FR 63216 - Small Business Size Standards: Information

    Science.gov (United States)

    2011-10-12

    ... Federal small business assistance, SBA establishes small business definitions (referred to as size... business definition or size standard established by the SBA Administrator. The SBA considers as part of its... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG26 Small Business Size Standards...

  10. Darwin Core: An Evolving Community-Developed Biodiversity Data Standard

    Science.gov (United States)

    Wieczorek, John; Bloom, David; Guralnick, Robert; Blum, Stan; Döring, Markus; Giovanni, Renato; Robertson, Tim; Vieglais, David

    2012-01-01

    Biodiversity data derive from myriad sources stored in various formats on many distinct hardware and software platforms. An essential step towards understanding global patterns of biodiversity is to provide a standardized view of these heterogeneous data sources to improve interoperability. Fundamental to this advance are definitions of common terms. This paper describes the evolution and development of Darwin Core, a data standard for publishing and integrating biodiversity information. We focus on the categories of terms that define the standard, differences between simple and relational Darwin Core, how the standard has been implemented, and the community processes that are essential for maintenance and growth of the standard. We present case-study extensions of the Darwin Core into new research communities, including metagenomics and genetic resources. We close by showing how Darwin Core records are integrated to create new knowledge products documenting species distributions and changes due to environmental perturbations. PMID:22238640

  11. Positive predictive value of a case definition for diabetes mellitus using automated administrative health data in children and youth exposed to antipsychotic drugs or control medications: a Tennessee Medicaid study

    Directory of Open Access Journals (Sweden)

    Bobo William V

    2012-08-01

    Full Text Available Abstract Background We developed and validated an automated database case definition for diabetes in children and youth to facilitate pharmacoepidemiologic investigations of medications and the risk of diabetes. Methods The present study was part of an in-progress retrospective cohort study of antipsychotics and diabetes in Tennessee Medicaid enrollees aged 6–24 years. Diabetes was identified from diabetes-related medical care encounters: hospitalizations, outpatient visits, and filled prescriptions. The definition required either a primary inpatient diagnosis or at least two other encounters of different types, most commonly an outpatient diagnosis with a prescription. Type 1 diabetes was defined by insulin prescriptions with at most one oral hypoglycemic prescription; other cases were considered type 2 diabetes. The definition was validated for cohort members in the 15 county region geographically proximate to the investigators. Medical records were reviewed and adjudicated for cases that met the automated database definition as well as for a sample of persons with other diabetes-related medical care encounters. Results The study included 64 cases that met the automated database definition. Records were adjudicated for 46 (71.9%, of which 41 (89.1% met clinical criteria for newly diagnosed diabetes. The positive predictive value for type 1 diabetes was 80.0%. For type 2 and unspecified diabetes combined, the positive predictive value was 83.9%. The estimated sensitivity of the definition, based on adjudication for a sample of 30 cases not meeting the automated database definition, was 64.8%. Conclusion These results suggest that the automated database case definition for diabetes may be useful for pharmacoepidemiologic studies of medications and diabetes.

  12. Positive predictive value of a case definition for diabetes mellitus using automated administrative health data in children and youth exposed to antipsychotic drugs or control medications: a Tennessee Medicaid study

    Science.gov (United States)

    2012-01-01

    Background We developed and validated an automated database case definition for diabetes in children and youth to facilitate pharmacoepidemiologic investigations of medications and the risk of diabetes. Methods The present study was part of an in-progress retrospective cohort study of antipsychotics and diabetes in Tennessee Medicaid enrollees aged 6–24 years. Diabetes was identified from diabetes-related medical care encounters: hospitalizations, outpatient visits, and filled prescriptions. The definition required either a primary inpatient diagnosis or at least two other encounters of different types, most commonly an outpatient diagnosis with a prescription. Type 1 diabetes was defined by insulin prescriptions with at most one oral hypoglycemic prescription; other cases were considered type 2 diabetes. The definition was validated for cohort members in the 15 county region geographically proximate to the investigators. Medical records were reviewed and adjudicated for cases that met the automated database definition as well as for a sample of persons with other diabetes-related medical care encounters. Results The study included 64 cases that met the automated database definition. Records were adjudicated for 46 (71.9%), of which 41 (89.1%) met clinical criteria for newly diagnosed diabetes. The positive predictive value for type 1 diabetes was 80.0%. For type 2 and unspecified diabetes combined, the positive predictive value was 83.9%. The estimated sensitivity of the definition, based on adjudication for a sample of 30 cases not meeting the automated database definition, was 64.8%. Conclusion These results suggest that the automated database case definition for diabetes may be useful for pharmacoepidemiologic studies of medications and diabetes. PMID:22920280

  13. Estimating time-varying exposure-outcome associations using case-control data: logistic and case-cohort analyses

    Directory of Open Access Journals (Sweden)

    Ruth H. Keogh

    2016-01-01

    Full Text Available Abstract Background Traditional analyses of standard case-control studies using logistic regression do not allow estimation of time-varying associations between exposures and the outcome. We present two approaches which allow this. The motivation is a study of vaccine efficacy as a function of time since vaccination. Methods Our first approach is to estimate time-varying exposure-outcome associations by fitting a series of logistic regressions within successive time periods, reusing controls across periods. Our second approach treats the case-control sample as a case-cohort study, with the controls forming the subcohort. In the case-cohort analysis, controls contribute information at all times they are at risk. Extensions allow left truncation, frequency matching and, using the case-cohort analysis, time-varying exposures. Simulations are used to investigate the methods. Results The simulation results show that both methods give correct estimates of time-varying effects of exposures using standard case-control data. Using the logistic approach there are efficiency gains by reusing controls over time and care should be taken over the definition of controls within time periods. However, using the case-cohort analysis there is no ambiguity over the definition of controls. The performance of the two analyses is very similar when controls are used most efficiently under the logistic approach. Conclusions Using our methods, case-control studies can be used to estimate time-varying exposure-outcome associations where they may not previously have been considered. The case-cohort analysis has several advantages, including that it allows estimation of time-varying associations as a continuous function of time, while the logistic regression approach is restricted to assuming a step function form for the time-varying association.

  14. Environmental radiation standards

    International Nuclear Information System (INIS)

    Kocher, D.C.

    1987-01-01

    This document contains an outline of an oral presentation on environmental radiation standards presented to the American Nuclear Societies' Topical Conference on Population Exposure from the Nuclear Fuel Cycle. The paper contains several definitions, a summary of current radiation exposure limits; and numerous proposed changes to current standards. 7 figs

  15. 16 CFR 1203.4 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.4 Definitions. (a) Basic plane means an anatomical plane... bottom edges of the eye sockets). The ISO headforms are marked with a plane corresponding to this basic...

  16. Extended definitions of wake fields and their influence on beam dynamics

    Directory of Open Access Journals (Sweden)

    V. Danilov

    2000-01-01

    Full Text Available Based on experience gained from present machines, a new generation of accelerators with high intensities and low losses is being designed. For example, the design for the Spallation Neutron Source storage ring specifies fractional beam losses of the order of 10^{-4}, so that even small instabilities or resonances can lead to the violation of this number. The purpose of this paper is to show that there exist potentially important beam fields, missing from standard analyses, that can lead either to instabilities or to large deviations of instability thresholds from their conventional values. Some of these fields and related effects, e.g., “fast damping,” were discovered earlier and are presented here in more standard form as an extension of the wake field's definition. In addition, nonrelativistic collective phenomena are analyzed. It is shown that the nonrelativistic case could be significantly different from the relativistic case.

  17. 78 FR 45096 - Standards for Business Practices and Communication Protocols for Public Utilities

    Science.gov (United States)

    2013-07-26

    ... Related to Terms, Definition and 24 Acronyms 6. Commission Proposal 24 D. Implementation 24 III. Notice of... between the two markets \\5\\ and re-organized and revised definitions to create a standard set of terms, definitions and acronyms applicable to all NAESB WEQ standards.\\6\\ NAESB states that the Version 003 Standards...

  18. Vertically Differentiating Environmental Standards: The Case of the Marine Stewardship Council

    Directory of Open Access Journals (Sweden)

    Simon R. Bush

    2015-02-01

    Full Text Available This paper explores the externally-led vertical differentiation of third-party certification standards using the case of the Marine Stewardship Council (MSC. We analyze this process in two dimensions. First, fisheries employ strategies to capture further market value from fishing practices that go beyond their initial conditions for certification and seek additional recognition for these activities through co-labelling with, amongst others, international NGOs. Second, fisheries not yet able to meet the requirements of MSC standards are being enrolled in NGO and private sector sponsored Fisheries Improvement Projects (FIPs, providing an alternative route to global markets. In both cases the credibility and authority of the MSC is challenged by new coalitions of market actors opening up new strategies for capturing market value and/or improving the conditions of international market access. Through the lens of global value chains, the results offer new insights on how such standards not only influence trade and markets, but are also starting to change their internal governance in response to threats to their credibility by actors and modes of coordination in global value chains.

  19. Some practical applications of fundamental standards in radiation protection

    International Nuclear Information System (INIS)

    Duhamel, Francis; Lavie, Jean-Marie

    1964-05-01

    After some general considerations on the recommendations made by the International Commission on Radiological Protection (ICRP) regarding standards of internal or external exposure of organs or tissues to different types of radiations, and a recall of the main problems raised by acute radio-exposures (dose assessment in case of accident, assessment of the dose due to an emergency intervention in case of accident, classification of radio-elements), this report describes how ICRP recommendations have been implemented by the CEA, and tries to relate the problem of acute radio-exposures to the problem of chronic radio-exposures. This study is limited to the case of workers and to internal contamination by inhalation, but can be easily extended to other groups or other contamination types. The authors thus recall some fundamental data and definitions regarding values recommended by the ICRP for chronic radio-exposure and for acute exposure (acceptable exposure, accidental exposure, concerted exposure, units), present and comment how standards are practically applied for dose calculation and assessment. Formulas allow a quick assessment of radiological consequences of an acute radio-exposure, or vice-versa [fr

  20. 4 CFR 21.0 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... at GAO. (g) Alternative dispute resolution encompasses various means of resolving cases expeditiously... 4 Accounts 1 2010-01-01 2010-01-01 false Definitions. 21.0 Section 21.0 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES BID PROTEST REGULATIONS § 21.0 Definitions. (a)(1) Interested party...

  1. 29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

    Science.gov (United States)

    2010-07-01

    ... surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation—(1) How do I classify medical removal cases on the OSHA 300 Log? You must enter each medical removal case on the OSHA 300 Log as either a case involving days away from work or a case involving restricted...

  2. A case of standardization?

    DEFF Research Database (Denmark)

    Rod, Morten Hulvej; Høybye, Mette Terp

    2016-01-01

    the ones envisioned by the makers of standards. In 2012, the Danish National Health Authorities introduced a set of health promotion guidelines that were meant to guide the decision making and priority setting of Denmark's 98 local governments. The guidelines provided recommendations for health promotion...... and standardization. It remains an open question whether or not the guidelines lead to more standardized policies and interventions, but we suggest that the guidelines promote a risk factor-oriented approach as the dominant frame for knowledge, reasoning, decision making and priority setting in health promotion. We...

  3. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review

    Directory of Open Access Journals (Sweden)

    Schwenk Michael

    2012-04-01

    Full Text Available Abstract Background The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs on fall prevention. Methods An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls". Results The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes. Conclusions No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

  4. Updating OSHA standards based on national consensus standards. Direct final rule.

    Science.gov (United States)

    2007-12-14

    In this direct final rule, the Agency is removing several references to consensus standards that have requirements that duplicate, or are comparable to, other OSHA rules; this action includes correcting a paragraph citation in one of these OSHA rules. The Agency also is removing a reference to American Welding Society standard A3.0-1969 ("Terms and Definitions") in its general-industry welding standards. This rulemaking is a continuation of OSHA's ongoing effort to update references to consensus and industry standards used throughout its rules.

  5. Developing syndrome definitions based on consensus and current use

    Science.gov (United States)

    Dowling, John N; Baer, Atar; Buckeridge, David L; Cochrane, Dennis; Conway, Michael A; Elkin, Peter; Espino, Jeremy; Gunn, Julia E; Hales, Craig M; Hutwagner, Lori; Keller, Mikaela; Larson, Catherine; Noe, Rebecca; Okhmatovskaia, Anya; Olson, Karen; Paladini, Marc; Scholer, Matthew; Sniegoski, Carol; Thompson, David; Lober, Bill

    2010-01-01

    Objective Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. Design Clinical condition–syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. Results Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. Limitations The consensus definitions have not yet been validated through implementation. Conclusion The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions. PMID:20819870

  6. A modern definition of mediastinal compartments.

    Science.gov (United States)

    Carter, Brett W; Tomiyama, Noriyuki; Bhora, Faiz Y; Rosado de Christenson, Melissa L; Nakajima, Jun; Boiselle, Phillip M; Detterbeck, Frank C; Marom, Edith M

    2014-09-01

    Division of the mediastinum into compartments is used to help narrow the differential diagnosis of newly detected mediastinal masses, to assist in planning biopsy and surgical procedures, and to facilitate communication among clinicians of multiple disciplines. Several traditional mediastinal division schemes exist based upon arbitrary landmarks on the lateral chest radiograph. We describe a modern, computed tomography-based mediastinal division scheme, which has been accepted by the International Thymic Malignancy Interest Group as a new standard. This clinical classification defines a prevascular (anterior), a visceral (middle), and a paravertebral (posterior) compartment, with anatomic boundaries defined clearly by computed tomography. It is our intention that this definition be used in the reporting of clinical cases and the design of prospective clinical trials.

  7. High-definition television evaluation for remote handling task performance

    International Nuclear Information System (INIS)

    Fujita, Y.; Omori, E.; Hayashi, S.; Draper, J.V.; Herndon, J.N.

    1986-01-01

    In a plant that employs remote handling techniques for equipment maintenance, operators perform maintenance tasks primarily by using the information from television systems. The efficiency of the television system has a significant impact on remote maintenance task performance. High-definition television (HDTV) transmits a video image with more than twice the number of horizontal scan lines as standard-resolution television (1125 for HDTV to 525 for standard-resolution NTSC television). The added scan lines dramatically improve the resolution of images on the HDTV monitors. This paper describes experiments designed to evaluate the impact of HDTV on the performance of typical remote tasks. The experiments described in this paper compared the performance of four operators using HDTV with their performance while using other television systems. The experiments included four television systems: (a) high-definition color television, (b) high-definition monochromatic television, (c) standard-resolution monochromatic television, and (d) standard-resolution stereoscopic monochromatic television

  8. A redesign of OGC Symbology Encoding standard for sharing cartography

    Directory of Open Access Journals (Sweden)

    Erwan Bocher

    2018-01-01

    Full Text Available Despite most Spatial Data Infrastructures offering service-based visualization of geospatial data, requirements are often at a very basic level leading to poor quality of maps. This is a general observation for any geospatial architecture as soon as open standards as those of the Open Geospatial Consortium (OGC are applied. To improve the situation, this paper does focus on improvements at the portrayal interoperability side by considering standardization aspects. We propose two major redesign recommendations. First to consolidate the cartographic theory at the core of the OGC Symbology Encoding standard. Secondly to build the standard in a modular way so as to be ready to be extended with upcoming future cartographic requirements. Thus, we start by defining portrayal interoperability by means of typical-use cases that frame the concept of sharing cartography. Then we bring to light the strengths and limits of the relevant open standards to consider in this context. Finally we propose a set of recommendations to overcome the limits so as to make these use cases a true reality. Even if the definition of a cartographic-oriented standard is not able to act as a complete cartographic design framework by itself, we argue that pushing forward the standardization work dedicated to cartography is a way to share and disseminate good practices and finally to improve the quality of the visualizations.

  9. Establishing the isolated Standard Model

    Energy Technology Data Exchange (ETDEWEB)

    Wells, James D.; Zhang, Zhengkang [Michigan Univ., Ann Arbor, MI (United States). Michigan Center for Theoretical Physics; Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); Zhao, Yue [Michigan Univ., Ann Arbor, MI (United States). Michigan Center for Theoretical Physics

    2017-02-15

    The goal of this article is to initiate a discussion on what it takes to claim ''there is no new physics at the weak scale,'' namely that the Standard Model (SM) is ''isolated.'' The lack of discovery of beyond the SM (BSM) physics suggests that this may be the case. But to truly establish this statement requires proving all ''connected'' BSM theories are false, which presents a significant challenge. We propose a general approach to quantitatively assess the current status and future prospects of establishing the isolated SM (ISM), which we give a reasonable definition of. We consider broad elements of BSM theories, and show many examples where current experimental results are not sufficient to verify the ISM. In some cases, there is a clear roadmap for the future experimental program, which we outline, while in other cases, further efforts - both theoretical and experimental - are needed in order to robustly claim the establishment of the ISM in the absence of new physics discoveries.

  10. Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics.

    Science.gov (United States)

    Lusk, M Josephine; Garden, Frances L; Rawlinson, William D; Naing, Zin W; Cumming, Robert G; Konecny, Pam

    2016-05-01

    Studies examining cervicitis aetiology and prevalence lack comparability due to varying criteria for cervicitis. We aimed to outline cervicitis associations and suggest a best case definition. A cross-sectional study of 558 women at three sexually transmitted infection clinics in Sydney, Australia, 2006-2010, examined pathogen and behavioural associations of cervicitis using three cervicitis definitions: 'microscopy' (>30 pmnl/hpf (polymorphonuclear leucocytes per high-powered field on cervical Gram stain)), 'cervical discharge' (yellow and/or mucopurulent cervical discharge) or 'micro+cervical discharge' (combined 'microscopy' and 'cervical discharge'). Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV) and Neisseria gonorrhoeae (NG) had the strongest associations with cervicitis definitions 'micro+cervical discharge': CT adjusted prevalence ratio (APR)=2.13 (95% CI 1.38 to 3.30) p=0.0006, MG APR=2.21 (1.33 to 3.69) p=0.002, TV APR=2.37 (1.44 to 3.90) p=0.0007 NG PR=4.42 (3.79 to 5.15) pdefinitions with best clinical utility and pathogen prediction were 'cervical discharge' and 'micro+cervical discharge'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Airside HVAC BESTEST. Adaptation of ASHRAE RP 865 Airside HVAC Equipment Modeling Test Cases for ASHRAE Standard 140. Volume 1, Cases AE101-AE445

    Energy Technology Data Exchange (ETDEWEB)

    Neymark, J. [J. Neymark & Associates, Golden, CO (United States); Kennedy, M. [Mike D. Kennedy, Inc., Townsend, WA (United States); Judkoff, R. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gall, J. [AAON, Inc., Tulsa, OK (United States); Knebel, D. [AAON, Inc., Tulsa, OK (United States); Henninger, R. [GARD Analytics, Inc., Arlington Heights, IL (United States); Witte, M. [GARD Analytics, Inc., Arlington Heights, IL (United States); Hong, T. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McDowell, T. [Thermal Energy System Specialists, Madison, WI (United States); Yan, D. [Tsinghua Univ., Beijing (China); Zhou, X. [Tsinghua Univ., Beijing (China)

    2016-03-01

    This report documents a set of diagnostic analytical verification cases for testing the ability of whole building simulation software to model the air distribution side of typical heating, ventilating and air conditioning (HVAC) equipment. These cases complement the unitary equipment cases included in American National Standards Institute (ANSI)/American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Standard 140, Standard Method of Test for the Evaluation of Building Energy Analysis Computer Programs, which test the ability to model the heat-transfer fluid side of HVAC equipment.

  12. Definition of healthcare-associated influenza: A review and results from an international survey.

    Science.gov (United States)

    Munier-Marion, Elodie; Bénet, Thomas; Vanhems, Philippe

    2017-09-01

    To describe definitions of healthcare-associated influenza (HAI) in recent literature and in hospitals participating in a survey of Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) members. A review with PubMed search was undertaken to retrieve articles published between 2008 and 2016, focusing on the subject headings "influenza, human" and "cross infection." Definitions of clinical influenza-like illness (ILI) and HAI were identified. An invitation to participate in the survey was sent to 218 SRN members via email. Of 75 articles on HAI included in the review, 30 presented a standardized definition of clinical ILI based on fever (100%), cough (80%), and sore throat (70%). Forty studies (53%) contained a standardized HAI definition, grounded on threshold delay from admission in 29 of them, this delay ranging from 48 to 196 hour (median: 72 hour). Fifty-five SRN members responded to the survey, with a standardized definition of HAI adopted by 76% of them. This definition was based on clinical features for 24%, virological features for 31%, and both for 45%. Fever (mean threshold: 38.0°C) was part of the definition for 82%. The features required most frequently in the clinical definition were cough (46%) and sore throat (26%). Median threshold delay between admission and symptoms onset adopted for HAI definition was 48 hour (range: 24-96 hour). This work underlined the heterogeneity of HAI definitions in different countries. A standardized definition would be helpful to evaluate HAI spread, outcomes in patients and healthcare systems, and the impact of prevention measures, including vaccination. © 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

  13. Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

    Science.gov (United States)

    Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

    2014-11-01

    Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision

  14. Shielding standards: a case history

    International Nuclear Information System (INIS)

    Battat, M.E.

    1977-01-01

    A discussion of the sequence of events leading from the inception of a standard to its transmittal to the ANSI Board of Standards Review will be given. The standard referred to is entitled, ''Neutron and Gamma-Ray Flux-to-Dose-Rate Factors,'' (ANSI N666). Certain questions raised during the review process and the compatibility of this standard with the USA Code of Federal Regulations will be discussed

  15. 7 CFR 810.2201 - Definition of wheat.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of wheat. 810.2201 Section 810.2201... GRAIN United States Standards for Wheat Terms Defined § 810.2201 Definition of wheat. Grain that, before the removal of dockage, consists of 50 percent or more common wheat (Triticum aestivum L.), club wheat...

  16. On the definition of 'chaos'

    International Nuclear Information System (INIS)

    Kolesov, Andrei Yu; Rozov, Nikolai Kh

    2009-01-01

    A new definition of a chaotic invariant set is given for a continuous semiflow in a metric space. It generalizes the well-known definition due to Devaney and allows one to take into account a special feature occurring in the non-compact infinite-dimensional case: so-called turbulent chaos. The paper consists of two sections. The first contains several well-known facts from chaotic dynamics, together with new definitions and results. The second presents a concrete example demonstrating that our definition of chaos is meaningful. Namely, an infinite-dimensional system of ordinary differential equations is investigated having an attractor that is chaotic in the sense of the new definition but not in the sense of Devaney or Knudsen. Bibliography: 65 titles.

  17. A new definition of Bejan number

    Directory of Open Access Journals (Sweden)

    Awad Mohamed M.

    2012-01-01

    Full Text Available A new definition of Bejan number will be generated by replacing the thermal diffusivity with the mass diffusivity. For example, the Schmidt number is the mass transfer analog of the Prandtl number. For the case of Reynolds analogy (Sc = Pr = = 1, both current and new definitions of Bejan number are the same. This new definition is useful and needed for diffusion of mass (mass diffusion.

  18. A review on the risk management terminology for the use in standards

    International Nuclear Information System (INIS)

    Lee, Yong Hee; Lee, Jung Woon

    2001-03-01

    This technical report describes a result of reviews on the risk management terminology for the use in standards. Experiences in related technical fields and their definitions are reviewed according to the concepts and operational definitions of risk terminologies. It results into a draft standard for KS in the fields of product safety. Quality Assurance, Industrial and Occupational Safety, Financial Management and Risk Management, and others may show many different definitions for their own technical purpose. A draft KS standard for risk terminology must be revised and enhanced to be adopted to the product safety. However, this review does not provide a strict guide for use in the operational definitions of risk terms, but does provide a common base among application areas. The result of this review is submitted to Korea Standard Association in form of a draft KS standards, KS X 0000 : 2001 (ISO TBD : 1999), titled as ' Risk management terminology - Guidelines for use in standards '

  19. Definition of terms for practical superconductors

    International Nuclear Information System (INIS)

    Fickett, F.R.; Kaplan, S.B.; Powell, R.L.; Radebaugh, R.; Clark, A.F.

    1980-01-01

    The definitions of terms used in describing the phenomenology and measurement practices of practical superconductive materials are proposed. The definitions cover the subject categories of: 1, fundamental states and flux phenomena, 2, critical parameters, 3, fabrication, stabilization, and transient losses, and 4, Josephson phenomena. It is intended that these terms will become the basis for development of standard measurement practices and responses are invited. (author)

  20. Definitions of terms for practical superconductors

    International Nuclear Information System (INIS)

    Read, D.T.; Ekin, J.W.; Powell, R.L.; Clark, A.F.

    1979-01-01

    The definitions of terms used in describing the phenomenology and measurement practices of practical superconductive materials are proposed. The definitions cover the subject categories of: (1) fundamental states and flux phenomena; (2) critical parameters; (3) fabrication, stabilization, and transient losses; and (4) Josephson phenomena. It is intended that these terms will become the basis for the development of standard measurement practices and responses are invited. (author)

  1. Definitions of terms for practical superconductors

    International Nuclear Information System (INIS)

    Powell, R.; Clark, A.F.

    1977-01-01

    The definitions of terms used in describing the phenomenology and measurement practices of practical superconductive materials are proposed. The definitions cover the subject categories of: (1) fundamental states and flux phenomena, (2) critical parameters, (3) fabrication, stabilization, and transient losses, and (4) Josephson phenomena. It is intended that these terms become the basis for the development of standard measurement practices and responses are invited. (author)

  2. 7 CFR 810.401 - Definition of corn.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of corn. 810.401 Section 810.401... GRAIN United States Standards for Corn Terms Defined § 810.401 Definition of corn. Grain that consists of 50 percent or more of whole kernels of shelled dent corn and/or shelled flint corn (Zea mays L...

  3. Double standards and the international trade of pesticides: the Brazilian case.

    Science.gov (United States)

    Porto, Marcelo Firpo; Milanez, Bruno; Soares, Wagner Lopes; Meyer, Armando

    2010-01-01

    Despite bans on certain pesticides and their replacement by others considered less hazardous, the widespread use of these substances in agriculture continues to threaten the environment and the health of millions of people. This article discusses the current double standard in the international trade of pesticides and focuses on Brazil, one of the main users of pesticides in the world, analyzing the trends in foreign trade (imports and exports) of selected pesticides as a function of changes in legislation in the United States, the European Union, and Brazil from 1989 to 2006. We applied time line analysis to eight organochlorines already banned in Brazil and conducted a case-by-case qualitative and quantitative analysis of nine other pesticides. The results indicate the existence of double standards, as demonstrated by the continued exports to Brazil of some pesticides banned in the United States and Europe.

  4. Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis.

    Science.gov (United States)

    Schumacher, H Christian; Meyers, Philip M; Higashida, Randall T; Derdeyn, Colin P; Lavine, Sean D; Nesbit, Gary M; Sacks, David; Rasmussen, Peter; Wechsler, Lawrence R

    2010-12-01

    Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of Neurolnterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebro-vascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should

  5. EMBEDding the CEFR in Academic Writing Assessment : A case study in training and standardization

    NARCIS (Netherlands)

    Haines, Kevin; Lowie, Wander; Jansma, Petra; Schmidt, Nicole

    2013-01-01

    The CEFR is increasingly being used as the framework of choice for the assessment of language proficiency at universities across Europe. However, to attain consistent assessment, familiarization and standardization are essential. In this paper we report a case study of embedding a standardization

  6. Dengue disease outbreak definitions are implicitly variable

    Directory of Open Access Journals (Sweden)

    Oliver J. Brady

    2015-06-01

    Full Text Available Infectious diseases rarely exhibit simple dynamics. Outbreaks (defined as excess cases beyond response capabilities have the potential to cause a disproportionately high burden due to overwhelming health care systems. The recommendations of international policy guidelines and research agendas are based on a perceived standardised definition of an outbreak characterised by a prolonged, high-caseload, extra-seasonal surge. In this analysis we apply multiple candidate outbreak definitions to reported dengue case data from Brazil to test this assumption. The methods identify highly heterogeneous outbreak characteristics in terms of frequency, duration and case burden. All definitions identify outbreaks with characteristics that vary over time and space. Further, definitions differ in their timeliness of outbreak onset, and thus may be more or less suitable for early intervention. This raises concerns about the application of current outbreak guidelines for early warning/identification systems. It is clear that quantitatively defining the characteristics of an outbreak is an essential prerequisite for effective reactive response. More work is needed so that definitions of disease outbreaks can take into account the baseline capacities of treatment, surveillance and control. This is essential if outbreak guidelines are to be effective and generalisable across a range of epidemiologically different settings.

  7. Variation in Definition of Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Rose, Louise; McGinlay, Michael; Amin, Reshma; Burns, Karen Ea; Connolly, Bronwen; Hart, Nicholas; Jouvet, Philippe; Katz, Sherri; Leasa, David; Mawdsley, Cathy; McAuley, Danny F; Schultz, Marcus J; Blackwood, Bronagh

    2017-10-01

    Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym. We screened 5,331 references, reviewed 539 full-text references, and excluded 120. Of the 419 studies (representing 38 countries) meeting inclusion criteria, 297 (71%) reported data on a heterogeneous subject cohort, and 66 (16%) included surgical subjects only (46 of those 66, 70% cardiac surgery). Other studies described COPD (16, 4%), trauma (22, 5%), neuromuscular (17, 4%), and sepsis (1, 0.2%) cohorts. A total of 741 terms were used to refer to the 419 study cohorts. The most common terms were: prolonged mechanical ventilation (253, 60%), admission to specialized unit (107, 26%), and long-term mechanical ventilation (79, 19%). Some authors (282, 67%) defined their cohorts based on duration of mechanical ventilation, with 154 studies (55%) using this as the sole criterion. We identified 37 different durations of ventilation ranging from 5 h to 1 y, with > 21 d being the most common (28 of 282, 7%). For studies describing a surgical cohort, minimum ventilation duration required for inclusion was ≥ 24 h for 20 of 66 studies (30%). More than half of all studies (237, 57%) did not provide a reason/rationale for definitional criteria used, with only 28 studies (7%) referring to a consensus definition. We conclude that substantial variation exists in the terminology and definitional criteria for cohorts of subjects receiving prolonged mechanical ventilation. Standardization of

  8. Fulfillment of GMP standard, halal standard, and applying HACCP for production process of beef floss (Case study: Ksatria enterprise)

    Science.gov (United States)

    A'diat, Arkan Addien Al; Liquiddanu, Eko; Laksono, Pringgo Widyo; Sutopo, Wahyudi; Suletra, I. Wayan

    2018-02-01

    Along with the increasing number of the modern retail business in Indonesia, give an opportunity to small and medium enterprise (SME) to sell its products through the modern retailer. There are some obstacles faced by the SMEs, one of them is about product standard. Product standard that must be owned by SMEs are GMP standard and halal standard. This research was conducted to know the fulfillment by the beef floss enterprise in jagalan in fulfilling the GMP standard and halal. In addition, Hazard Analysis and Critical Control Points (HACCP) system was applied to analyze the process. HACCP which used in this research was based on the seven principles in SNI (Indonesian National Standard) 01-4852-1998. The seven principles included hazard analysis, critical control point (CCP) determination, critical limit establishment, CCP monitor system establishment, corrective action establishment, verification, and also documentation establishment that must be applied in preparing HACCP plan. Based on this case study, it is concluded that there were 5 CCPs : the boiling process, roasting process, frying process, the beef floss draining process, and the packaging process.

  9. 46 CFR Appendix B to Part 154 - Stress Analyses Definitions

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Stress Analyses Definitions B Appendix B to Part 154...—Stress Analyses Definitions The following are the standard definitions of stresses for the analysis of an independent tank type B: Normal stress means the component of stress normal to the plane of reference...

  10. 7 CFR 810.801 - Definition of mixed grain.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of mixed grain. 810.801 Section 810.801 Agriculture Regulations of the Department of Agriculture (Continued) GRAIN INSPECTION, PACKERS AND STOCKYARD... GRAIN United States Standards for Mixed Grain Terms Defined § 810.801 Definition of mixed grain. Any...

  11. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  12. Understanding standard drinks and drinking guidelines.

    Science.gov (United States)

    Kerr, William C; Stockwell, Tim

    2012-03-01

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

  13. Proposal and Evaluation of Subordinate Standard Solar Irradiance Spectra: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Habte, Aron M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Wilbert, Stefan [German Aerospace Center (DLR); Jessen, Wilko [German Aerospace Center (DLR); Gueymard, Chris [Solar Consulting Services; Polo, Jesus [CIEMAT; Bian, Zeqiang [China Meteorological Administration; Driesse, Anton [Photovoltaic Performance Labs; Marzo, Aitor [University of Antofagasta; Armstrong, Peter [Masdar Institute of Science & Technology; Vignola, Frank [University of Oregon; Ramirez, Lourdes [CIEMAT

    2018-04-12

    This paper introduces a concept for global tilted irradiance (GTI) subordinate standard spectra to supplement the current standard spectra used in solar photovoltaic applications as defined in ASTM G173 and IEC60904. The proposed subordinate standard spectra correspond to atmospheric conditions and tilt angles that depart significantly from the main standard spectrum, and they can be used to more accurately represent various local conditions. For the definition of subordinate standard spectra cases with an elevation 1.5 km above sea level, the question arises whether the air mass should be calculated including a pressure correction or not. This study focuses on the impact of air mass used in standard spectra, and it uses data from 29 locations to examine which air mass is most appropriate for GTI and direct normal irradiance (DNI) spectra. Overall, it is found that the pressure-corrected air mass of 1.5 is most appropriate for DNI spectra. For GTI, a non-pressure-corrected air mass of 1.5 was found to be more appropriate.

  14. 40 CFR 421.251 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE CATEGORY Primary Precious Metals and Mercury Subcategory § 421.251 Specialized definitions. For the purpose of this subpart the general...

  15. Radiation protection. Terms and definitions

    Energy Technology Data Exchange (ETDEWEB)

    1981-04-01

    An alphabetical list in German is given of all terms and definitions important to radiation protection under consideration of all Austrian laws concerning this subject scope as also pertinent standards of ISO, DIN and OENORM.

  16. The Definition and Classification of Universes

    International Nuclear Information System (INIS)

    Bjorken, J.

    2004-01-01

    We assume that the concept of a multiverse makes sense, and suggest a specific, standardized definition for member universes which are similar to our own. Central to this description is the definition of size, which is taken to be the asymptotic value, at large times, of the inverse Hubble constant. Thus the cosmological constant plays a central role in defining the properties of the subset of universes similar to our own. We then assume that vacuum parameters and coupling constants of the standard model are dependent upon the size of a universe, and propose a specific form for the dependence. Anthropic considerations then limit the size of habitable universes (as we understand that concept) to be within a factor two of our own. Implications of this picture for understanding the standard-model ''hierarchy problem'' are discussed, as are general issues of falsifiability and/or verifiability of these ideas

  17. 45 CFR 170.402 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.402 Definitions. For...

  18. 7 CFR 51.2560 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Standards for Grades of Shelled Pistachio Nuts § 51.2560 Definitions. (a) Well dried means the kernel is... than pistachio kernels. No allowable tolerances for metal or glass. (d) Whole kernel means 3/4 of a...

  19. Inter-state coupling and definitions of bright and dark states

    International Nuclear Information System (INIS)

    Mensik, Miroslav; Nespurek, Stanislav

    2007-01-01

    Contrary to a standard definition of diabatic states (i.e., those without momentum-dependent coupling), based on the construction from adiabatic ones, we defined diabatic states as bright and dark states of a given experiment. Namely, they are defined as states providing maximum, respectively, zero value of electronic transition dipole moments projected to a given polarization vector. Second, the state from (or to) which the optical transition is performed is not from the space of investigated electronic excited state manifold, but it is chosen by the observer. It is shown, for this case, that the inter-state coupling is a general function of vibrational coordinates. The explicit dependence of the inter-state coupling on vibrational coordinates is particularly important for system with strong Stokes shift. The role of exact definitions of bright and dark states as well as the inter-state coupling is discussed with respect to the coherent structure of electronic population observed in optical spectroscopy

  20. The definitions of information and meaning two possible boundaries between physics and biology.

    Science.gov (United States)

    Barbieri, Marcello

    2004-01-01

    The standard approach to the definition of the physical quantities has not produced satisfactory results with the concepts of information and meaning. In the case of information we have at least two unrelated definitions, while in the case of meaning we have no definition at all. Here it is shown that both information and meaning can be defined by operative procedures, but it is also pointed out that we need to recognize them as a new type of natural entities. They are not quantities (neither fundamental nor derived) because they cannot be measured, and they are not qualities because are not subjective features. Here it is proposed to call them nominable entities, i.e., entities which can be specified only by naming their components in their natural order. If the genetic code is not a linguistic metaphor but a reality, we must conclude that information and meaning are real natural entities, and now we must also conclude that they are not equivalent to the quantities and qualities of our present theoretical framework. This gives us two options. One is to extend the definition of physics and say that the list of its fundamental entities must include information and meaning. The other is to say that physics is the science of quantities only, and in this case information and meaning become the exclusive province of biology. The boundary between physics and biology, in short, is a matter of convention, but the existence of information and meaning is not. We can decide to study them in the framework of an extended physics or in a purely biological framework, but we cannot avoid studying them for what they are, i.e., as fundamental components of the fabric of Nature.

  1. Combined use of high-definition and volumetric optical coherence tomography for the segmentation of neural canal opening in cases of optic nerve edema

    Science.gov (United States)

    Wang, Jui-Kai; Kardon, Randy H.; Garvin, Mona K.

    2015-03-01

    In cases of optic-nerve-head edema, the presence of the swelling reduces the visibility of the underlying neural canal opening (NCO) within spectral-domain optical coherence tomography (SD-OCT) volumes. Consequently, traditional SD-OCT-based NCO segmentation methods often overestimate the size of the NCO. The visibility of the NCO can be improved using high-definition 2D raster scans, but such scans do not provide 3D contextual image information. In this work, we present a semi-automated approach for the segmentation of the NCO in cases of optic disc edema by combining image information from volumetric and high-definition raster SD-OCT image sequences. In particular, for each subject, five high-definition OCT B-scans and the OCT volume are first separately segmented, and then the five high-definition B-scans are automatically registered to the OCT volume. Next, six NCO points are placed (manually, in this work) in the central three high-definition OCT B-scans (two points for each central B-scans) and are automatically transferred into the OCT volume. Utilizing a combination of these mapped points and the 3D image information from the volumetric scans, a graph-based approach is used to identify the complete NCO on the OCT en-face image. The segmented NCO points using the new approach were significantly closer to expert-marked points than the segmented NCO points using a traditional approach (root mean square differences in pixels: 5.34 vs. 21.71, p < 0.001).

  2. Safety standards for near surface disposal and the safety case and supporting safety assessment for demonstrating compliance with the standards

    International Nuclear Information System (INIS)

    Metcalf, P.

    2003-01-01

    The report presents the safety standards for near surface disposal (ICRP guidance and IAEA standards) and the safety case and supporting safety assessment for demonstrating compliance with the standards. Special attention is paid to the recommendations for disposal of long-lived solid radioactive waste. The requirements are based on the principle for the same level of protection of future individuals as for the current generation. Two types of exposure are considered: human intrusion and natural processes and protection measures are discussed. Safety requirements for near surface disposal are discussed including requirements for protection of human health and environment, requirements or safety assessments, waste acceptance and requirements etc

  3. On the use of Standardized Drought Indices under decadal climate variability: Critical assessment and drought policy implications

    Science.gov (United States)

    Núñez, J.; Rivera, D.; Oyarzún, R.; Arumí, J. L.

    2014-09-01

    Since the recent High Level Meeting on National Drought Policy held in Geneva in 2013, a greater concern about the creation and adaptation of national drought monitoring systems is expected. Consequently, backed by international recommendations, the use of Standardized Drought Indices (SDI), such as the Standardized Precipitation Index (SPI), as an operational basis of drought monitoring systems has been increasing in many parts of the world. Recommendations for the use of the SPI, and consequently, those indices that share its properties, do not take into account the limitations that this type of index can exhibit under the influence of multidecadal climate variability. These limitations are fundamentally related to the lack of consistency among the operational definition expressed by this type of index, the conceptual definition with which it is associated and the political definition it supports. Furthermore, the limitations found are not overcome by the recommendations for their application. This conclusion is supported by the long-term study of the Standardized Streamflow Index (SSI) in the arid north-central region of Chile, under the influence of multidecadal climate variability. The implications of the findings of the study are discussed with regard to their link to aspects of drought policy in the cases of Australia, the United States and Chile.

  4. Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010-2015.

    Science.gov (United States)

    Wiltz, Jennifer L; Blanck, Heidi M; Lee, Brian; Kocot, S Lawrence; Seeff, Laura; McGuire, Lisa C; Collins, Janet

    2017-10-26

    Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the "ABCDs" of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public-private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems.

  5. Preliminary definition of improvement in juvenile arthritis.

    Science.gov (United States)

    Giannini, E H; Ruperto, N; Ravelli, A; Lovell, D J; Felson, D T; Martini, A

    1997-07-01

    To identify a core set of outcome variables for the assessment of children with juvenile arthritis (JA), to use the core set to develop a definition of improvement to determine whether individual patients demonstrate clinically important improvement, and to promote this definition as a single efficacy measure in JA clinical trials. A core set of outcome variables was established using a combination of statistical and consensus formation techniques. Variables in the core set consisted of 1) physician global assessment of disease activity; 2) parent/patient assessment of overall well-being; 3) functional ability; 4) number of joints with active arthritis; 5) number of joints with limited range of motion; and 6) erythrocyte sedimentation rate. To establish a definition of improvement using this core set, 21 pediatric rheumatologists from 14 countries met, and, using consensus formation techniques, scored each of 72 patient profiles as improved or not improved. Using the physicians' consensus as the gold standard, the chi-square, sensitivity, and specificity were calculated for each of 240 possible definitions of improvement. Definitions with sensitivity or specificity of definitions to discriminate between the effects of active agent and those of placebo, using actual trial data, was then observed. Each definition was also ranked for face validity, and the sum of the ranks was then multiplied by the kappa statistic. The definition of improvement with the highest final score was as follows: at least 30% improvement from baseline in 3 of any 6 variables in the core set, with no more than 1 of the remaining variables worsening by >30%. The second highest scoring definition was closely related to the first; the third highest was similar to the Paulus criteria used in adult rheumatoid arthritis trials, except with different variables. This indicates convergent validity of the process used. We propose a definition of improvement for JA. Use of a uniform definition will help

  6. 77 FR 42211 - Small Business Size Standards: Arts, Entertainment, and Recreation

    Science.gov (United States)

    2012-07-18

    ..., SBA establishes small business definitions (referred to as size standards) for private sector... operated; (2) not dominant in its field of operation; and (3) within a specific small business definition... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG36 Small Business Size Standards: Arts...

  7. Developing a Standard Definition of Whole-Grain Foods for Dietary Recommendations: Summary Report of a Multidisciplinary Expert Roundtable Discussion12

    Science.gov (United States)

    Ferruzzi, Mario G.; Jonnalagadda, Satya S.; Liu, Simin; Marquart, Len; McKeown, Nicola; Reicks, Marla; Riccardi, Gabriele; Seal, Chris; Slavin, Joanne; Thielecke, Frank; van der Kamp, Jan-Willem; Webb, Densie

    2014-01-01

    Although the term “whole grain” is well defined, there has been no universal standard of what constitutes a “whole-grain food,” creating challenges for researchers, the food industry, regulatory authorities, and consumers around the world. As part of the 2010 Dietary Guidelines for Americans, the U.S. Dietary Guidelines Technical Advisory Committee issued a call to action to develop definitions for whole-grain foods that could be universally accepted and applied to dietary recommendations and planning. The Committee’s call to action, and the lack of a global whole-grain food definition, was the impetus for the Whole Grain Roundtable held 3–5 December 2012 in Chicago, Illinois. The objective was to develop a whole-grain food definition that is consistent with the quartet of needs of science, food product formulation, consumer behavior, and label education. The roundtable’s expert panel represented a broad range of expertise from the United States and Europe, including epidemiology and dietary intervention researchers, consumer educators, government policy makers, and food and nutrition scientists from academia and the grain food industry. Taking into account the totality, quality, and consistency of available scientific evidence, the expert panel recommended that 8 g of whole grain/30 g serving (27 g/100 g), without a fiber requirement, be considered a minimum content of whole grains that is nutritionally meaningful and that a food providing at least 8 g of whole grains/30-g serving be defined as a whole-grain food. Having an established whole-grain food definition will encourage manufacturers to produce foods with meaningful amounts of whole grain, allow consistent product labeling and messaging, and empower consumers to readily identify whole-grain foods and achieve whole-grain dietary recommendations. PMID:24618757

  8. 7 CFR 868.301 - Definition of milled rice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of milled rice. 868.301 Section 868.301... FOR CERTAIN AGRICULTURAL COMMODITIES United States Standards for Milled Rice Terms Defined § 868.301 Definition of milled rice. Whole or broken kernels of rice (Oryza sativa L.) from which the hulls and at...

  9. 7 CFR 868.201 - Definition of rough rice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Definition of rough rice. 868.201 Section 868.201... FOR CERTAIN AGRICULTURAL COMMODITIES United States Standards for Rough Rice Terms Defined § 868.201 Definition of rough rice. Rice (Oryza sativa L.) which consists of 50 percent or more of paddy kernels (see...

  10. Product Structure, the Heart of Product Definition

    Science.gov (United States)

    DeHoog, C., Jr.

    1999-01-01

    This paper describes the LMMSS Product Definition System (PDS) philosophy and approach were the use of each item parts document or software can be traced to a specific end item (EI) serial/tail number of the product. It explains why a part-oriented approach to data organization and configuration management is required. The definition of part-oriented is that all appropriate product definition data products will be collected. Referenced and managed by their linkage/relationship to parts/items, The paper will touch upon how LMMSS store/controls product definition information under each project's top product designator in a two tiered approach. One tier for each product end item and another tier which contain/controls listings of drawings, documents. Specifications and standards that are required for hardware item definition.

  11. 40 CFR 405.81 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... STANDARDS DAIRY PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts Subcategory § 405.81 Specialized definitions. For the purpose of this subpart: (a) Except...

  12. Sputum, sex and scanty smears: new case definition may reduce sex disparities in smear-positive tuberculosis

    OpenAIRE

    Ramsay, A; Bonnet, M; Gagnidze, L; Githui, W; Varaine, F; Guérin, P J

    2009-01-01

    SETTING: Urban clinic, Nairobi. OBJECTIVES: To evaluate the impact of specimen quality and different smear-positive tuberculosis (TB) case (SPC) definitions on SPC detection by sex. DESIGN: Prospective study among TB suspects. RESULTS: A total of 695 patients were recruited: 644 produced > or =1 specimen for microscopy. The male/female sex ratio was 0.8. There were no significant differences in numbers of men and women submitting three specimens (274/314 vs. 339/380, P = 0.43). Significantly ...

  13. Clinical case review: a method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia.

    Science.gov (United States)

    Puumalainen, Taneli; Quiambao, Beatriz; Abucejo-Ladesma, Erma; Lupisan, Socorro; Heiskanen-Kosma, Tarja; Ruutu, Petri; Lucero, Marilla G; Nohynek, Hanna; Simoes, Eric A F; Riley, Ian

    2008-07-21

    The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing) had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. ISRCTN62323832.

  14. Definition of drug-resistant epilepsy: is it evidence based?

    Science.gov (United States)

    Wiebe, Samuel

    2013-05-01

    Clinical case definitions are the cornerstone of clinical communication and of clinical and epidemiologic research. The ramifications of establishing a case definition are extensive, including potentially large changes in epidemiologic estimates of frequency, and decisions for clinical management. Yet, defining a condition entails numerous challenges such as defining the scope and purpose, incorporating the strongest evidence base with clinical expertise, accounting for patients' values, and considering impact on care. The clinical case definition of drug-resistant epilepsy, in addition, must address what constitutes an adequate intervention for an individual drug, what are the outcomes of relevance, what period of observation is sufficient to determine success or failure, how many medications should be tried, whether seizure frequency should play a role, and what is the role of side effects and tolerability. On the other hand, the principles of evidence-based medicine (EBM) aim at providing a systematic approach to incorporating the best available evidence into the process of clinical decision for individual patients. The case definition of drug-resistant epilepsy proposed by the the International League Against Epilepsy (ILAE) in 2009 is evaluated in terms of the principles of EBM as well as the stated goals of the authors of the definition. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  15. Interpretation of drinking water quality guidelines – The case of arsenic

    African Journals Online (AJOL)

    ... both in the creation of sound drinking water quality guidelines or standards, and in the problem of how to interpret the risk to human health when guideline values are exceeded. In this paper this problem is discussed using the case of arsenic, where the definition of the boundaries of the grey area is particularly uncertain.

  16. 47 CFR 64.1701 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Definitions. 64.1701 Section 64.1701 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS... accredited standards development organization, funding party, generic requirement, and industry-wide have the...

  17. 30 CFR 250.302 - Definitions concerning air quality.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Definitions concerning air quality. 250.302... Definitions concerning air quality. For purposes of §§ 250.303 and 250.304 of this part: Air pollutant means..., pursuant to section 109 of the Clean Air Act, national primary or secondary ambient air quality standards...

  18. Towards a definition of the "practical" epileptogenic zone: a case of epilepsy with dual pathology.

    Science.gov (United States)

    Chassagnon, Serge; Valenti, Maria Paola; Sabourdy, Cécile; Esposito, Philippe; Kehrli, Pierre; Arzimanoglou, Alexis; Ryvlin, Philippe; Kahane, Philippe; Hirsch, Edouard

    2006-08-01

    Presurgical evaluation for patients with drug-resistant epilepsy requires the definition of various zones that have a variable spatial relationship with the epileptogenic zone. All the available methods to directly measure the actual seizure-onset zone and to define "the minimum amount of cortical tissue that must be resected to produce seizure-freedom" have significant limitations. We report on the case of a patient with dual pathology (hippocampal sclerosis and a post-traumatic scar) and discuss the contribution of the various presurgical investigations that led to surgery and seizure-freedom.

  19. Standardizing terms, definitions and concepts for describing and interpreting unwanted immunogenicity of biopharmaceuticals: recommendations of the Innovative Medicines Initiative ABIRISK consortium.

    Science.gov (United States)

    Rup, B; Pallardy, M; Sikkema, D; Albert, T; Allez, M; Broet, P; Carini, C; Creeke, P; Davidson, J; De Vries, N; Finco, D; Fogdell-Hahn, A; Havrdova, E; Hincelin-Mery, A; C Holland, M; H Jensen, P E; Jury, E C; Kirby, H; Kramer, D; Lacroix-Desmazes, S; Legrand, J; Maggi, E; Maillère, B; Mariette, X; Mauri, C; Mikol, V; Mulleman, D; Oldenburg, J; Paintaud, G; R Pedersen, C; Ruperto, N; Seitz, R; Spindeldreher, S; Deisenhammer, F

    2015-09-01

    Biopharmaceuticals (BPs) represent a rapidly growing class of approved and investigational drug therapies that is contributing significantly to advancing treatment in multiple disease areas, including inflammatory and autoimmune diseases, genetic deficiencies and cancer. Unfortunately, unwanted immunogenic responses to BPs, in particular those affecting clinical safety or efficacy, remain among the most common negative effects associated with this important class of drugs. To manage and reduce risk of unwanted immunogenicity, diverse communities of clinicians, pharmaceutical industry and academic scientists are involved in: interpretation and management of clinical and biological outcomes of BP immunogenicity, improvement of methods for describing, predicting and mitigating immunogenicity risk and elucidation of underlying causes. Collaboration and alignment of efforts across these communities is made difficult due to lack of agreement on concepts, practices and standardized terms and definitions related to immunogenicity. The Innovative Medicines Initiative (IMI; www.imi-europe.org), ABIRISK consortium [Anti-Biopharmaceutical (BP) Immunization Prediction and Clinical Relevance to Reduce the Risk; www.abirisk.eu] was formed by leading clinicians, academic scientists and EFPIA (European Federation of Pharmaceutical Industries and Associations) members to elucidate underlying causes, improve methods for immunogenicity prediction and mitigation and establish common definitions around terms and concepts related to immunogenicity. These efforts are expected to facilitate broader collaborations and lead to new guidelines for managing immunogenicity. To support alignment, an overview of concepts behind the set of key terms and definitions adopted to date by ABIRISK is provided herein along with a link to access and download the ABIRISK terms and definitions and provide comments (http://www.abirisk.eu/index_t_and_d.asp). © 2015 British Society for Immunology.

  20. Consensus Based Definition of Growth Restriction in the Newborn.

    Science.gov (United States)

    Beune, Irene M; Bloomfield, Frank H; Ganzevoort, Wessel; Embleton, Nicholas D; Rozance, Paul J; van Wassenaer-Leemhuis, Aleid G; Wynia, Klaske; Gordijn, Sanne J

    2018-05-01

    To develop a consensus definition of growth restriction in the newborn that can be used clinically to identify newborn infants at risk and in research to harmonize reporting and definition in the current absence of a gold standard. An international panel of pediatric leaders in the field of neonatal growth were invited to participate in an electronic Delphi procedure using standardized methods and predefined consensus rules. Responses were fed back at group-level and the list of participants was provided. Nonresponders were excluded from subsequent rounds. In the first round, variables were scored on a 5-point Likert scale; in subsequent rounds, inclusion of variables and cut-offs were determined with a 70% level of agreement. In the final round participants selected the ultimate algorithm. In total, 57 experts participated in the first round; 79% completed the procedure. Consensus was reached on the following definition: birth weight less than the third percentile, or 3 out of the following: birth weight definition for growth restriction in the newborn. This definition recognizes that infants with birth weights 10th percentile can be growth restricted. This definition can be adopted in clinical practice and in clinical trials to better focus on newborns at risk, and is complementary to the previously determined definition of fetal growth restriction. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. "First among Others? Cohen's ""d"" vs. Alternative Standardized Mean Group Difference Measures"

    Directory of Open Access Journals (Sweden)

    Sorel Cahan

    2011-06-01

    Full Text Available Standardized effect size measures typically employed in behavioral and social sciences research in the multi-group case (e.g., 2, f2 evaluate between-group variability in terms of either total or within-group variability, such as variance or standard deviation -' that is, measures of dispersion about the mean. In contrast, the definition of Cohen's d, the effect size measure typically computed in the two-group case, is incongruent due to a conceptual difference between the numerator -' which measures between-group variability by the intuitive and straightforward raw difference between the two group means -' and the denominator - which measures within-group variability in terms of the difference between all observations and the group mean (i.e., the pooled within-groups standard deviation, SW. Two congruent alternatives to d, in which the root square or absolute mean difference between all observation pairs is substituted for SW as the variability measure in the denominator of d, are suggested and their conceptual and statistical advantages and disadvantages are discussed.

  2. Aerosol exposure: Concepts, criteria, standards and applications

    International Nuclear Information System (INIS)

    Vincent, James H

    2009-01-01

    This paper places Inhaled Particles X in the context of the whole sequence of such symposia, going back to the first one in 1961. It draws together some of the essential principles that have been learned since that earlier meeting about the nature of exposure and exposure assessment and thus provides a framework by which to integrate the new knowledge presented at this latest one. In the process, the importance of understanding the formal definition of aerosol exposure is stressed, including the distinction between exposure intensity and exposure history, and how that relates to some measure of cumulative dose which, in turn, may be linked with knowledge about intrinsic toxicity, etc. This then leads to a definition of exposure standards, and the important ingredients of criteria, sampling and limit values. A summary is provided of the current set of particle size-selective criteria that have been widely agreed in the international occupational and environmental health community. Some ideas are presented about how this set might be expanded for certain applications, the important case of ultrafine aerosols being one of them.

  3. 76 FR 14323 - Small Business Size Standards: Professional, Scientific and Technical Services

    Science.gov (United States)

    2011-03-16

    ... government small business assistance programs, SBA establishes small business size definitions (referred to... its field of operation and (3) within a specific small business definition or size standard... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG07 Small Business Size Standards...

  4. Euro-FISH: A concerted action towards standardized translocation detection in pathology

    DEFF Research Database (Denmark)

    Rijk, A. Van; Mason, D.; Leoncini, L.

    2007-01-01

    Background: Lymphomas are cancers originating from the lymphatic system. This specific group of cancers can be divided into two major categories; Hodgkin versus non-Hodgkin lymphomas. Their definition is based on clinical, morphological, immunophenotypic and genetic features and is generally...... at a validation of a robust, standardized FISH protocol. When implemented this procedure will be an aid in discriminating the most difficult to diagnose cases. Method: The Euro-FISH protocol is a useful tool in discerning the different types of lymphoma and available treatment options. The Euro-FISH project...... reliable results in at least 90% of the cases tested and can in principal be implemented for routine use in every pathology laboratory with access to a fluorescence microscope....

  5. 15 CFR 290.2 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... operational, management and financial sensse to improve the levels of technology they employ. ... STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE NIST EXTRAMURAL PROGRAMS REGIONAL CENTERS FOR THE TRANSFER OF MANUFACTURING TECHNOLOGY § 290.2 Definitions. (a) The phrase advanced manufacturing technology...

  6. 20 CFR 702.601 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Definitions. 702.601 Section 702.601 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which...

  7. NASA Technology Readiness Level Definitions

    Science.gov (United States)

    Mcnamara, Karen M.

    2012-01-01

    This presentation will cover the basic Technology Readiness Level (TRL) definitions used by the National Aeronautics and Space Administration (NASA) and their specific wording. We will discuss how they are used in the NASA Project Life Cycle and their effectiveness in practice. We'll also discuss the recent efforts by the International Standards Organization (ISO) to develop a broadly acceptable set of TRL definitions for the international space community and some of the issues brought to light. This information will provide input for further discussion of the use of the TRL scale in manufacturing.

  8. Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

    OpenAIRE

    Puumalainen, Taneli; Quiambao, Beatriz; Abucejo-Ladesma, Erma; Lupisan, Socorro; Heiskanen-Kosma, Tarja; Ruutu, Petri; Lucero, Marilla G; Nohynek, Hanna; Simoes, Eric AF; Riley, Ian

    2008-01-01

    Abstract Background The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. Methods A group of paediatricians conducted a retrospective review of clinical and laboratory da...

  9. Standardization of the Descemet membrane endothelial keratoplasty technique: Outcomes of the first 450 consecutive cases.

    Science.gov (United States)

    Satué, M; Rodríguez-Calvo-de-Mora, M; Naveiras, M; Cabrerizo, J; Dapena, I; Melles, G R J

    2015-08-01

    To evaluate the clinical outcome of the first 450 consecutive cases after Descemet membrane endothelial keratoplasty (DMEK), as well as the effect of standardization of the technique. Comparison between 3 groups: Group I: (cases 1-125), as the extended learning curve; Group II: (cases 126-250), transition to technique standardization; Group III: (cases 251-450), surgery with standardized technique. Best corrected visual acuity, endothelial cell density, pachymetry and intra- and postoperative complications were evaluated before, and 1, 3 and 6 months after DMEK. At 6 months after surgery, 79% of eyes reached a best corrected visual acuity of≥0.8 and 43%≥1.0. Mean preoperative endothelial cell density was 2,530±220 cells/mm2 and 1,613±495 at 6 months after surgery. Mean pachymetry measured 668±92 μm and 526±46 μm pre- and (6 months) postoperatively, respectively. There were no significant differences in best corrected visual acuity, endothelial cell density and pachymetry between the 3 groups (P > .05). Graft detachment presented in 17.3% of the eyes. The detachment rate declined from 24% to 12%, and the rate of secondary surgeries from 9.6% to 3.5%, from group I to III respectively. Visual outcomes and endothelial cell density after DMEK are independent of the technique standardization. However, technique standardization may have contributed to a lower graft detachment rate and a relatively low number of secondary interventions required. As such, DMEK may become the first choice of treatment in corneal endothelial disease. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

    NARCIS (Netherlands)

    Dalbeth, N.; Schumacher, H.R.; Fransen, J.; Neogi, T.; Jansen, T.L; Brown, M.; Louthrenoo, W.; Vazquez-Mellado, J.; Eliseev, M.; McCarthy, G.; Stamp, L.K.; Perez-Ruiz, F.; Sivera, F.; Ea, H.K.; Gerritsen, M.; Scire, C.A.; Cavagna, L.; Lin, C.; Chou, Y.Y.; Tausche, A.K.; Rocha Castelar-Pinheiro, G. da; Janssen, M; Chen, J.H.; Cimmino, M.A.; Uhlig, T.; Taylor, W.J.

    2016-01-01

    OBJECTIVE: To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. METHODS: Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study.

  11. 40 CFR 266.201 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Definitions. 266.201 Section 266.201 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR THE MANAGEMENT OF SPECIFIC HAZARDOUS WASTES AND SPECIFIC TYPES OF HAZARDOUS WASTE MANAGEMENT...

  12. 18 CFR 725.4 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... EXECUTIVE ORDERS 11988, FLOODPLAIN MANAGEMENT AND 11990, PROTECTION OF WETLANDS Introduction § 725.4... definitions listed in the Glossary of the Council's Floodplain Management Guidelines for Implementing E.O... Council's Principles, Standards and Procedures (P,S,&P), provision of financial assistance for State...

  13. 40 CFR 60.601 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Definitions. 60.601 Section 60.601 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF..., transportation, collection, concentration, and purification of organic solvents. It may include enclosures, hoods...

  14. 12 CFR 615.5301 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... set forth in Statement of Financial Accounting Standards No. 133, Accounting for Derivative... AND OPERATIONS, AND FUNDING OPERATIONS Surplus and Collateral Requirements § 615.5301 Definitions. For...) Undistributed earnings/unallocated surplus less, for associations only, an amount equal to the net investment in...

  15. 7 CFR 2900.2 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURE ESSENTIAL AGRICULTURAL USES AND VOLUMETRIC REQUIREMENTS-NATURAL GAS POLICY ACT § 2900.2... maintenance of food quality after processing. (b) Establishment means an economic unit, generally at a single... definition used in the Standard Industrial Classification Manual, 1972 edition). (c) Essential Agricultural...

  16. Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

    Directory of Open Access Journals (Sweden)

    Ruutu Petri

    2008-07-01

    Full Text Available Abstract Background The World Health Organization's (WHO case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. Methods A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Results Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. Conclusion The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. Trial registration ISRCTN62323832

  17. Characterizing eating patterns: a comparison of eating occasion definitions.

    Science.gov (United States)

    Leech, Rebecca M; Worsley, Anthony; Timperio, Anna; McNaughton, Sarah A

    2015-11-01

    To date, many approaches have been used to define eating occasions (EOs). A standard definition for EOs is required to facilitate further research. In this study, we examined the influence of differing definitions of EOs on the characterization of eating patterns. Cross-sectional dietary data from two 24-h recalls collected during the 2011-12 Australian National Nutrition and Physical Activity Survey (n = 5242 adults, aged ≥19 y) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (individual EOs separated by different time intervals and/or an additional energy criterion of 210 kJ). Frequency of and total energy intake from meals, snacks, and all EOs were estimated, as appropriate. Differences were tested by using F tests, stratified by sex and age group. Agreement between different definitions of meal and snack frequencies was assessed by using intraclass correlation coefficients (ICCs). For each definition, linear regression was used to estimate the proportion of variance in total energy intake (kJ) and amount of food intake (g) predicted by frequency of EOs and meals and snacks. Among both sexes and across all age groups, mean frequencies of meals differed between the participant-identified and time-of-day definitions (mean difference range = 0.1-0.3; P good agreement for snacks (men: ICC = 0.89; women: ICC = 0.87) but not meal frequencies (men: ICC = 0.38; women: ICC = 0.36) between the participant-identified and time-of-day definitions. The neutral definition (15-min time interval plus energy criterion) best predicted variance in total energy intake (R(2) range = 19.3-27.8). Different approaches to the definition of EOs affect how eating patterns are characterized, with the neutral definition best predicting variance in total energy intake. Further research that examines how different EO definitions affect associations with health outcomes is needed to develop consensus on a standard EO definition.

  18. 77 FR 72766 - Small Business Size Standards: Support Activities for Mining

    Science.gov (United States)

    2012-12-06

    ... eligibility for Federal small business assistance, SBA establishes small business size definitions (referred... operation; and (3) within a specific small business definition or size standard established by SBA... to SBA's Administrator the responsibility for establishing small business definitions. The Act also...

  19. A dynamic case definition is warranted for adequate notification in an extended epidemic setting: the Dutch Q fever outbreak 2007-2009 as exemplar.

    Science.gov (United States)

    Jaramillo-Gutierrez, G; Wegdam-Blans, M C; ter Schegget, R; Korbeeck, J M; van Aken, R; Bijlmer, H A; Tjhie, J H; Koopmans, M P

    2013-10-10

    Q fever is a notifiable disease in the Netherlands:laboratories are obliged to notify possible cases to the Municipal Health Services. These services then try to reconfirm cases with additional clinical and epidemiological data and provide anonymised reports to the national case register of notifiable diseases. Since the start of the 2007–2009 Dutch Q fever outbreak,notification rules remained unchanged, despite new laboratory insights and altered epidemiology. In this study, we retrospectively analysed how these changes influenced the proportion of laboratory-defined acute Q fever cases (confirmed, probable and possible)that were included in the national case register, during(2009) and after the outbreak (2010 and 2011).The number of laboratory-defined cases notified to the Municipal Health Services was 377 in 2009, 96 in 2010 and 50 in 2011. Of these, 186 (49.3%) in 2009, 12(12.5%) in 2010 and 9 (18.0%) in 2011 were confirmed as acute infection by laboratory interpretation. The proportion of laboratory-defined acute Q fever cases that was reconfirmed by the Municipal Health Services and that were included in the national case register decreased from 90% in 2009, to 22% and 24% in 2010 and 2011, respectively. The decrease was observed in all categories of cases, including those considered to be confirmed by laboratory criteria. Continued use ofa pre-outbreak case definition led to over-reporting of cases to the Municipal Health Services in the post-epidemic years. Therefore we recommend dynamic laboratory notification rules, by reviewing case definitions periodically in an ongoing epidemic, as in the Dutch Q fever outbreak.

  20. Indigenous Peoples’ Natural Resources and Business: Inter-American Standards and Chilean Case Law

    Directory of Open Access Journals (Sweden)

    Gonzalo Aguilar Cavallo

    2015-10-01

    Full Text Available In this brief analysis we will review the difficulties faced in establishing responsibility for human rights violation to companies as well as the Inter-American Court of Human Rights’ case law in the field. We will analyze the international standards established in corporate responsibility. Finally, we will examine if the Chilean national courts incorporate the standards set by the Inter-American Court of Human Rights, especially concerning private companies.

  1. COMPUTER INTEGRATED MANUFACTURING: OVERVIEW OF MODERN STANDARDS

    Directory of Open Access Journals (Sweden)

    A. Рupena

    2016-09-01

    Full Text Available The article deals with modern international standards ISA-95 and ISA-88 on the development of computer inegreted manufacturing. It is shown scope of standards in the context of a hierarchical model of the enterprise. Article is built in such a way to describe the essence of the standards in the light of the basic descriptive models: product definition, resources, schedules and actual performance of industrial activity. Description of the product definition is given by hierarchical presentation of products at various levels of management. Much attention is given to describe this type of resources like equipment, which is logical chain to all these standards. For example, the standard batch process control shows the relationship between the definition of product and equipment on which it is made. The article shows the hierarchy of planning ERP-MES / MOM-SCADA (in terms of standard ISA-95, which traces the decomposition of common production plans of enterprises for specific works at APCS. We consider the appointment of the actual performance of production at MES / MOM considering KPI. Generalized picture of operational activity on a level MES / MOM is shown via general circuit diagrams of the relationship of activities and information flows between the functions. The article is finished by a substantiation of necessity of distribution, approval and development of standards ISA-88 and ISA-95 in Ukraine. The article is an overview and can be useful to specialists in computer-integrated systems control and management of industrial enterprises, system integrators and suppliers.

  2. Standard English and Language Attitudes

    OpenAIRE

    ソランキ, ネイディン

    2005-01-01

    This paper investigates the attitudes and opinions surrounding Standard English (SE) within the United Kingdom. The definition of SE, for the purposes of this study, is standard grammar and standard pronunciation of southern English, commonly referred to as 'BBC English'. The subject of SE and attitudes towards different accents and dialects of British English is emotive and attracts strong opinions. The main issues discussed here are the place of language in society, the social implications ...

  3. Human exposure standards in the frequency range 1 Hz To 100 kHz: the case for adoption of the IEEE standard.

    Science.gov (United States)

    Patrick Reilly, J

    2014-10-01

    Differences between IEEE C95 Standards (C95.6-2002 and C95.1-2005) in the low-frequency (1 Hz-100 kHz) and the ICNIRP-2010 guidelines appear across the frequency spectrum. Factors accounting for lack of convergence include: differences between the IEEE standards and the ICNIRP guidelines with respect to biological induction models, stated objectives, data trail from experimentally derived thresholds through physical and biological principles, selection and justification of safety/reduction factors, use of probability models, compliance standards for the limbs as distinct from the whole body, defined population categories, strategies for central nervous system protection below 20 Hz, and correspondence of environmental electric field limits with contact currents. This paper discusses these factors and makes the case for adoption of the limits in the IEEE standards.

  4. 30 CFR 20.2 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... MINING PRODUCTS ELECTRIC MINE LAMPS OTHER THAN STANDARD CAP LAMPS § 20.2 Definitions. (a) Adequate... its lamp has been adjudged satisfactory under the requirements of this part. (c) Explosion-proof... or discharge of flame and without ignition of surrounding explosive methane-air mixtures. (d...

  5. 36 CFR 1194.4 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS General § 1194.4 Definitions. The following... limited to, Braille, ASCII text, large print, recorded audio, and electronic formats that comply with this... people with disabilities. Alternate methods may include, but are not limited to, voice, fax, relay...

  6. JPL Thermal Design Modeling Philosophy and NASA-STD-7009 Standard for Models and Simulations - A Case Study

    Science.gov (United States)

    Avila, Arturo

    2011-01-01

    The Standard JPL thermal engineering practice prescribes worst-case methodologies for design. In this process, environmental and key uncertain thermal parameters (e.g., thermal blanket performance, interface conductance, optical properties) are stacked in a worst case fashion to yield the most hot- or cold-biased temperature. Thus, these simulations would represent the upper and lower bounds. This, effectively, represents JPL thermal design margin philosophy. Uncertainty in the margins and the absolute temperatures is usually estimated by sensitivity analyses and/or by comparing the worst-case results with "expected" results. Applicability of the analytical model for specific design purposes along with any temperature requirement violations are documented in peer and project design review material. In 2008, NASA released NASA-STD-7009, Standard for Models and Simulations. The scope of this standard covers the development and maintenance of models, the operation of simulations, the analysis of the results, training, recommended practices, the assessment of the Modeling and Simulation (M&S) credibility, and the reporting of the M&S results. The Mars Exploration Rover (MER) project thermal control system M&S activity was chosen as a case study determining whether JPL practice is in line with the standard and to identify areas of non-compliance. This paper summarizes the results and makes recommendations regarding the application of this standard to JPL thermal M&S practices.

  7. 76 FR 70680 - Small Business Size Standards: Real Estate and Rental and Leasing

    Science.gov (United States)

    2011-11-15

    ... eligibility for Federal small business assistance, SBA establishes small business size definitions (referred... business definition or size standard established by the SBA Administrator. SBA considers as part of its... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG28 Small Business Size Standards: Real...

  8. 22 CFR 231.02 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Definitions. 231.02 Section 231.02 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ARAB REPUBLIC OF EGYPT LOAN GUARANTEES ISSUED UNDER THE EMERGENCY WARTIME SUPPLEMENTAL APPROPRIATIONS ACT OF 2003, PUBLIC LAW 108-11-STANDARD TERMS AND CONDITIONS...

  9. 30 CFR 74.2 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Definitions. 74.2 Section 74.2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH COAL MINE... consensus standards used worldwide. (f) Precision: the relative variability of measurements from a...

  10. 20 CFR 726.301 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Definitions. 726.301 Section 726.301 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE Civil...

  11. 20 CFR 726.8 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Definitions. 726.8 Section 726.8 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE General...

  12. 49 CFR 591.4 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... (other than a damage settlement in connection with a recovered theft vehicle unless such motor vehicle..., DEPARTMENT OF TRANSPORTATION (CONTINUED) IMPORTATION OF VEHICLES AND EQUIPMENT SUBJECT TO FEDERAL SAFETY, BUMPER AND THEFT PREVENTION STANDARDS § 591.4 Definitions. All terms used in this part that are defined...

  13. 16 CFR 314.2 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION § 314.2 Definitions. (a) In general. Except as modified by this part or unless the... Commission's rule governing the Privacy of Consumer Financial Information, 16 CFR part 313. (b) Customer...

  14. 30 CFR 75.201 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... SAFETY STANDARDS-UNDERGROUND COAL MINES Roof Support § 75.201 Definitions. Automated temporary roof support (ATRS) system. A device to provide temporary roof support from a location where the equipment operator is protected from roof falls. Pillar recovery. Any reduction in pillar size during retreat mining. ...

  15. 48 CFR 27.301 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Patent Rights under Government Contracts 27.301 Definitions. As used... taxation under section 501(a) of the Internal Revenue Code (26 U.S.C. 501(a)), or any nonprofit scientific... process or method; or to operate, in the case of a machine or system; and, in each case, under such...

  16. Terms and definitions in the field of radiological technique. Dose quantities and units

    International Nuclear Information System (INIS)

    1985-12-01

    The standard gives the terms and definitions of concepts, dose quantities and units. The radiation field condition 'secondary electron equilibrium', which forms part of the definition of standard ion dose, is given more precisely. The term 'free in air' is used in its original meaning, i.e. characterization of measuring conditions excluding avoidable stray radiation, which deviates from DIN 6814, part 3/06.72. Dosemeters for measurement of standard ion dose of air kerma are calibrated 'free in air', but this calibration condition is not part of the quantity definition. The quantities standard ion dose or air kerma therefore can also be measured in any other material. The qunatitative relationships between standard ion dose and the quantities 'exposure' and air kerma, as given in the ICRU publication 33 'Quantities and Units' (1980), are explained. The standard introduces the SI units Gray (for energy dose), Sievert (for dose equivalent), and Becquerel (for the activity of a radioactive substance). As the change to the SI units conceals the approximated equality of the numerical values of the standrd ion dose of photon radiation in roentgen, of the energy dose for soft tissue in rad, and of the dose equivalent in rem, new definitions are given in accordance with ICRU 33 for the quantities specified dose rate, dose rate constant, and area exposure product. These definitions use the terms 'energy dose' and 'kerma'. The dose concepts applied in the field of radiation protection, especially ambient dose and individual dose, are defined as dose equivalents in compliance with the Radiation Protection Ordinance. The relevant sections present information on the conversion of standard ion dose values to the corresponding values of kerma, energy dose, or dose equivalent. (orig./HP) [de

  17. A review of the literature and discussion: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach.

    Science.gov (United States)

    Brackstone, Murial

    2016-09-01

    Chronic pain presents a management challenge for physicians and patients alike, and post-mastectomy pain is no exception. In this issue, Waltho and Rockwell present a review of post-mastectomy pain syndrome (PMPS) and propose a standard definition that should allow future studies to be comparable. The proposed definition of "post-breast surgery pain syndrome" includes pain after any type of breast surgery that is of at least moderate intensity and comprises neuropathic qualities, that is present in the ipsilateral breast/chest/arm, that lasts longer than 6 months and is present at least half the time. Further work is needed to clarify whether this pain syndrome is in fact driven by neuralgia resulting from the axillary dissection component of breast cancer surgery.

  18. Quality assurance terms and definitions - approved 1973

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    Standards for certain terms and their definitions that are important to the uniform understanding of the intent of required quality assurance practices for the construction of nuclear power plants are presented

  19. The SGML Standardization Framework and the Introduction of XML

    Science.gov (United States)

    Grütter, Rolf

    2000-01-01

    Extensible Markup Language (XML) is on its way to becoming a global standard for the representation, exchange, and presentation of information on the World Wide Web (WWW). More than that, XML is creating a standardization framework, in terms of an open network of meta-standards and mediators that allows for the definition of further conventions and agreements in specific business domains. Such an approach is particularly needed in the healthcare domain; XML promises to especially suit the particularities of patient records and their lifelong storage, retrieval, and exchange. At a time when change rather than steadiness is becoming the faithful feature of our society, standardization frameworks which support a diversified growth of specifications that are appropriate to the actual needs of the users are becoming more and more important; and efforts should be made to encourage this new attempt at standardization to grow in a fruitful direction. Thus, the introduction of XML reflects a standardization process which is neither exclusively based on an acknowledged standardization authority, nor a pure market standard. Instead, a consortium of companies, academic institutions, and public bodies has agreed on a common recommendation based on an existing standardization framework. The consortium's process of agreeing to a standardization framework will doubtlessly be successful in the case of XML, and it is suggested that it should be considered as a generic model for standardization processes in the future. PMID:11720931

  20. 78 FR 27857 - United States Standards for Wheat

    Science.gov (United States)

    2013-05-13

    ... RIN 0580-AB12 United States Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards... (GIPSA) is revising the United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change...

  1. Combinatorics of transformations from standard to non-standard bases in Brauer algebras

    International Nuclear Information System (INIS)

    Chilla, Vincenzo

    2007-01-01

    Transformation coefficients between standard bases for irreducible representations of the Brauer centralizer algebra B f (x) and split bases adapted to the B f 1 (x) x B f 2 (x) subset of B f (x) subalgebra (f 1 + f 2 = f) are considered. After providing the suitable combinatorial background, based on the definition of the i-coupling relation on nodes of the subduction grid, we introduce a generalized version of the subduction graph which extends the one given in Chilla (2006 J. Phys. A: Math. Gen. 39 7657) for symmetric groups. Thus, we can describe the structure of the subduction system arising from the linear method and give an outline of the form of the solution space. An ordering relation on the grid is also given and then, as in the case of symmetric groups, the choices of the phases and of the free factors governing the multiplicity separations are discussed

  2. 40 CFR 427.41 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Specialized definitions. 427.41 Section 427.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS ASBESTOS MANUFACTURING POINT SOURCE CATEGORY Asbestos Paper (Elastomeric Binder...

  3. Standardization process for pipeline right-of-way activities: the case of TRANSPETRO's Oil Pipeline and Terminals Business Unit

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Kassandra Senra de Morais M.; Goncalves, Bruno Martins [TRANSPETRO - PETROBRAS Transporte S.A., Rio de Janeiro, RJ (Brazil). Diretoria de Terminais e Oleodutos; Almeida, Maria Fatima Ludovico de [Pontificia Universidade Catolica do Rio de Janeiro (PUC-Rio/ITUC), Rio de Janeiro, RJ (Brazil). Instituto Tecnologico

    2009-07-01

    This paper describes the experience of PETROBRAS Transporte S.A. concerning the standardization process for its pipeline right-of-way (ROW) activities. This standardization initiative has been carried out within the Oil Pipelines and Terminals Standardization Program (PRONOT), focusing on planning, standardization and implementation of all norms and corporate procedures referring to TRANSPETRO's right-of-way activities. The process promoted the integration of isolated regional initiatives, a sense of unity and the creation of a learning network consisting of 60 employees. This paper presents the last phase's results concerning implementation of corporate standards, based upon achievements of previous phases. It covers the following topics: a general view of the whole process by way of introduction; the potential of integration of recent standardization results with TRANSPETRO's corporate management tools and information systems; definition of four performance indicators and their metrics related to pipeline right-of-way management, as well as a corporate standard for the requirements for contracting services related to rights-of-way inspection, maintenance and communication; challenges, barriers and benefits perceived by the team responsible for formulating and implementing standards and procedures in TRANSPETRO's Oil Pipelines and Terminals Unit. (author)

  4. Suggested improvements to the definitions of Standardized Plant Analysis of Risk-Human Reliability Analysis (SPAR-H) performance shaping factors, their levels and multipliers and the nominal tasks

    International Nuclear Information System (INIS)

    Laumann, Karin; Rasmussen, Martin

    2016-01-01

    This paper discusses the definitions and content of eight performance shaping factors (PSFs) used in Standardized Plant Analysis of Risk-Human Reliability Analysis (SPAR-H) and their levels and multipliers. Definitions of nominal tasks are also discussed. The discussion is based on a review of literature on PSFs, interviews with consultants who have carried out SPAR-H analysis in the petroleum industry and an evaluation of human reliability analysis reports based on SPAR-H analysis. We concluded that SPAR-H definitions and descriptions of the PSFs are unclear and overlap too much, making it difficult for the analyst to choose between them and select the appropriate level. This reduces inter-rater reliability and thus the consistency of SPAR-H analyses. New definitions of the PSFs, levels and multipliers are suggested with the aim to develop more specific definitions of the PSFs in order to increase the inter-rater reliability of SPAR-H. Another aim was to construct more varied and more nuanced levels and multipliers to improve the capacity of SPAR-H analysis to capture the degree of difficulty faced by operators in different scenarios. We also suggest that only one of two nominal SPAR-H tasks should be retained owing to the difficulty in distinguishing between them. - Highlights: • The SPAR-H guidelines should be revised. • Descriptions of the PSFs should be improved. • New definitions should reduce overlap between the PSFs. • The multipliers are based on an “old” method and should be revised. • Some PSF levels and multipliers in SPAR-H are not logical.

  5. 7 CFR 210.2 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... of the cost of that lunch. Yogurt means commercially prepared coagulated milk products obtained by the fermentation of specific bacteria, that meet milk fat or milk solid requirements and to which...'s Definition and Standard of Identity for yogurt, lowfat yogurt, and nonfat yogurt, 21 CFR 131.200...

  6. 7 CFR 220.2 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... department of education. Yogurt means commercially prepared coagulated milk products obtained by the fermentation of specific bacteria, that meet milk fat or milk solid requirements and to which flavoring foods... Definition and Standard of Identity for yogurt, lowfat yogurt, and nonfat yogurt, 21 CFR 131.200, 21 CFR 131...

  7. 29 CFR 29.2 - Definitions.

    Science.gov (United States)

    2010-07-01

    ..., as provided for in the criteria described in § 29.3(g) and (h). Quality assurance assessment means a... technical assistance; conducting reviews for compliance with 29 CFR parts 29 and 30 and quality assurance... of Labor LABOR STANDARDS FOR THE REGISTRATION OF APPRENTICESHIP PROGRAMS § 29.2 Definitions...

  8. 29 CFR 1910.251 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Welding, Cutting and Brazing § 1910.251 Definitions. As used in this subpart: (a) Welder and welding operator mean any operator of electric or gas welding and cutting equipment. (b) Approved means listed or approved by a nationally recognized testing laboratory. Refer to...

  9. 49 CFR 541.4 - Definitions.

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR VEHICLE THEFT PREVENTION STANDARD § 541.4 Definitions. (a... same make. (4) 1990/91 median theft rate means 3.5826 thefts per thousand vehicles produced. (5... surface means, with respect to a vehicle part, a surface that is not directly exposed to sun and...

  10. 30 CFR 57.4000 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Definitions. 57.4000 Section 57.4000 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Fire Prevention and Control § 57...

  11. 40 CFR 427.31 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Specialized definitions. 427.31 Section 427.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS ASBESTOS MANUFACTURING POINT SOURCE CATEGORY Asbestos Paper (Starch Binder) Subcategory...

  12. 40 CFR 428.61 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Specialized definitions. 428.61 Section 428.61 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS RUBBER MANUFACTURING POINT SOURCE CATEGORY Medium-Sized General Molded, Extruded, and...

  13. Consensus Statement on Research Definitions for Drug-Resistant Tuberculosis in Children.

    Science.gov (United States)

    Seddon, James A; Perez-Velez, Carlos M; Schaaf, H Simon; Furin, Jennifer J; Marais, Ben J; Tebruegge, Marc; Detjen, Anne; Hesseling, Anneke C; Shah, Sarita; Adams, Lisa V; Starke, Jeffrey R; Swaminathan, Soumya; Becerra, Mercedes C

    2013-06-01

    Few children with drug-resistant (DR) tuberculosis (TB) are identified, diagnosed, and given an appropriate treatment. The few studies that have described this vulnerable population have used inconsistent definitions. The World Health Organization (WHO) definitions used for adults with DR-TB and for children with drug-susceptible TB are not always appropriate for children with DR-TB. The Sentinel Project on Pediatric Drug-Resistant Tuberculosis was formed in 2011 as a network of experts and stakeholders in childhood DR-TB. An early priority was to establish standardized definitions for key parameters in order to facilitate study comparisons and the development of an evidence base to guide future clinical management. This consensus statement proposes standardized definitions to be used in research. In particular, it suggests consistent terminology, as well as definitions for measures of exposure, drug resistance testing, previous episodes and treatment, certainty of diagnosis, site and severity of disease, adverse events, and treatment outcome. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society.

  14. Comparative Test Case Specification

    DEFF Research Database (Denmark)

    Kalyanova, Olena; Heiselberg, Per

     This document includes a definition of the comparative test cases DSF200_3 and DSF200_4, which previously described in the comparative test case specification for the test cases DSF100_3 and DSF200_3 [Ref.1]....... This document includes a definition of the comparative test cases DSF200_3 and DSF200_4, which previously described in the comparative test case specification for the test cases DSF100_3 and DSF200_3 [Ref.1]....

  15. Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

    Science.gov (United States)

    Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

    2009-10-01

    The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

  16. Starworld: Preparing Accountants for the Future: A Case-Based Approach to Teach International Financial Reporting Standards Using ERP Software

    Science.gov (United States)

    Ragan, Joseph M.; Savino, Christopher J.; Parashac, Paul; Hosler, Jonathan C.

    2010-01-01

    International Financial Reporting Standards now constitute an important part of educating young professional accountants. This paper looks at a case based process to teach International Financial Reporting Standards using integrated Enterprise Resource Planning software. The case contained within the paper can be used within a variety of courses…

  17. The definitive diagnostic process and successful treatment for ABPM caused by Schizophyllum commune: a report of two cases.

    Science.gov (United States)

    Ogawa, Haruhiko; Fujimura, Masaki; Takeuchi, Yasuo; Makimura, Koichi; Satoh, Kazuo

    2012-03-01

    Although mucoid impaction of the bronchi (MIB) is a well-known manifestation in allergic bronchopulmonary mycosis (ABPM), when unknown samples or plural eumycetes are cultured from bronchial materials, several problems are encountered which can affect the definitive diagnostic process or successful treatment. The definitive diagnostic process of two patients [a 58-(Case 1) and a 70-(Case 2) year-old female] with MIB was: 1) to identify the existence of any allergic respiratory disorder, 2) to detect the fungi obtained from bronchial materials, with use of the 28S rDNA sequencing and analysis, 3) to investigate whether the detected fungus was a probable etiologic antigen, and 4) to make the final diagnosis based on the results of the inhalation examinations using the antigenic solution of the fungi. As a treatment strategy, bronchial toilet and low dose itraconazole therapy were planned according to the clinical manifestations of each patient. The two patients with MIB were successfully diagnosed as ABPM caused by Schizophyllum commune (Sc-ABPM) accompanied with hyperattenuating mucoid impaction. The reliability of some allergological makers as a substitution for the bronchoprovocation test should be clarified in near future. Clinical manifestations demonstrated in our cases suggested that the allergic reaction such as eosinophilic bronchoalveolitis spreading around the mucus plug was a primary lesion underlying the Sc-ABPM. The success of the treatment for Sc-ABPM will be achieved by the strategy targeting to fundamental condition and by the control of the disease recurrence by means of effective environmental management.

  18. 78 FR 37404 - Small Business Size Standards: Support Activities for Mining

    Science.gov (United States)

    2013-06-20

    ... assistance programs, SBA establishes small business size definitions (referred to as size standards) for... million should be the limit of a small business definition and anything larger than that, such as that SBA... Business Act (15 U.S.C. 632(a)) (Act) requires that small business size definitions vary to reflect...

  19. 49 CFR 543.4 - Definitions.

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF TRANSPORTATION EXEMPTION FROM VEHICLE THEFT PREVENTION STANDARD § 543.4 Definitions. (a) Statutory terms. All terms defined in sections 2, 601, and 605 of the Motor Vehicle Information and Cost... a group of motor vehicles of the same make which have the same body or chassis, or otherwise are...

  20. 30 CFR 56.4000 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Definitions. 56.4000 Section 56.4000 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Fire Prevention and Control § 56.4000...

  1. 5 CFR 550.703 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Severance Pay § 550.703 Definitions. In this subpart: Agency means an agency as defined in 5 U.S.C. 5595(a... expectations of the local community. When an employee's residence is within the standard commuting area for a...

  2. 77 FR 23420 - United States Standards for Wheat

    Science.gov (United States)

    2012-04-19

    ... and Stockyards Administration 7 CFR Part 810 RIN 0580-AB12 United States Standards for Wheat AGENCY..., 2012, regarding a proposal to revise the U.S. Standards for Wheat under the U.S. Grain Standards Act. The proposed rule would change the definition of Contrasting classes in Hard White wheat and change...

  3. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints...... in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US...... pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis....

  4. 40 CFR 417.81 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 417.81 Section 417.81 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Soaps Subcategory...

  5. 40 CFR 407.51 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 407.51 Section 407.51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Dehydrated Potato...

  6. 40 CFR 407.41 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 407.41 Section 407.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Frozen Potato Products...

  7. 40 CFR 407.31 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 407.31 Section 407.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Citrus Products...

  8. 40 CFR 407.21 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 407.21 Section 407.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Apple Products...

  9. 40 CFR 407.11 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 407.11 Section 407.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Apple Juice...

  10. 40 CFR 436.241 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Specialized definitions. 436.241 Section 436.241 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY Diatomite Subcategory § 436.241...

  11. Just-in-time inventions and the development of standards : how firms use opportunistic strategies to obtain standard-essential patents (SEPs)

    NARCIS (Netherlands)

    Kang, B.; Bekkers, R.N.A.

    2013-01-01

    Recent years have seen large-scale litigation of standard-essential patents between companies like Apple, Samsung, Google, Motorola and Microsoft. Such patents are particular because they are, by definition, indispensable to any company wishing to implement a technical standard. Firms that do not

  12. Sepsis Definitions: The Search for Gold and What CMS Got Wrong.

    Science.gov (United States)

    Kalantari, Annahieta; Mallemat, Haney; Weingart, Scott D

    2017-08-01

    On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.

  13. Dynamic Target Definition: A novel approach for PTV definition in ion beam therapy

    International Nuclear Information System (INIS)

    Cabal, Gonzalo A.; Jäkel, Oliver

    2013-01-01

    Purpose: To present a beam arrangement specific approach for PTV definition in ion beam therapy. Materials and methods: By means of a Monte Carlo error propagation analysis a criteria is formulated to assess whether a voxel is safely treated. Based on this a non-isotropical expansion rule is proposed aiming to minimize the impact of uncertainties on the dose delivered. Results: The method is exemplified in two cases: a Head and Neck case and a Prostate case. In both cases the modality used is proton beam irradiation and the sources of uncertainties taken into account are positioning (set up) errors and range uncertainties. It is shown how different beam arrangements have an impact on plan robustness which leads to different target expansions necessary to assure a predefined level of plan robustness. The relevance of appropriate beam angle arrangements as a way to minimize uncertainties is demonstrated. Conclusions: A novel method for PTV definition in on beam therapy is presented. The method show promising results by improving the probability of correct dose CTV coverage while reducing the size of the PTV volume. In a clinical scenario this translates into an enhanced tumor control probability while reducing the volume of healthy tissue being irradiated

  14. Tacit definitions of informal caregiving.

    Science.gov (United States)

    Wrubel, J; Richards, T A; Folkman, S; Acree, M C

    2001-01-01

    This study describes three tacit definitions of informal caregiving and explores the extent to which differences in these tacit definitions explain variation in caregivers' negative mood over time. There is a growing need to understand the sources of stress and gratification for informal caregivers. Tacit definitions of informal caregiving refer to caregivers' understanding of what caregiving entails. These definitions are tacit because they arise from caregivers' taken-for-granted understanding rather than formally articulated positions concerning caregiving. A random sample of 60 men, all of whom were caregiving partners of men with acquired immunodeficiency syndrome (AIDS), was drawn from a larger cohort of 253 participants in the University of California San Francisco (UCSF) Coping Project (1990-1997). The caregivers were assessed bimonthly for 2 years with procedures that included a semi-structured interview focusing on a recent stressful event involving caregiving, and quantitative measures of well-being. Interpretive phenomenological case studies of the narrative accounts of the 60 caregivers produced three tacit definitions of caregiving - engagement, conflict and distance. These three tacit definitions were distinguished by differences in learning about caregiving, involvement in health care decisions, caregiving activities and reported sources of stress. The three groups differed on measures of dyadic adjustment, depression, anger and anxiety. Better understanding of caregivers' tacit definitions can facilitate and enhance effective support and interventions for caregivers.

  15. Evaluation of an influenza-like illness case definition in the diagnosis of influenza among patients with acute febrile illness in Cambodia.

    Science.gov (United States)

    Kasper, Matthew R; Wierzba, Thomas F; Sovann, Ly; Blair, Patrick J; Putnam, Shannon D

    2010-11-07

    Influenza-like illness (ILI) is often defined as fever (>38.0°C) with cough or sore throat. In this study, we tested the sensitivity, specificity, and positive and negative predictive values of this case definition in a Cambodia patient population. Passive clinic-based surveillance was established at nine healthcare centers to identify the causes of acute undifferentiated fever in patients aged two years and older seeking treatment. Fever was defined as tympanic membrane temperature >38°C lasting more than 24 hours and less than 10 days. Influenza virus infections were identified by polymerase chain reaction. From July 2008 to December 2008, 2,639 patients were enrolled. From 884 (33%) patients positive for influenza, 652 presented with ILI and 232 acute fever patients presented without ILI. Analysis by age group identified no significant differences between influenza positive patients from the two groups. Positive predictive values (PPVs) varied during the course of the influenza season and among age groups. The ILI case definition can be used to identify a significant percentage of patients with influenza infection during the influenza season in Cambodia, assisting healthcare providers in its diagnosis and treatment. However, testing samples based on the criteria of fever alone increased our case detection by 34%.

  16. Definition of the Flexible Image Transport System (FITS), Version 3.0

    Science.gov (United States)

    Pence, W. D.; Chiapetti, L.; Page, C. G.; Shaw, R. A.; Stobie, E.

    2010-01-01

    The Flexible Image Transport System (FITS) has been used by astronomers for over 30 years as a data interchange and archiving format; FITS files are now handled by a wide range of astronomical software packages. Since the FITS format definition document (the "standard") was last printed in this journal in 2001, several new features have been developed and standardized, notably support for 64-bit integers in images and tables, variable-length arrays in tables, and new world coordinate system conventions which provide a mapping from an element in a data array to a physical coordinate on the sky or within a spectrum. The FITS Working Group of the International Astronomical Union has therefore produced this new Version 3.0 of the FITS standard, which is provided here in its entirety. In addition to describing the new features in FITS, numerous editorial changes were made to the previous version to clarify and reorganize many of the sections. Also included are some appendices which are not formally part of the standard. The FITS standard is likely to undergo further evolution, in which case the latest version may be found on the FITS Support Office Web site at http://fits.gsfc.nasa.gov/, which also provides many links to FITS-related resources.

  17. 48 CFR 52.222-11 - Subcontracts (Labor Standards).

    Science.gov (United States)

    2010-10-01

    ...: Subcontracts (Labor Standards) (JUL 2005) (a) Definition. Construction, alteration or repair, as used in this... dedicated to the construction of the building or work and is deemed part of the site of the work within the meaning of paragraph (2) of the “site of work” definition; and (5) Transportation of portions of the...

  18. Standardized terminology in electronic

    International Nuclear Information System (INIS)

    Pallas, R.

    1985-01-01

    The correct definitions of the most usual terms on standardization and homologation are given. Then the factors concerning the safety of electrical equipments are reviewed, as they are considered in most of the present legislations. Last, the state of homologations in Spain and Europe is included. (author)

  19. Clinical case definition and manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome.

    Science.gov (United States)

    Manosuthi, Weerawat; Van Tieu, Hong; Mankatitham, Wiroj; Lueangniyomkul, Aroon; Ananworanich, Jintanat; Avihingsanon, Anchalee; Siangphoe, Umaporn; Klongugkara, Sukonsri; Likanonsakul, Sirirat; Thawornwan, Unchana; Suntisuklappon, Bussakorn; Sungkanuparph, Somnuek

    2009-11-27

    The International Network for the Study of HIV-associated IRIS (INSHI) recently published criteria for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) diagnosis. The performance of this definition and clinical manifestations of TB-IRIS were studied. Antiretroviral therapy-naive HIV/TB Thai patients receiving antituberculous therapy were enrolled during 2006-2007 and prospectively followed through 24 weeks of antiretroviral therapy. Patients were defined as having paradoxical TB-IRIS if they fulfilled the 'study definition' by French 2004 and were confirmed by an external reviewer. All were later compared by the classification according to 'INSHI-2008'. For the 126 patients, median baseline CD4 cell count was 43 cells/microl and HIV-1 RNA was 5.9 log(10) Y copies/ml. Seventy-three (58%) had extrapulmonary/disseminated TB. Twenty-two (18%) and 21 (17%) fulfilled TB-IRIS criteria according to the study definition and INSHI-2008 definition, respectively. Two (2%) were diagnosed by study definition only and one (1%) by INSHI-2008 definition only. Twenty (16%) were concordantly diagnosed by both definitions and 103 (82%) were consistently negative. Eighteen (82%) had worsening of a preexisting site, whereas four (18%) had TB-IRIS in a new location. Lymph node enlargement (73%) and fever (59%) were common in TB-IRIS. Sensitivity and specificity of INSHI-2008 was 91% (95% confidence interval, 72-98%) and 99% (95% confidence interval, 95-99.8%), respectively. Positive predictive value was 95% and negative predictive value was 98%. By multivariate analysis, factors predicting TB-IRIS were extrapulmonary TB (odds ratio, 8.63) and disseminated TB (odds ratio, 4.17). There was high concordance between the INSHI-2008 and French 2004 definition for TB-IRIS diagnosis in HIV/TB patients with relatively high rate of paradoxical TB-IRIS. This suggests that lack of HIV-1 RNA and CD4 cell count monitoring does not impede the ability to diagnose TB-IRIS.

  20. 21 CFR 146.3 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... CONSUMPTION CANNED FRUIT JUICES General Provisions § 146.3 Definitions. For the purposes of this part: (a) The... hydrolyzed starch. (c) The term dried glucose sirup means the product obtained by drying glucose sirup. (d... following: Unless otherwise provided in a standard, a lot of canned fruits shall be deemed in compliance for...

  1. The emerging High Efficiency Video Coding standard (HEVC)

    International Nuclear Information System (INIS)

    Raja, Gulistan; Khan, Awais

    2013-01-01

    High definition video (HDV) is becoming popular day by day. This paper describes the performance analysis of latest upcoming video standard known as High Efficiency Video Coding (HEVC). HEVC is designed to fulfil all the requirements for future high definition videos. In this paper, three configurations (intra only, low delay and random access) of HEVC are analyzed using various 480p, 720p and 1080p high definition test video sequences. Simulation results show the superior objective and subjective quality of HEVC

  2. Definitional Arguments in Children’s Speech

    Directory of Open Access Journals (Sweden)

    Rebecca Schar

    2017-07-01

    Full Text Available Based on the debate on children’s ability to produce argumentative discourse in different edu­cational settings, this paper provides further support for the fact that small children are able to support their opinions with arguments. In particular, the paper makes a case in point on children’s appeal to definitional loci, when supporting their standpoints. The analysis of their reasoning’s implicit components shows how children apply different definitional arguments.

  3. Just-in-time inventions and the development of standards : how firms use opportunistic strategies to obtain standard-essential patents (SEPs)

    NARCIS (Netherlands)

    Kang, B.; Bekkers, R.N.A.

    2013-01-01

    Recent years have seen large-­scale litigation of standard-­essential patents between companies like Apple, Samsung, Google, Motorola and Microsoft. Such patents are particular because they are, by definition, indispensable to any company wishing to implement a technical standard. Firms that do not

  4. 40 CFR 415.641 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... AND STANDARDS INORGANIC CHEMICALS MANUFACTURING POINT SOURCE CATEGORY Cadmium Pigments and Salts Production Subcategory § 415.641 Specialized definitions. For the purpose of this subpart: (a) Except as... this chapter shall apply to this subpart. (b) The term product shall mean cadmium pigment or cadmium...

  5. 40 CFR 406.41 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 406.41 Section 406.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Bulgur Wheat Flour Milling Subcategory § 406.41 Specialized...

  6. 40 CFR 406.31 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. 406.31 Section 406.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Normal Wheat Flour Milling Subcategory § 406.31 Specialized...

  7. 40 CFR 439.11 - Special definitions.

    Science.gov (United States)

    2010-07-01

    ... STANDARDS PHARMACEUTICAL MANUFACTURING POINT SOURCE CATEGORY Fermentation Products § 439.11 Special definitions. For the purpose of this subpart: (a) Fermentation means process operations that utilize a... occurring in unicellular plants such as yeast, molds, or fungi to produce a specified product. (b) Product...

  8. 20 CFR 702.172 - Certification; definitions.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Certification; definitions. 702.172 Section 702.172 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR LONGSHOREMEN'S... engaged in commerce but does not include military vessels or Coast Guard vessels. (b) “Federal Maritime...

  9. Standard generalized markup language: A guide for transmitting encoded bibliographic records

    International Nuclear Information System (INIS)

    1994-09-01

    This document provides the guidance necessary to transmit to DOE's Office of Scientific and Technical Information (OSTI) an encoded bibliographic record that conforms to International Standard ISO 8879, Information Processing -- Text and office systems -- Standard Generalized Markup Language (SGML). Included in this document are element and attribute tag definitions, sample bibliographic records, the bibliographic document type definition, and instructions on how to transmit a bibliographic record electronically to OSTI

  10. Standard generalized markup language: A guide for transmitting encoded bibliographic records

    Energy Technology Data Exchange (ETDEWEB)

    1994-09-01

    This document provides the guidance necessary to transmit to DOE`s Office of Scientific and Technical Information (OSTI) an encoded bibliographic record that conforms to International Standard ISO 8879, Information Processing -- Text and office systems -- Standard Generalized Markup Language (SGML). Included in this document are element and attribute tag definitions, sample bibliographic records, the bibliographic document type definition, and instructions on how to transmit a bibliographic record electronically to OSTI.

  11. Use of standardized multidimensional evaluation tools and the emergence of the case manager's professional identity in France.

    Science.gov (United States)

    Nugue, Mathilde; De Stampa, Matthieu; Couturier, Yves; Somme, Dominique

    2012-01-01

    In France, the national public health plan proposes a group of innovations including the initiation of case management for older adults in complex situations, particularly those with cognitive disorders. In this context, public authorities asked case managers to use a standardized multidimensional evaluation tool. The results of a qualitative study on the pertinence of such a tool relative to the emergence of this new professional field are described. Early use of an evaluation tool seems to be linked to the emergence of a new professional identity for recently recruited case managers. Factors determining the strength of this link are training tool standardization, computerization, and local structure's involvement. Our results contribute to identifying one of the ways by which professional identity can be changed to become a case manager.

  12. THE ADAPTATION VS. STANDARDIZATION DILEMMA: THE CASE OF AN AMERICAN COMPANY IN BRAZIL

    Directory of Open Access Journals (Sweden)

    Thelma Valéria Rocha

    2011-01-01

    Full Text Available This study analyzes the adaptation versus standardization dilemma in International Marketing in subsidiaries of multinationals corporations. It highlights the importance of GMS – global marketing strategies – in the ability to innovate in subsidiaries in emerging economies, as Brazil. The objective is to find out how the level of autonomy displayed by subsidiaries influences the adaptation vs. standardization dilemma, and, consequently, the marketing-mix program. The methodology followed is qualitative research using a case-study approach in an American multinational from the food sector. In this case, we found out that firm's brands are very important to this firm's success overseas, which sustains that brand policies should be defined carefully at both levels: subsidiaries and headquarters. This brand policy influences direct the autonomy to innovate in marketing at subsidiaries level. This study is useful for managers at subsidiaries who need to understand the importance of global marketing strategies, and also for managers at headquarters who need to verify in which circumstances autonomy pays off.

  13. Lattice cell diffusion coefficients. Definitions and comparisons

    International Nuclear Information System (INIS)

    Hughes, R.P.

    1980-01-01

    Definitions of equivalent diffusion coefficients for regular lattices of heterogeneous cells have been given by several authors. The paper begins by reviewing these different definitions and the unification of their derivation. This unification makes clear how accurately each definition (together with appropriate cross-section definitions to preserve the eigenvalue) represents the individual reaction rates within the cell. The approach can be extended to include asymmetric cells and whereas before, the buckling describing the macroscopic flux shape was real, here it is found to be complex. A neutron ''drift'' coefficient as well as a diffusion coefficient is necessary to produce the macroscopic flux shape. The numerical calculation of the various different diffusion coefficients requires the solutions of equations similar to the ordinary transport equation for an infinite lattice. Traditional reactor physics codes are not sufficiently flexible to solve these equations in general. However, calculations in certain simple cases are presented and the theoretical results quantified. In difficult geometries, Monte Carlo techniques can be used to calculate an effective diffusion coefficient. These methods relate to those already described provided that correlation effects between different generations of neutrons are included. Again, these effects are quantified in certain simple cases. (author)

  14. Humidity correction in the standard measurement of exposure

    International Nuclear Information System (INIS)

    Ibaraki, Yasuyuki; Katoh, Akira

    1980-01-01

    This paper deals with the humidity correction to be made in the standard measurement of the exposure to the measured ionization current in the humid air for the purpose of excluding the influence of the water vapour that is not included in the definition of the exposure. First, formulae giving the humidity correction factors for a parallel plate free air chamber and a cavity chamber have been derived respectively in the case where the contributions of air and water vapour to the ionization are independent. Next, in the case where the contributions are not independent, i.e., the Jesse effect is taken into account, a formula to obtain the W-value for humid air has been derived on the basis of the Niatel's experimental result. Using this formula, formulae to obtain the humidity correction factors for the free air chamber and the cavity chamber are derived. The humidity calculated by the latter formulae show good agreements with the results by Niatel and Guiho, respectively. (author)

  15. 29 CFR 4.1a - Definitions and use of terms.

    Science.gov (United States)

    2010-07-01

    ... includes any determination of minimum wage rates or fringe benefits made pursuant to the provisions of... 29 Labor 1 2010-07-01 2010-07-01 true Definitions and use of terms. 4.1a Section 4.1a Labor Office... Standards Provisions and Procedures § 4.1a Definitions and use of terms. As used in this part, unless...

  16. 10 CFR 851.3 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... ENERGY WORKER SAFETY AND HEALTH PROGRAM General Provisions § 851.3 Definitions. (a) As used in this part: AEA means the Atomic Energy Act of 1954, 42 U.S.C. 2011 et seq. Affected worker means a worker who... action to be appropriate. National defense variance means relief from a safety and health standard, or...

  17. 7 CFR 51.2547 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... Standards for Grades of Pistachio Nuts in the Shell § 51.2547 Definitions. (a) Well dried means the kernel... to nuts, or any substance other than pistachio shells or kernels. Glass, metal or live insects shall... inch round opening. (5) Undersize means pistachio nuts in the shell which fall through a 30/64 inch...

  18. Topological characteristics of brainstem lesions in clinically definite and clinically probable cases of multiple sclerosis: An MRI-study

    International Nuclear Information System (INIS)

    Brainin, M.; Omasits, M.; Reisner, T.; Neuhold, A.; Wicke, L.

    1987-01-01

    Disseminated lesions in the white matter of the cerebral hemispheres and confluent lesions at the borders of the lateral ventricles as seen on MRI are both considered acceptable paraclinical evidence for the diagnosis of multiple sclerosis. Similar changes are, however, also found in vascular diseases of the brain. We therefore aimed at identifying those additional traits in the infratentorial region, which in our experience are not frequently found in cerebrovascular pathology. We evaluated MR brain scans of 68 patients and found pontine lesions in 71% of cases with a clinically definite diagnosis (17 out of 24) and in 33% of cases with a probable diagnosis (14 out of 43). Lesions in the medulla oblongata were present in 50% and 16%, respectively, and in the midbrain in 25% and 7%, respectively. With rare exceptions all brainstem lesions were contiguous with the cisternal or ventricular cerebrospinal fluid spaces. In keeping with post-mortem reports the morphological spectrum ranged from large confluent patches to solitary, well delineated paramedian lesions or discrete linings of the cerebrospinal fluid border zones and were most clearly depicted from horizontal and sagittal T2 weighted SE-sequences. If there is a predilection for the outer or inner surfaces of the brainstem, such lesions can be considered an additional typical feature of multiple sclerosis and can be more reliably weighted as paraclinical evidence for a definite diagnosis. (orig.)

  19. Randomization and Data-Analysis Items in Quality Standards for Single-Case Experimental Studies

    Science.gov (United States)

    Heyvaert, Mieke; Wendt, Oliver; Van den Noortgate, Wim; Onghena, Patrick

    2015-01-01

    Reporting standards and critical appraisal tools serve as beacons for researchers, reviewers, and research consumers. Parallel to existing guidelines for researchers to report and evaluate group-comparison studies, single-case experimental (SCE) researchers are in need of guidelines for reporting and evaluating SCE studies. A systematic search was…

  20. On the definition of absorbed dose

    International Nuclear Information System (INIS)

    Grusell, Erik

    2015-01-01

    Purpose: The quantity absorbed dose is used extensively in all areas concerning the interaction of ionizing radiation with biological organisms, as well as with matter in general. The most recent and authoritative definition of absorbed dose is given by the International Commission on Radiation Units and Measurements (ICRU) in ICRU Report 85. However, that definition is incomplete. The purpose of the present work is to give a rigorous definition of absorbed dose. Methods: Absorbed dose is defined in terms of the random variable specific energy imparted. A random variable is a mathematical function, and it cannot be defined without specifying its domain of definition which is a probability space. This is not done in report 85 by the ICRU, mentioned above. Results: In the present work a definition of a suitable probability space is given, so that a rigorous definition of absorbed dose is possible. This necessarily includes the specification of the experiment which the probability space describes. In this case this is an irradiation, which is specified by the initial particles released and by the material objects which can interact with the radiation. Some consequences are discussed. Specific energy imparted is defined for a volume, and the definition of absorbed dose as a point function involves the specific energy imparted for a small mass contained in a volume surrounding the point. A possible more precise definition of this volume is suggested and discussed. Conclusions: The importance of absorbed dose motivates a proper definition, and one is given in the present work. No rigorous definition has been presented before. - Highlights: • A stringent definition of absorbed dose is given. • This requires the definition of an irradiation and a suitable probability space. • A stringent definition is important for an understanding of the concept absorbed dose

  1. 40 CFR 467.02 - General definitions.

    Science.gov (United States)

    2010-07-01

    ... coating and anodizing when performed as an integral part of the aluminum forming operations are considered... STANDARDS ALUMINUM FORMING POINT SOURCE CATEGORY General Provisions § 467.02 General definitions. In...) Aluminum forming is a set of manufacturing operations in which aluminum and aluminum alloys are made into...

  2. 40 CFR 432.101 - Special definitions.

    Science.gov (United States)

    2010-07-01

    ... slaughterhouse, packinghouse or poultry dressing or processing operation, uses raw material at rates greater than... STANDARDS MEAT AND POULTRY PRODUCTS POINT SOURCE CATEGORY Renderers § 432.101 Special definitions. For the... animal and poultry trimmings, bones, meat scraps, dead animals, feathers and related usable by-products...

  3. Definition of a Storage Accounting Record

    CERN Document Server

    Jensen, H. T.; Müller-Pfefferkorn, R.; Nilsen, J. K.; Zsolt, M.; Zappi, R.

    2011-01-01

    In this document a storage accounting record StAR is defined reflecting practical, financial and legal requirements of storage location, usage and space and data flow. The definition might be the base for a standardized schema or an extension of an existing record like the OGF UR.

  4. 48 CFR 9905.505-30 - Definitions.

    Science.gov (United States)

    2010-10-01

    ... are definitions of terms which are prominent in this Standard. Other terms defined elsewhere in this... express provisions of an applicable law, regulation, or contract, is specifically named and stated to be... is allocable. (b) The following modifications of terms defined elsewhere in this chapter 99 are...

  5. Nuclear Engineering Committee KTA. A collection of definitions as of January 16, 1987

    International Nuclear Information System (INIS)

    Riedel, U.

    1987-01-01

    The collection of definitions mainly comprises terms which are laid down in the recommendations of the Nuclear Engineering Committee (KTA) or in overriding regulations and specifications. The collection aims at a KTA-standardized use of terms and at the avoidance of groundless divergences. The compiled definitions are followed by a list of the sources considered, namely laws, ordinances, administrative recommendations, KTA regulations as well as other recommendations and standards. (orig./HSCH) [de

  6. Terms and definitions in the field of radiological technology. Begriffe und Benennungen in der radiologischen Technik

    Energy Technology Data Exchange (ETDEWEB)

    1983-01-01

    The radiation field condition ''secondary electron equilibrium'' as part of the definition for the standard ion dose is specified. The term ''free in air'' gets - contrary to DIN 6814, sec. 3, June 1972 issue - its original meaning, i.e. the definition of measuring conditions eliminating avoidable scatter. For measuring the standard ion dose, dose meters are calibrated ''free in air''. The quantity ''Standard ion dose'' can be measured in any material. The quantitative ratios between standard ion dose and the quantities ''exposure'' and ''air kerma'' as per ICRU report 33 ''Quantities and Units'' (1980) are described. The SI-units Gray, Sievert and Becquerel are introduced. For the quantities ''core dose rate'' ''dose rate constant'' and ''aereal dose product'' new definitions are given, according to the ICRU report 33, using the terms ''absorbed dose'' and ''kerma''.

  7. Making the Case for a Model-Based Definition of Engineering Materials (Postprint)

    Science.gov (United States)

    2017-09-12

    MBE relies on digi- tal representations, or a model-based definition (MBD), to define a product throughout design , manufacturing and sus- tainment...discovery through development, scale-up, product design and qualification, manufacture and sustainment have changed little over the past decades. This...testing data provided a certifiable material definition, so as to minimize risk and simplify procurement of materials during the design , manufacture , and

  8. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia.

    Science.gov (United States)

    Walsh, Michele C; Wilson-Costello, Deanna; Zadell, Arlene; Newman, Nancy; Fanaroff, Avroy

    2003-09-01

    Bronchopulmonary dysplasia (BPD) is the focus of many intervention trials, yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians. Thus, we wished to define BPD by a standardized oxygen saturation monitoring at 36 weeks corrected age, and compare this physiologic definition with the standard clinical definition of BPD based solely on oxygen administration. A total of 199 consecutive very low birthweight infants (VLBW, 501 to 1500 g birthweight) were assessed prospectively at 36+/-1 weeks corrected age. Neonates on positive pressure support or receiving >30% supplemental oxygen were assigned the outcome BPD. Those receiving or =88% for 60 minutes) or "BPD" (saturation reliability, test-retest reliability, and validity of the physiologic definition vs the clinical definition were assessed. A total of 199 VLBW were assessed, of whom 45 (36%) were diagnosed with BPD by the clinical definition of oxygen use at 36 weeks corrected age. The physiologic definition identified 15 infants treated with oxygen who successfully passed the saturation monitoring test in room air. The physiologic definition diagnosed BPD in 30 (24%) of the cohort. All infants were safely studied. The test was highly reliable (inter-rater reliability, kappa=1.0; test-retest reliability, kappa=0.83) and highly correlated with discharge home in oxygen, length of hospital stay, and hospital readmissions in the first year of life. The physiologic definition of BPD is safe, feasible, reliable, and valid and improves the precision of the diagnosis of BPD. This may be of benefit in future multicenter clinical trials.

  9. 16 CFR 1211.22 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... definitions shall apply to this subpart: (a) Private labeler means an owner of a brand or trademark which is used on an operator subject to the standard and which is not the brand or trademark of the manufacturer of the operator, provided the owner of the brand or trademark caused or authorized the operator to be...

  10. 16 CFR 1204.12 - Definitions.

    Science.gov (United States)

    2010-01-01

    ... following definitions shall apply to this subpart B of part 1204: (a) Private labeler means an owner of a brand or trademark which is used on the label of a CB antenna subject to the standard, which bears a... means a period of time determined by the manufacturer or importer that is appropriate for conducting a...

  11. 40 CFR 63.822 - Definitions.

    Science.gov (United States)

    2010-07-01

    ..., labels, liners and wraps utilizing paper, plastic, film, aluminum foil, metalized or coated paper or film... Standards for the Printing and Publishing Industry § 63.822 Definitions. (a) All terms used in this subpart... device. Car-seal means a seal that is placed on a device that is used to change the position of a valve...

  12. 78 FR 72533 - Energy Conservation Program: Energy Conservation Standards for Certain Consumer Products

    Science.gov (United States)

    2013-12-03

    ... published on October 23, 2013. That final rule adopted changes to definitions and energy conservation... revised definition and revised energy conservation standards for small duct high velocity central air... Congress has provided in the AEMTCA for the Secretary of Energy to revise definitions and energy...

  13. New Definitions of Electromagnetic Screening of Cases in Front of Radiates Interferences

    Science.gov (United States)

    Garcia Perez, Luis Gines

    results have been obtained for some definitions and used SE indicators for incident plane wave against enclosures in a specific bandwidth. The plane wave has been treated as a reference interference to compare to other electromagnetic interference cases. It has been verified that the laboratory measurements and the simulations are in good agreement. The effects of the electric (dipole) and magnetic (loop) probes presences have been analysed too, as they can modified the results. In this study new SE definitions (new indicators) have been evaluated too, and they have been compared with the classical time-domain SE definitions. These new indicators have been studied as function of several parameters that can be modified in the enclosures as the aperture dimensions or the enclosure dimensions. Finally, in order to get more generic solutions that can be useful to later SE studies, the new SE results have been analysed and interpreted for an aperture size scanning that provide an unique value for the more critical SE indicator and for an specific bandwidth allowing direct SE comparisons with other enclosures.

  14. Merging fluxgate and induction coil data to produce low-noise geomagnetic observatory data meeting the INTERMAGNET definitive 1 s data standard

    Science.gov (United States)

    Brunke, Heinz-Peter; Widmer-Schnidrig, Rudolf; Korte, Monika

    2017-11-01

    For frequencies above 30 mHz the instrument intrinsic noise level of typical fluxgate magnetometers used at geomagnetic observatories usually masks ambient magnetic field variations on magnetically quiet days. This is especially true for stations located at middle and low latitudes, where variations are generally smaller than at high latitudes. INTERMAGNET has set a minimum quality standard for definitive 1 s data. Natural field variations referred to as pulsations (Pc-1, Pc-2, Pi-1) fall in this band. Usually their intensity is so small that they rarely surpass the instrumental noise of fluxgate magnetometers. Moreover, high-quality magnetic field observations in the band 30 mHz-0.5 Hz contain interesting information, e.g., for the study of ionospheric electron interactions with electromagnetic ion cyclotron plasma waves. We propose a method to improve 1 Hz observatory data by merging data from the proven and tested fluxgate magnetometers currently in use with induction coil magnetometers into a single data stream. We show how measurements of both instruments can be combined without information loss or phase distortion. The result is a time series of the magnetic field vector components, combining the benefits of both instruments: long-term stability (fluxgate) and low noise at high frequencies (induction coil). This new data stream fits perfectly into the data management procedures of INTERMAGNET and meets the requirements defined in the definitive 1 s data standard. We describe the applied algorithm and validate the result by comparing power spectra of the fluxgate magnetometer output with the merged signal. Daily spectrograms from the Niemegk observatory show that the resulting data series reveal information at frequencies above 30 mHz that cannot be seen in raw fluxgate data.

  15. Development of a Conceptual Mapping Standard to Link Building and Geospatial Information

    Directory of Open Access Journals (Sweden)

    Taewook Kang

    2018-04-01

    Full Text Available This study introduces the BIM (building information modeling-GIS (geographic information system conceptual mapping (B2GM standard ISO N19166 and proposes a mapping mechanism. In addition, the major issues concerning BIM-GIS integration, and the considerations that it requires, are discussed. The B2GM is currently being standardized by the spatial-information international standardization organization TC211. Previous studies on BIM-GIS integration seem to focus on the integration of different types of model schemas and on the implementation of service interfaces. B2GM concerns the clear definition of the conditions and methods for mapping the object information required from the user’s use-case viewpoint for city-scale mapping. The benefits of the B2GM approach are that the user is able directly control the BIM-GIS linkage and integration process in order to acquire the necessary objection information. This can reveal cases of possibly unclear BIM-GIS integration outside the black box in an explicit and standard way, so that the user can distinctively predict the final output obtainable from the BIM-GIS integration. This study examined B2GM in terms of its development background, components, and several utilization examples, as well as the levels and considerations of the integration of different BIM-GIS models.

  16. Application of information retrieval approaches to case classification in the vaccine adverse event reporting system.

    Science.gov (United States)

    Botsis, Taxiarchis; Woo, Emily Jane; Ball, Robert

    2013-07-01

    Automating the classification of adverse event reports is an important step to improve the efficiency of vaccine safety surveillance. Previously we showed it was possible to classify reports using features extracted from the text of the reports. The aim of this study was to use the information encoded in the Medical Dictionary for Regulatory Activities (MedDRA(®)) in the US Vaccine Adverse Event Reporting System (VAERS) to support and evaluate two classification approaches: a multiple information retrieval strategy and a rule-based approach. To evaluate the performance of these approaches, we selected the conditions of anaphylaxis and Guillain-Barré syndrome (GBS). We used MedDRA(®) Preferred Terms stored in the VAERS, and two standardized medical terminologies: the Brighton Collaboration (BC) case definitions and Standardized MedDRA(®) Queries (SMQ) to classify two sets of reports for GBS and anaphylaxis. Two approaches were used: (i) the rule-based instruments that are available by the two terminologies (the Automatic Brighton Classification [ABC] tool and the SMQ algorithms); and (ii) the vector space model. We found that the rule-based instruments, particularly the SMQ algorithms, achieved a high degree of specificity; however, there was a cost in terms of sensitivity in all but the narrow GBS SMQ algorithm that outperformed the remaining approaches (sensitivity in the testing set was equal to 99.06 % for this algorithm vs. 93.40 % for the vector space model). In the case of anaphylaxis, the vector space model achieved higher sensitivity compared with the best values of both the ABC tool and the SMQ algorithms in the testing set (86.44 % vs. 64.11 % and 52.54 %, respectively). Our results showed the superiority of the vector space model over the existing rule-based approaches irrespective of the standardized medical knowledge represented by either the SMQ or the BC case definition. The vector space model might make automation of case definitions for

  17. 40 CFR 415.491 - Specialized definitions. [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Specialized definitions. [Reserved] 415.491 Section 415.491 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS INORGANIC CHEMICALS MANUFACTURING POINT SOURCE CATEGORY Oxygen and Nitrogen...

  18. 40 CFR 405.101 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... AND STANDARDS DAIRY PRODUCTS PROCESSING POINT SOURCE CATEGORY Dry Milk Subcategory § 405.101... definitions, abbreviations and methods of analysis set forth in part 401 of this chapter shall apply to this.... Composition of input materials may be based on either direct analysis or generally accepted published values. ...

  19. Teaching Undergraduate Accounting Majors How to Interpret the Accounting Standards Codification: An Alternative to Research Cases

    Science.gov (United States)

    Toerner, Michael C.; Swindle, C. Bruce; Burckel, Daryl V.

    2014-01-01

    Professional accountants regularly search the FASB'S Accounting Standards Codification to find answers to financial accounting questions. Accounting educators know this and frequently use research cases in an attempt to help students begin developing this ability. But many students struggle with these cases because they have not been taught how to…

  20. Standardizing the Term "Strategy" in Retail and Business Curriculum

    Science.gov (United States)

    Song, So Young

    2017-01-01

    Strategy is a key concept in retail and business education. Yet, this important term has evolved to include many definitions, which can create confusion in the classroom environment. This paper proposes a standardized use of the term "strategy" in retail and business classrooms. It suggests a focused definition of strategy as "the…

  1. The MSFC Collaborative Engineering Process for Preliminary Design and Concept Definition Studies

    Science.gov (United States)

    Mulqueen, Jack; Jones, David; Hopkins, Randy

    2011-01-01

    This paper describes a collaborative engineering process developed by the Marshall Space Flight Center's Advanced Concepts Office for performing rapid preliminary design and mission concept definition studies for potential future NASA missions. The process has been developed and demonstrated for a broad range of mission studies including human space exploration missions, space transportation system studies and in-space science missions. The paper will describe the design team structure and specialized analytical tools that have been developed to enable a unique rapid design process. The collaborative engineering process consists of integrated analysis approach for mission definition, vehicle definition and system engineering. The relevance of the collaborative process elements to the standard NASA NPR 7120.1 system engineering process will be demonstrated. The study definition process flow for each study discipline will be will be outlined beginning with the study planning process, followed by definition of ground rules and assumptions, definition of study trades, mission analysis and subsystem analyses leading to a standardized set of mission concept study products. The flexibility of the collaborative engineering design process to accommodate a wide range of study objectives from technology definition and requirements definition to preliminary design studies will be addressed. The paper will also describe the applicability of the collaborative engineering process to include an integrated systems analysis approach for evaluating the functional requirements of evolving system technologies and capabilities needed to meet the needs of future NASA programs.

  2. Unified definition of a class of Monte Carlo estimators

    International Nuclear Information System (INIS)

    Lux, I.

    1978-01-01

    A unified definition of a wide class of Monte Carlo reaction rate estimators is presented, since most commonly used estimators belong to that class. The definition is given through an integral transformation of an arbitrary estimator of the class. Since the transformation contains an arbitrary function, in principle an infinite number of new estimators can be defined on the basis of one known estimator. It is shown that the most common estimators belonging to the class, such as the track-length and expectation estimators, are special cases of transformation, corresponding to the simplest transformation kernels when transforming the usual collision estimator. A pair of new estimators is defined and their variances are compared to the variance of the expectation estimator. One of the new estimators, called the trexpectation estimator, seems to be appropriate for flux-integral estimation in moderator regions. The other one, which uses an intermediate estimation of the final result and is therefore called the self-improving estimator, always yields a lower variance than the expectation estimator. As is shown, this estimator approximates well to possibly the best estimator of the class. Numerical results are presented for the simplest geometries, and these results indicate that for absorbers that are not too strong, in practical cases the standard deviation of the self-improving estimator is less than that of the expectation estimator by more than 10%. The experiments also suggest that the self-improving estimator is always superior to the track-length estimator as well, i.e., that it is the best of all known estimators belonging to the class. In the Appendices, for simplified cases, approximate conditions are given for which the trexpectation and track-length estimators show a higher efficiency than the expectation estimator

  3. Claims-based definition of death in Japanese claims database: validity and implications.

    Science.gov (United States)

    Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

    2013-01-01

    For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations.

  4. Calibration of Flick standards

    International Nuclear Information System (INIS)

    Thalmann, Ruedi; Spiller, Jürg; Küng, Alain; Jusko, Otto

    2012-01-01

    Flick standards or magnification standards are widely used for an efficient and functional calibration of the sensitivity of form measuring instruments. The results of a recent measurement comparison have shown to be partially unsatisfactory and revealed problems related to the calibration of these standards. In this paper the influence factors for the calibration of Flick standards using roundness measurement instruments are discussed in detail, in particular the bandwidth of the measurement chain, residual form errors of the device under test, profile distortions due to the diameter of the probing element and questions related to the definition of the measurand. The different contributions are estimated using simulations and are experimentally verified. Also alternative methods to calibrate Flick standards are investigated. Finally the practical limitations of Flick standard calibration are shown and the usability of Flick standards both to calibrate the sensitivity of roundness instruments and to check the filter function of such instruments is analysed. (paper)

  5. Adult Current Smoking: Differences in Definitions and Prevalence Estimates—NHIS and NSDUH, 2008

    Science.gov (United States)

    Ryan, Heather; Trosclair, Angela; Gfroerer, Joe

    2012-01-01

    Objectives. To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH). Methods. 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen) were used. Results. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. Conclusions. Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions. PMID:22649464

  6. Adult current smoking: differences in definitions and prevalence estimates--NHIS and NSDUH, 2008.

    Science.gov (United States)

    Ryan, Heather; Trosclair, Angela; Gfroerer, Joe

    2012-01-01

    To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH). 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen) were used. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions.

  7. Adult Current Smoking: Differences in Definitions and Prevalence Estimates—NHIS and NSDUH, 2008

    Directory of Open Access Journals (Sweden)

    Heather Ryan

    2012-01-01

    Full Text Available Objectives. To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS and the National Survey on Drug Use and Health (NSDUH. Methods. 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen were used. Results. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. Conclusions. Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions.

  8. Some polite applause for the 2003 APA Division 30 definition of hypnosis.

    Science.gov (United States)

    Woody, Erik; Sadler, Pamela

    The authors argue that the new definition of hypnosis by Division 30 of the American Psychological Association contains questionable information about the role of imagination in hypnosis, about the use versus omission of the word hypnosis in inductions, and about the nature of individual differences and their relation to the standardized scales. In addition, the definition appears to conflate formal and exemplar-based types of definition, and it does not seem particularly well-tuned to the interests of lay persons. The authors advance some suggestions for future definitional efforts.

  9. Annual Book of ASTM Standards, Part 23: Water; Atmospheric Analysis.

    Science.gov (United States)

    American Society for Testing and Materials, Philadelphia, PA.

    Standards for water and atmospheric analysis are compiled in this segment, Part 23, of the American Society for Testing and Materials (ASTM) annual book of standards. It contains all current formally approved ASTM standard and tentative test methods, definitions, recommended practices, proposed methods, classifications, and specifications. One…

  10. 75 FR 75549 - Defense Federal Acquisition Regulation Supplement; Business Systems-Definition and Administration...

    Science.gov (United States)

    2010-12-03

    ..., et al. Defense Federal Acquisition Regulation Supplement; Business Systems-- Definition and... Regulation Supplement; Business Systems--Definition and Administration (DFARS Case 2009-D038) AGENCY: Defense.... SUPPLEMENTARY INFORMATION: I. Background DoD published a proposed rule for Business Systems--Definition and...

  11. Automatic extraction of legal concepts and definitions

    NARCIS (Netherlands)

    Winkels, R.; Hoekstra, R.

    2012-01-01

    In this paper we present the results of an experiment in automatic concept and definition extraction from written sources of law using relatively simple natural language and standard semantic web technology. The software was tested on six laws from the tax domain.

  12. Consensus standard requirements and guidance

    International Nuclear Information System (INIS)

    Putman, V.L.

    1995-01-01

    This report presents information from the ANS Criticality Alarm System Workshop relating to the consensus standard requirements and guidance. Topics presented include: definition; nomenclature; requirements and recommendations; purpose of criticality alarms; design criteria; signal characteristics; reliability, dependability and durability; tests; and emergency preparedness and planning

  13. 40 CFR 461.2 - General definitions.

    Science.gov (United States)

    2010-07-01

    ...) “Battery” means a modular electric power source where part or all of the fuel is contained within the unit... STANDARDS BATTERY MANUFACTURING POINT SOURCE CATEGORY General Provisions § 461.2 General definitions. In... heat cycle engine. In this regulation there is no differentiation between a single cell and a battery...

  14. Definition of the Flexible Image Transport System (FITS), version 3.0

    Science.gov (United States)

    Pence, W. D.; Chiappetti, L.; Page, C. G.; Shaw, R. A.; Stobie, E.

    2010-12-01

    The Flexible Image Transport System (FITS) has been used by astronomers for over 30 years as a data interchange and archiving format; FITS files are now handled by a wide range of astronomical software packages. Since the FITS format definition document (the “standard”) was last printed in this journal in 2001, several new features have been developed and standardized, notably support for 64-bit integers in images and tables, variable-length arrays in tables, and new world coordinate system conventions which provide a mapping from an element in a data array to a physical coordinate on the sky or within a spectrum. The FITS Working Group of the International Astronomical Union has therefore produced this new version 3.0 of the FITS standard, which is provided here in its entirety. In addition to describing the new features in FITS, numerous editorial changes were made to the previous version to clarify and reorganize many of the sections. Also included are some appendices which are not formally part of the standard. The FITS standard is likely to undergo further evolution, in which case the latest version may be found on the FITS Support Office Web site at http://fits.gsfc.nasa.gov/, which also provides many links to FITS-related resources.

  15. A re-audit of the use of definitions of sudden infant death syndrome (SIDS) in peer-reviewed literature.

    Science.gov (United States)

    Byard, Roger W; Lee, Vivian

    2012-11-01

    The use of different definitions of sudden infant death syndrome (SIDS) may make comparison of data among studies difficult. Fifty randomly selected papers dealing with SIDS that were published between 2010 and 2011 in peer-reviewed journals were reviewed to determine whether one of three internationally accepted definitions of SIDS had been either written in the text or referenced. A significant improvement in the use of definitions has occurred since 2005, with the percentage of papers either quoting or referencing a standard definition increasing by 26%, from 42 to 68%. The 1989 NICHD definition remained the most commonly used definition (35.1%) followed by the 2004 San Diego definition (26.3%). Although the percentage of papers where either no definition was provided or where an idiosyncratic or mis-cited definition was used fell 26%, from 58 to 32%, nearly one in three papers published on SIDS in peer-reviewed journals that were included in this study still did not cite a standard definition. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  16. Biofuel sustainability standards and public policy: A case study of Swedish ethanol imports from Brazil

    DEFF Research Database (Denmark)

    Bolwig, Simon; Gibbon, Peter

    sustainability standards for those fuels. Central to these standards are criteria addressing the direct, and sometimes also indirect, greenhouse gas emissions resulting from the production, transport and use of the biofuels. This case study examines the first scheme applied to a traded biofuel, the Verified...... Sustainable Ethanol Initiative (VSEI), a private initiative of the Swedish fuel-ethanol supplier, SEKAB. VSEI went into operation in August 2008 to verify that the ethanol it was importing from Brazil met its own minimum standards for ―field-to-wheel‖ (life-cycle) greenhouse-gas emission standards...... is that it reduces consumer doubts about their product, and reduces competition from producers not participating in the Initiative; for SEKAB it increases the company’s credibility in various private and public forums working on sustainability standards for biofuels, and gives it a first-mover advantage once...

  17. Overview of service oriented architecture: definition, use in ...

    African Journals Online (AJOL)

    Overview of service oriented architecture: definition, use in healthcare ... of service oriented architecture in Healthcare with focus on the pros and cons of its use as ... technologies adapted the required healthcare standards and challenges and ...

  18. 76 FR 28855 - Defense Federal Acquisition Regulation Supplement; Business Systems-Definition and Administration

    Science.gov (United States)

    2011-05-18

    ...; Business Systems-- Definition and Administration; Interim Rule #0;#0;Federal Register / Vol. 76 , No. 96...-AG58 Defense Federal Acquisition Regulation Supplement; Business Systems--Definition and Administration... an initial proposed rule for Business Systems-- Definition and Administration (DFARS Case 2009-D038...

  19. 44 CFR 61.14 - Standard Flood Insurance Policy Interpretations.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Standard Flood Insurance Policy Interpretations. 61.14 Section 61.14 Emergency Management and Assistance FEDERAL EMERGENCY...) Definition. A Standard Flood Insurance Policy Interpretation is a written determination by the Federal...

  20. Chronic Fatigue Syndrome – A clinically empirical approach to its definition and study

    Directory of Open Access Journals (Sweden)

    Papanicolaou Dimitris A

    2005-12-01

    Full Text Available Abstract Background The lack of standardized criteria for defining chronic fatigue syndrome (CFS has constrained research. The objective of this study was to apply the 1994 CFS criteria by standardized reproducible criteria. Methods This population-based case control study enrolled 227 adults identified from the population of Wichita with: (1 CFS (n = 58; (2 non-fatigued controls matched to CFS on sex, race, age and body mass index (n = 55; (3 persons with medically unexplained fatigue not CFS, which we term ISF (n = 59; (4 CFS accompanied by melancholic depression (n = 27; and (5 ISF plus melancholic depression (n = 28. Participants were admitted to a hospital for two days and underwent medical history and physical examination, the Diagnostic Interview Schedule, and laboratory testing to identify medical and psychiatric conditions exclusionary for CFS. Illness classification at the time of the clinical study utilized two algorithms: (1 the same criteria as in the surveillance study; (2 a standardized clinically empirical algorithm based on quantitative assessment of the major domains of CFS (impairment, fatigue, and accompanying symptoms. Results One hundred and sixty-four participants had no exclusionary conditions at the time of this study. Clinically empirical classification identified 43 subjects as CFS, 57 as ISF, and 64 as not ill. There was minimal association between the empirical classification and classification by the surveillance criteria. Subjects empirically classified as CFS had significantly worse impairment (evaluated by the SF-36, more severe fatigue (documented by the multidimensional fatigue inventory, more frequent and severe accompanying symptoms than those with ISF, who in turn had significantly worse scores than the not ill; this was not true for classification by the surveillance algorithm. Conclusion The empirical definition includes all aspects of CFS specified in the 1994 case definition and identifies persons with

  1. Spectrum of fungal keratitis:clinicopathologic study of 44 cases

    Directory of Open Access Journals (Sweden)

    Rajpal Singh Punia

    2014-02-01

    Full Text Available AIM:To determine the causative agents of fungal keratitis and study the predisposing factors over a period of ten years in a single tertiary care hospital.METHODS:A retrospective analysis of fungal corneal ulcers was done from 2003-2012. Patients’ clinical data were noted from the file records. Correlation of histopathological diagnosis was done with the report on fungal culture.RESULTS: Mycotic keratitis was established in 44 cases by a positive fungal culture. Direct microscopic examination of potassium hydroxide (KOH mounts revealed fungal elements in 39 cases while 40 cases showed fungus on Gram stained smears. Males (54.55% were more commonly affected than the females (45.45%. The age ranged from 18 to 82 years. Most common age group to be involved was 41-60 years. Predisposing risk factors were seen in 34 (77.27% cases. Most common findings on clinical examination were anterior chamber reaction and conjunctival injection seen in all the cases. Other common findings were stromal infiltration and hypopyon seen in 20 (45.45% and 18 (40.91% cases respectively. On histopathological examination the fungus was typed, as aspergillus in 34 cases while no definite typing was possible in 10 cases. The predominant isolate was aspergillus flavus (59.09% followed by fusarium (15.91%. Mixed fungal and bacterial infection was seen in 3 (6.82% cases.CONCLUSION:Although culture is the gold standard for definitive diagnosis of fungal keratitis, direct microscopic examination of corneal scrapings or histomorphological evaluation of biopsies allow a rapid preliminary diagnosis. Early administration of antifungal treatment helps in preventing dreadful complications.

  2. Enhancing the power of genetic association studies through the use of silver standard cases derived from electronic medical records.

    Directory of Open Access Journals (Sweden)

    Andrew McDavid

    Full Text Available The feasibility of using imperfectly phenotyped "silver standard" samples identified from electronic medical record diagnoses is considered in genetic association studies when these samples might be combined with an existing set of samples phenotyped with a gold standard technique. An analytic expression is derived for the power of a chi-square test of independence using either research-quality case/control samples alone, or augmented with silver standard data. The subset of the parameter space where inclusion of silver standard samples increases statistical power is identified. A case study of dementia subjects identified from electronic medical records from the Electronic Medical Records and Genomics (eMERGE network, combined with subjects from two studies specifically targeting dementia, verifies these results.

  3. 25 CFR 39.1001 - Definitions.

    Science.gov (United States)

    2010-04-01

    ... an in some cases providing administrative direction to one or more off-reservation boarding schools... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Administrative Cost Formula § 39.1001 Definitions. (a) Agency Education Office means a field office of the Office...

  4. High-definition television evaluation for remote handling task performance

    International Nuclear Information System (INIS)

    Fujita, Y.; Omori, E.; Hayashi, S.; Draper, J.V.; Herndon, J.N.

    1986-01-01

    This paper describes experiments designed to evaluate the impact of HDTV on the performance of typical remote tasks. The experiments described in this paper compared the performance of four operators using HDTV with their performance while using other television systems. The experiments included four television systems: (1) high-definition color television, (2) high-definition monochromatic television, (3) standard-resolution monochromatic television, and (4) standard-resolution stereoscopic monochromatic television. The stereo system accomplished stereoscopy by displaying two cross-polarized images, one reflected by a half-silvered mirror and one seen through the mirror. Observers wore a pair of glasses with cross-polarized lenses so that the left eye received only the view from the left camera and the right eye received only the view from the right camera

  5. 40 CFR 463.21 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... usage flow rate” for a plant with more than one plastics molding and forming process that uses cleaning... AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY Cleaning Water Subcategory § 463.21 Specialized definitions. For the purpose of this subpart: (a) The “average process water usage flow rate” of a...

  6. 40 CFR 463.31 - Specialized definitions.

    Science.gov (United States)

    2010-07-01

    ... usage flow rate” for a plant with more than one plastics molding and forming process that uses finishing... AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY Finishing Water Subcategory § 463.31 Specialized definitions. For the purpose of this subpart: (a) The “average process water usage flow rate” of a...

  7. A System Approach to Advanced Practice Clinician Standardization and High Reliability.

    Science.gov (United States)

    Okuno-Jones, Susan; Siehoff, Alice; Law, Jennifer; Juarez, Patricia

    Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs.

  8. Primary T cell central nervous system lymphoblastic lymphoma in a child: case report and literature review.

    Science.gov (United States)

    Mazur, Marcus D; Ravindra, Vijay M; Alashari, Mouied; Raetz, Elizabeth; Poppe, Matthew M; Bollo, Robert J

    2015-06-01

    Primary central nervous system lymphoma (PCNSL) of T cell origin is rare in pediatric patients. We report a case of T cell PCNSL in a 12-year-old boy and review the literature to highlight the importance of brain biopsy to definitively establish the diagnosis when PCNSL is suspected. A 12-year-old boy presented with worsening left-sided weakness, nausea, vomiting, headache, blurred vision, and diplopia. Magnetic resonance imaging revealed right parietal gyral thickening with faint meningeal contrast enhancement. No clear diagnosis was identified after serum testing, cerebrospinal fluid analysis, and cerebral angiography. To establish the diagnosis definitively, a right craniotomy and open, frameless stereotactic biopsy were performed, which yielded the diagnosis of lymphoblastic T cell lymphoma. PCNSL of T cell origin in children remains poorly studied, with only 18 detailed cases reported over the last three decades, including this case. Establishing a definitive diagnosis of PCNSL is challenging, and a brain biopsy is often required to obtain enough tissue for pathological analysis. Increasing awareness and identification of children diagnosed with T cell PCNSL is needed to better understand the molecular biology of this disease and develop more standardized treatment regimens.

  9. [Definition and specification requirements for PAC-systems (picture archiving and communication system). A performance index with reference to the standard "IEEE Recommended Practice for Software Requirement Specifications"].

    Science.gov (United States)

    König, H; Klose, K J

    1999-04-01

    The formulation of requirements is necessary to control the goals of a PACS project. Furthermore, in this way, the scope of functionality necessary to support radiological working processes becomes clear. Definitions of requirements and specification are formulated independently of systems according to the IEEE standard "Recommended Practice for Software Requirements Specifications". Definitions are given in the Request for Information, specifications in the Request for Proposal. Functional and non-functional requirements are distinguished. The solutions are rated with respect to scope, appropriateness and quality of implementation. A PACS checklist was created according to the methods described above. It is published on the homepage of the "Arbeitsgemeinschaft Informationstechnologie" (AGIT) within the "Deutsche Röntgengesellschaft" (DRG) (http://www.uni-marburg.de/mzr/agit). The checklist provides a discussion forum which should contribute to an agreement on accepted basic PACS functionalities.

  10. 76 FR 16263 - Revision to Electric Reliability Organization Definition of Bulk Electric System

    Science.gov (United States)

    2011-03-23

    ...; Order No. 743-A] Revision to Electric Reliability Organization Definition of Bulk Electric System AGENCY... certain provisions of the Final Rule. Order No. 743 directed the Electric Reliability Organization (ERO) to revise the definition of the term ``bulk electric system'' through the ERO's Reliability Standards...

  11. Definition of aggressive periodontitis in periodontal research. A systematic review

    DEFF Research Database (Denmark)

    Ramírez, Valeria; Hach, Maria; López, Rodrigo

    2018-01-01

    . Consequently, considerable variation in the understanding of aggressive periodontitis can be anticipated. AIM: To systematically asses, the definitions of aggressive periodontitis reported in original periodontal research. METHODS: A systematic review of original research on aggressive periodontitis published.......7% of the publications no information is provided as to how the cases were defined. Many combinations of criteria for case definition were found. CONCLUSIONS: This study revealed significant heterogeneity in the understanding and use of the term aggressive periodontitis in original research and poor documentation...

  12. Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications

    Science.gov (United States)

    Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

    2013-01-01

    Background For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. Methodology/Principal Findings We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. Conclusions/Significance The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations. PMID:23741526

  13. Definitions of fuel poverty: Implications for policy

    International Nuclear Information System (INIS)

    Moore, Richard

    2012-01-01

    This paper outlines why the definition of fuel poverty is important in policy formulation and describes how the Government's current definitions evolved from the original concept. It discusses the determination of income and fuel costs and the possibilities for a relative and common European measure. It examines problems inherent in assessing fuel costs as a percentage of income and puts forward the arguments for a ‘budget standard’ approach. The paper illustrates how the size of the problem depends on the definition and chosen threshold and suggests advantages for a rating scale. It illustrates how the income composition and thresholds also govern the distribution of the target populations and the relative importance of the main causal factors, and examines the consequent policy implications. It explores the definition of vulnerable households and the importance of severity and questions whether the UK fuel poverty strategy is targeted at households least able to afford their fuel costs (as the name implies) or primarily those at risk from excess winter and summer mortality and morbidity. Finally, after examining the role of supplementary indicators, it looks at the opportunities for changing the definition and comments on the Government review of the definition and targets. - Highlights: ► There are major failings in the existing official definitions of fuel poverty. ► expressing fuel costs as a percentage of income is a poor indicator of fuel poverty. ► A budget standard approach provides a more consistent, meaningful and fairer measure. ► The scale and nature of the problem changes dramatically with different definitions. ► The definition is crucial to the mix of policies and allocation of resources required.

  14. GENERIC QUALITY STANDARDS VS. SPECIFIC QUALITY STANDARDS: THE CASE OF HIGHER EDUCATION

    Directory of Open Access Journals (Sweden)

    Laila El Abbadi

    2011-06-01

    Full Text Available Quality as a new requirement for the field of higher education leads institutions to seek to satisfy generic or specific quality standards imposed directly or indirectly by its customers. The aim of this study is to compare between ISO9001, as a generic quality standard, and the Code of Practice of the Quality Assurance Agency for Higher Education (QAA, as a specific quality standard. A correlation matrix is drawn and correlation rates are calculated to show similarities and differences between them. This paper shows, first, that ISO9001 and QAA Code of Practice are compatible. Second, implementing a quality management system in accordance with ISO9001 requirements can constitute an adequate framework for the application of the QAA Code of Practice requirements. Third, to make the ISO9001 requirements closer to a specific quality standard in the field of higher education, it is recommended to complete these standards by specific requirements to the field of higher education.

  15. Elements of morphology: standard terminology for the external genitalia

    NARCIS (Netherlands)

    Hennekam, Raoul C. M.; Allanson, Judith E.; Biesecker, Leslie G.; Carey, John C.; Opitz, John M.; Vilain, Eric

    2013-01-01

    An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions

  16. 76 FR 70667 - Small Business Size Standards: Educational Services

    Science.gov (United States)

    2011-11-15

    ... business assistance, SBA establishes small business size definitions (referred to as size standards) for... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG29 Small Business Size Standards: Educational Services AGENCY: U.S. Small Business Administration. ACTION: Proposed rule. SUMMARY: The U.S...

  17. Avoiding pitfalls in molecular genetic testing: case studies of high-resolution array comparative genomic hybridization testing in the definitive diagnosis of Mowat-Wilson syndrome.

    Science.gov (United States)

    Kluk, Michael Joseph; An, Yu; James, Philip; Coulter, David; Harris, David; Wu, Bai-Lin; Shen, Yiping

    2011-05-01

    The molecular testing options available for the diagnosis of genetic disorders are numerous and include a variety of different assay platforms. The consultative input of molecular pathologists and cytogeneticists, working closely with the ordering clinicians, is often important for definitive diagnosis. Herein, we describe two patients who had long histories of unexplained signs and symptoms with a high clinical suspicion of an underlying genetic etiology. Initial molecular testing in both cases was negative, but the application of high-resolution array comparative genomic hybridization technology lead to definitive diagnosis in both cases. We summarize the clinical findings and molecular testing in each case, discuss the differential diagnoses, and review the clinical and pathological findings of Mowat-Wilson syndrome. This report highlights the importance for those involved in molecular testing to know the nature of the underlying genetic abnormalities associated with the suspected diagnosis, to recognize the limitations of each testing platform, and to persistently pursue repeat testing using high-resolution technologies when indicated. This concept is applicable to both germline and somatic molecular genetic testing. Copyright © 2011 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  18. Limiting value definition in radiation protection physics, legislation and toxicology. Fundamentals, contrasts, perspectives

    International Nuclear Information System (INIS)

    Smeddinck, Ulrich; Koenig, Claudia

    2016-01-01

    The volume is the documentation of an ENTRIA workshop discussion on limiting value definition in radiation protection including the following contributions: Introduction in radiation protection -fundamentals concepts of limiting values, heterogeneity; evaluation standards for dose in radiation protection in the context of final repository search; definition of limiting values in toxicology; public participation to limiting value definition - a perspective for the radiation protection regulation; actual developments in radiation protection.

  19. Clinical application of removable partial dentures using thermoplastic resin-part I: definition and indication of non-metal clasp dentures.

    Science.gov (United States)

    Fueki, Kenji; Ohkubo, Chikahiro; Yatabe, Masaru; Arakawa, Ichiro; Arita, Masahiro; Ino, Satoshi; Kanamori, Toshikazu; Kawai, Yasuhiko; Kawara, Misao; Komiyama, Osamu; Suzuki, Tetsuya; Nagata, Kazuhiro; Hosoki, Maki; Masumi, Shin-Ichi; Yamauchi, Mutsuo; Aita, Hideki; Ono, Takahiro; Kondo, Hisatomo; Tamaki, Katsushi; Matsuka, Yoshizo; Tsukasaki, Hiroaki; Fujisawa, Masanori; Baba, Kazuyoshi; Koyano, Kiyoshi; Yatani, Hirofumi

    2014-01-01

    This position paper proposes a definition and naming standard for removable partial dentures (RPDs) using thermoplastic resin, and presents a guideline for clinical application. A panel of 14 experts having broad experience with clinical application of RPDs using thermoplastic resin was selected from members of the Japan Prosthodontic Society. At a meeting of the panel, "non-metal clasp denture" was referred as the generic name of RPDs with retentive elements (resin clasps) made of thermoplastic resin. The panel classified non-metal clasp dentures into two types: one with a flexible structure that lacks a metal framework and the other having a rigid structure that includes a metal framework. According to current prosthetic principles, flexible non-metal clasp dentures are not recommended as definitive dentures, except for limited cases such as patients with a metal allergy. Rigid non-metal clasp dentures are recommended in cases where patients will not accept metal clasps for esthetic reasons. Non-metal clasp dentures should follow the same design principles as conventional RPDs using metal clasps. Copyright © 2013 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  20. Proposal for an absolute, atomic definition of mass

    International Nuclear Information System (INIS)

    Wignall, J.W.G.

    1991-11-01

    It is proposed that the mass of a particle be defined absolutely as its de Broglie frequency, measured as the mean de Broglie wavelength of the particle when it has a mean speed (v) and Lorentz factor γ; the masses of systems too large to have a measurable de Broglie wavelength mean are then to be derived by specifying the usual inertial and additive properties of mass. This definition avoids the use of an arbitrary macroscopic standard such as the prototype kilogram, and, if present theory is correct, does not even require the choice of a specific particle as a mass standard. Suggestions are made as to how this absolute mass can be realized and measured at the macroscopic level and, finally, some comments are made on the effect of the new definition on the form of the equations of physics. 19 refs

  1. 14 CFR 1261.602 - Definitions.

    Science.gov (United States)

    2010-01-01

    ...) Collection by Offset From Indebted Government Employees § 1261.602 Definitions. For purposes of this subpart..., rents, royalties, services, sales of real or personal property, overpayments, penalties, damages... pay, retired pay, retainer pay, or in the case of an employee not entitled to basic pay, other...

  2. 5 CFR 550.1103 - Definitions.

    Science.gov (United States)

    2010-01-01

    ...) Collection by Offset From Indebted Government Employees § 550.1103 Definitions. For purposes of this subpart... fees, leases, rents, royalties, services, sales of real or personal property, overpayments, penalties... current basic pay, special pay, incentive pay, retired pay, retainer pay, or in the case of an employee...

  3. Merging fluxgate and induction coil data to produce low-noise geomagnetic observatory data meeting the INTERMAGNET definitive 1 s data standard

    Directory of Open Access Journals (Sweden)

    H.-P. Brunke

    2017-11-01

    Full Text Available For frequencies above 30 mHz the instrument intrinsic noise level of typical fluxgate magnetometers used at geomagnetic observatories usually masks ambient magnetic field variations on magnetically quiet days. This is especially true for stations located at middle and low latitudes, where variations are generally smaller than at high latitudes. INTERMAGNET has set a minimum quality standard for definitive 1 s data. Natural field variations referred to as pulsations (Pc-1, Pc-2, Pi-1 fall in this band. Usually their intensity is so small that they rarely surpass the instrumental noise of fluxgate magnetometers. Moreover, high-quality magnetic field observations in the band 30 mHz–0.5 Hz contain interesting information, e.g., for the study of ionospheric electron interactions with electromagnetic ion cyclotron plasma waves. We propose a method to improve 1 Hz observatory data by merging data from the proven and tested fluxgate magnetometers currently in use with induction coil magnetometers into a single data stream. We show how measurements of both instruments can be combined without information loss or phase distortion. The result is a time series of the magnetic field vector components, combining the benefits of both instruments: long-term stability (fluxgate and low noise at high frequencies (induction coil. This new data stream fits perfectly into the data management procedures of INTERMAGNET and meets the requirements defined in the definitive 1 s data standard. We describe the applied algorithm and validate the result by comparing power spectra of the fluxgate magnetometer output with the merged signal. Daily spectrograms from the Niemegk observatory show that the resulting data series reveal information at frequencies above 30 mHz that cannot be seen in raw fluxgate data.

  4. Impacts of Policies on Poverty: The Definition of Poverty

    OpenAIRE

    Bellù, Lorenzo Giovanni; Liberati, Paolo

    2005-01-01

    This module illustrates how poverty can be defined in the context of policy impact analysis. After reporting and discussing the definition of poverty as “the lack of, or the inability to achieve, a socially acceptable standard of living”, it discusses the mono-dimensional and multi-dimensional approaches to the definition of poverty. Furthermore, the module focuses on the absolute and the relative concept of poverty, also drawing some analogies and differences with the concept of food secu...

  5. Automatic definition of prescription isodose for stereotactic irradiations of arteriovenous malformations

    International Nuclear Information System (INIS)

    Dejean, C.; Lefkopoulos, D.; Foulquier, J.N.; Schlienger, M.; Touboul, E.

    2001-01-01

    To evaluate dosimetric consequences generated by the automatic definition based on lesion coverage of prescription isodose. A clinical series of 124 arteriovenous malformations was analysed. Plan quality was quantified by the standard deviation of the differential dose volume histogram calculated in the lesion. We define two quantitative protocols based on lesion coverage for the automatic definition of prescription isodose using a volumetric definition of coverage (90% of lesion volume), and an isodose-based definition proposed) by RTOG (prescription isodose equals minimum isodose in the lesion divided by 0.9). We have evaluated the plans obtained for these two protocols, calculating several dose-volume indices. These indices are presented as a function of dose-volume histogram standard deviation in order to quantify the consequences of their variations for this representative series of plans. The margin our team tolerates is such that the sum of under-dosed lesion and overdosed healthy tissues factors remains lower than one. Protocol based on volumetric coverage gives results situated within this margin. Protocol based on RTOG definition produces conformation indices that could be greater than 1. The absolute dose would be decided taking into account examined dose-volume indices and clinical data. A protocol for automatic definition of prescription isodose using volumetric lesion coverage seems to be more judiciously adapted to arteriovenous malformation conformal plans in stereotactic conditions because of variations observed in the overdosage of healthy tissues. (authors)

  6. Definitions in use by the visible and near-infrared, and thermal working groups

    Science.gov (United States)

    Bruegge, Carol J.; Miller, ED; Martin, Bob; Kieffer, Hugh H.; Palmer, James M.

    1992-01-01

    The Calibration Advisory Panel (CAP) is composed of calibration experts from each of the Earth Observing System (EOS) instruments, science investigation, and cross-calibration teams. These members come from a variety of institutions and backgrounds. In order to facilitate an exchange of ideas, and assure a common basis for communication, it was desirable to assemble this list of definitions. These definitions were developed for use by the visible and near-infrared working group, and the thermal infrared working group. Where necessary or appropriate, deviations from these for specific instruments or other sensor types are given in the individual calibration plans. The definitions contained in this document are derived, wherever possible, from definitions accepted by international and national metrological commissions including the United States National Institute of Standards and Technology (NIST), the International Bureau of Weights and Measures (BIPM), the International Electrotechnical Commission (IEC), the International Organization for Standardization (ISO), and the International Organization of Legal Metrology (OIML).

  7. Experiences from Implementation of Lean Production: Standardization versus Self-management: A Swedish Case Study

    Directory of Open Access Journals (Sweden)

    Margareta Oudhuis

    2013-01-01

    Full Text Available In this article, we discuss important aspects of the perceived problematic relationship between self-management and standardization. The article presents data from three case studies conducted within manufacturing companies in Sweden, where the popularity of lean production has led to a renaissance for short-cycle and standardized assembly work in settings that traditionally have made use of sociotechnical production design. The data suggest that the implementation has not contributed to an increased commitment, smooth operations, and capacity for change and innovation. Despite these not so positive results, it is argued that it is possible to combine self-management principles with lean production and standardization if 1 the implementation of lean is done with a contextual sensitivity, 2 a balance is reached between the use of standards on the one hand and work enrichment on the other, and 3 a feeling of ownership as regards both implementation and production process is upheld among the product on personnel.

  8. Overdenture retained by teeth using a definitive denture base technique: a case report.

    Science.gov (United States)

    Nascimento, D F F; dos Santos, J F F; Marchini, L

    2010-09-01

    This paper presents a technique involving the use of a definitive denture base to make overdentures. Cores with ball attachments were cemented over remaining lower teeth. Impressions of the edentulous maxilla and mandible were taken to obtain a definitive acrylic resin base. The definitive base of the mandible was perforated at the location of ball attachments and its female components were fixed to the base using acrylic resin directly in the patient's mouth. Wax rims were then made, jaw relationships recorded, teeth mounted and tried in, and the dentures were cured. This technique allowed for easy fixing of female components and better retention during the recording of jaw relationships, and can also be used in the construction of implant retained dentures.

  9. Grain Elevators: New Source Performance Standards (NSPS)

    Science.gov (United States)

    The New Source Performance Standards (NSPS) for Grain Elevators aims to reduce particulate matter pollution. The new amendments seek to clarify definitions, and requirements, as well as propose new regulations on particulate matter emissions

  10. Integral definition of the logarithmic function and the derivative of the exponential function in calculus

    Science.gov (United States)

    Vaninsky, Alexander

    2015-04-01

    Defining the logarithmic function as a definite integral with a variable upper limit, an approach used by some popular calculus textbooks, is problematic. We discuss the disadvantages of such a definition and provide a way to fix the problem. We also consider a definition-based, rigorous derivation of the derivative of the exponential function that is easier, more intuitive, and complies with the standard definitions of the number e, the logarithmic, and the exponential functions.

  11. Inter- and intra-observer variation in soft-tissue sarcoma target definition.

    Science.gov (United States)

    Roberge, D; Skamene, T; Turcotte, R E; Powell, T; Saran, N; Freeman, C

    2011-08-01

    To evaluate inter- and intra-observer variability in gross tumor volume definition for adult limb/trunk soft tissue sarcomas. Imaging studies of 15 patients previously treated with preoperative radiation were used in this study. Five physicians (radiation oncologists, orthopedic surgeons and a musculoskeletal radiologist) were asked to contour each of the 15 tumors on T1-weighted, gadolinium-enhanced magnetic resonance images. These contours were drawn twice by each physician. The volume and center of mass coordinates for each gross tumor volume were extracted and a Boolean analysis was performed to measure the degree of volume overlap. The median standard deviation in gross tumor volumes across observers was 6.1% of the average volume (range: 1.8%-24.9%). There was remarkably little variation in the 3D position of the gross tumor volume center of mass. For the 15 patients, the standard deviation of the 3D distance between centers of mass ranged from 0.06 mm to 1.7 mm (median 0.1mm). Boolean analysis demonstrated that 53% to 90% of the gross tumor volume was common to all observers (median overlap: 79%). The standard deviation in gross tumor volumes on repeat contouring was 4.8% (range: 0.1-14.4%) with a standard deviation change in the position of the center of mass of 0.4mm (range: 0mm-2.6mm) and a median overlap of 93% (range: 73%-98%). Although significant inter-observer differences were seen in gross tumor volume definition of adult soft-tissue sarcoma, the center of mass of these volumes was remarkably consistent. Variations in volume definition did not correlate with tumor size. Radiation oncologists should not hesitate to review their contours with a colleague (surgeon, radiologist or fellow radiation oncologist) to ensure that they are not outliers in sarcoma gross tumor volume definition. Protocols should take into account variations in volume definition when considering tighter clinical target volumes. Copyright © 2011 Société française de radioth

  12. Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions: Findings From CHAMPION PHOENIX (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition).

    Science.gov (United States)

    Cavender, Matthew A; Bhatt, Deepak L; Stone, Gregg W; White, Harvey D; Steg, Ph Gabriel; Gibson, C Michael; Hamm, Christian W; Price, Matthew J; Leonardi, Sergio; Prats, Jayne; Deliargyris, Efthymios N; Mahaffey, Kenneth W; Harrington, Robert A

    2016-09-06

    Cangrelor is an intravenous P2Y12 inhibitor approved to reduce periprocedural ischemic events in patients undergoing percutaneous coronary intervention not pretreated with a P2Y12 inhibitor. A total of 11 145 patients were randomized to cangrelor or clopidogrel in the CHAMPION PHOENIX trial (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition). We explored the effects of cangrelor on myocardial infarction (MI) using different definitions and performed sensitivity analyses on the primary end point of the trial. A total of 462 patients (4.2%) undergoing percutaneous coronary intervention had an MI as defined by the second universal definition. The majority of these MIs (n=433, 93.7%) were type 4a. Treatment with cangrelor reduced the incidence of MI at 48 hours (3.8% versus 4.7%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.67-0.97; P=0.02). When the Society of Coronary Angiography and Intervention definition of periprocedural MI was applied to potential ischemic events, there were fewer total MIs (n=134); however, the effects of cangrelor on MI remained significant (OR, 0.65; 95% CI, 0.46-0.92; P=0.01). Similar effects were seen in the evaluation of the effects of cangrelor on MIs with peak creatinine kinase-MB ≥10 times the upper limit of normal (OR, 0.64; 95% CI, 0.45-0.91) and those with peak creatinine kinase-MB ≥10 times the upper limit of normal, ischemic symptoms, or ECG changes (OR, 0.63; 95% CI, 0.48-0.84). MIs defined by any of these definitions were associated with increased risk of death at 30 days. Treatment with cangrelor reduced the composite end point of death, MI (Society of Coronary Angiography and Intervention definition), ischemia-driven revascularization, or Academic Research Consortium definite stent thrombosis (1.4% versus 2.1%; OR, 0.69; 95% CI, 0.51-0.92). MI in patients undergoing percutaneous coronary intervention, regardless of definition, remains associated with increased risk of death

  13. Exploring Chinese cultural standards through the lens of German managers: A case study approach

    Directory of Open Access Journals (Sweden)

    Roger Moser

    2011-06-01

    Full Text Available The ability to understand one’s own culture and to deal with specificities of foreign cultures is one of the core requirements in today’s international business. Management skills are partially culture specific and a management approach that is appropriate in one cultural context may not be appropriate in another. Several business activities of companies nowadays take place abroad, which requires managers to interact with different cultures. This paper aims to analyse cultural characteristics, especially in a Sino-German business context. Based on literature analysis and case study research, relevant cultural standards in China were identified from the German perspective. The result differentiates three superordinate cultural areas and five specific cultural standards and analyses different influence factors on the dimensions of the identified Chinese cultural standards.

  14. A critical overview of definitions and determination techniques of the internal resistance using lithium-ion, lead-acid, nickel metal-hydride batteries and electrochemical double-layer capacitors as examples

    Science.gov (United States)

    Piłatowicz, Grzegorz; Marongiu, Andrea; Drillkens, Julia; Sinhuber, Philipp; Sauer, Dirk Uwe

    2015-11-01

    The internal resistance (Ri) is one of the key parameters that determine the current state of electrochemical storage systems (ESS). It is crucial for estimating cranking capability in conventional cars, available power in modern hybrid and electric vehicles and for determining commonly used factors such as state-of-health (SoH) and state-of-function (SoF). However, ESS are complex and non-linear systems. Their Ri depends on many parameters such as current rate, temperature, SoH and state-of-charge (SoC). It is also a fact that no standardized methodologies exist and many different definitions and ways of Ri determination are being used. Nevertheless, in many cases authors are not aware of the consequences that occur when different Ri definitions are being used, such as possible misinterpretations, doubtful comparisons and false figures of merit. This paper focuses on an application-oriented separation between various Ri definitions and highlights the differences between them. The investigation was based on the following technologies: lead-acid, lithium-ion and nickel metal-hydride batteries as well as electrochemical double-layer capacitors. It is not the target of this paper to provide a standardized definition of Ri but to give researchers, engineers and manufacturers a possibility to understand what the term Ri means in their own work.

  15. 31 CFR 30.1 - Q-1: What definitions apply in this part?

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Q-1: What definitions apply in this part? 30.1 Section 30.1 Money and Finance: Treasury Office of the Secretary of the Treasury TARP STANDARDS FOR COMPENSATION AND CORPORATE GOVERNANCE § 30.1 Q-1: What definitions apply in this part...

  16. Definitions of Quantities and Units.

    Science.gov (United States)

    Spurgin, C. B.

    1983-01-01

    Compares various methods of defining derived quantities, arguing for a definitional formula using base or fundamental units in a word equation, or symbol-equations with the symbols explained. Suggests that fundamental units be defined operationally or left regarded as intuitive as in the case of length and time. (JM)

  17. 32 CFR 725.4 - Definitions.

    Science.gov (United States)

    2010-07-01

    ... restrict. (3) Characterization of expected testimony by a requester as fact, opinion, or expert is not... FOR LITIGATION PURPOSES AND TESTIMONY BY DEPARTMENT OF THE NAVY PERSONNEL § 725.4 Definitions. (a... subject matter of the request, will act as determining authority. In all other cases, the responsibility...

  18. High-Definition transcranial direct current stimulation in early onset epileptic encephalopathy: a case study.

    Science.gov (United States)

    Meiron, Oded; Gale, Rena; Namestnic, Julia; Bennet-Back, Odeya; David, Jonathan; Gebodh, Nigel; Adair, Devin; Esmaeilpour, Zeinab; Bikson, Marom

    2018-01-01

    Early onset epileptic encephalopathy is characterized by high daily seizure-frequency, multifocal epileptic discharges, severe psychomotor retardation, and death at infancy. Currently, there are no effective treatments to alleviate seizure frequency and high-voltage epileptic discharges in these catastrophic epilepsy cases. The current study examined the safety and feasibility of High-Definition transcranial direct current stimulation (HD-tDCS) in reducing epileptiform activity in a 30-month-old child suffering from early onset epileptic encephalopathy. HD-tDCS was administered over 10 intervention days spanning two weeks including pre- and post-intervention video-EEG monitoring. There were no serious adverse events or side effects related to the HD-tDCS intervention. Frequency of clinical seizures was not significantly reduced. However, interictal sharp wave amplitudes were significantly lower during the post-intervention period versus baseline. Vital signs and blood biochemistry remained stable throughout the entire study. These exploratory findings support the safety and feasibility of 4 × 1 HD-tDCS in early onset epileptic encephalopathy and provide the first evidence of HD-tDCS effects on paroxysmal EEG features in electroclinical cases under the age of 36 months. Extending HD-tDCS treatment may enhance electrographic findings and clinical effects.

  19. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates

    DEFF Research Database (Denmark)

    Westergaard, Maria L; Hansen, Ebba Holme; Glümer, Charlotte

    2014-01-01

    Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta....

  20. Consultative Committee for Space Data Systems recommendation for space data system standards: Telecommand. Part 2.1: Command operation procedures

    Science.gov (United States)

    1991-01-01

    This recommendation contains the detailed specification of the logic required to carry out the Command Operations Procedures of the Transfer Layer. The Recommendation for Telecommand--Part 2, Data Routing Service contains the standard data structures and data communication procedures used by the intermediate telecommand system layers (the Transfer and Segmentation Layers). In particular, it contains a brief description of the Command Operations Procedures (COP) within the Transfer Layer. This recommendation contains the detailed definition of the COP's in the form of state tables, along with definitions of the terms used. It is assumed that the reader of this document is familiar with the data structures and terminology of part 2. In case of conflict between the description of the COP's in part 2 and in this recommendation, the definition in this recommendation will take precedence. In particular, this document supersedes section 4.3.3.1 through 4.3.3.4 of part 2.

  1. Tips for School Districts: GASB's New Fund Balance Standards

    Science.gov (United States)

    Mead, Dean Michael

    2010-01-01

    In March 2009, the Governmental Accounting Standards Board (GASB) issued Statement No. 54, "Fund Balance Reporting and Governmental Fund Type Definitions." School districts that prepare financial reports based on generally accepted accounting principles are required to implement this standard no later than the first fiscal year that starts after…

  2. Defining relative humidity in terms of water activity. Part 1: definition

    Science.gov (United States)

    Feistel, Rainer; Lovell-Smith, Jeremy W.

    2017-08-01

    Relative humidity (RH) is a quantity widely used in various fields such as metrology, meteorology, climatology or engineering. However, RH is neither uniformly defined, nor do some definitions properly account for deviations from ideal-gas properties, nor is the application range of interest fully covered. In this paper, a new full-range definition of RH is proposed that is based on the thermodynamics of activities in order to include deviations from ideal-gas behaviour. Below the critical point of pure water, at pressures p  definition is consistent with de-facto standard RH definitions published previously and recommended internationally. Virial approximations are reported for estimating small corrections to the ideal-gas equations.

  3. Making the Postclosure Safety Case for the Proposed Yucca Mountain Repository

    Energy Technology Data Exchange (ETDEWEB)

    P. Swift; A.V. Luik

    2006-08-28

    The International Atomic Energy Agency (IAEA), in its advisory standard for geological repositories promulgated jointly with the Nuclear Energy Agency (NEA) of the Organization for Economic Co-operation and Development, explicitly distinguishes between the concepts of a safety case and a safety assessment. As defined in the advisory standard, the safety case is a broader set of arguments that provide confidence and substantiate the formal analyses of system safety made through the process of safety assessment. Although the IAEAYs definitions include both preclosure (i.e., operational) safety and post-closure performance in the overall safety assessment and safety case, the emphasis in here is on long-term performance after waste has been emplaced and the repository has been closed. This distinction between pre- and postclosure aspects of the repository is consistent with the U.S. regulatory framework defined by the U.S. Environmental Protection Agency (Chapter 40 of the Code of Federal Regulations, Part 197, or 40 CFR 197) [2] and implemented by the U.S. Nuclear Regulatory Commission (Chapter 10 of the Code of Federal Regulations, Part 63, or 10 CFR 63) [3]. The separation of the pre- and postclosure safety cases is also consistent with the way in which the U.S. Department of Energy has assigned responsibilities for developing the safety case. Bechtel SAIC Company is the Management and Operating contractor responsible for the design and operation of the Yucca Mountain facility and is therefore responsible for the preparation of the preclosure aspects of the safety case. Sandia National Laboratories has lead responsibility for scientific work evaluating post-closure performance, and therefore is responsible for developing the post-closure aspects of the safety case. In the context of the IAEA definitions, both preclosure and postclosure safety, including safety assessment and the safety case, will be documented in the license application being prepared for the

  4. Making the Postclosure Safety Case for the Proposed Yucca Mountain Repository

    International Nuclear Information System (INIS)

    P. Swift; A.V. Luik

    2006-01-01

    The International Atomic Energy Agency (IAEA), in its advisory standard for geological repositories promulgated jointly with the Nuclear Energy Agency (NEA) of the Organization for Economic Co-operation and Development, explicitly distinguishes between the concepts of a safety case and a safety assessment. As defined in the advisory standard, the safety case is a broader set of arguments that provide confidence and substantiate the formal analyses of system safety made through the process of safety assessment. Although the IAEAYs definitions include both preclosure (i.e., operational) safety and post-closure performance in the overall safety assessment and safety case, the emphasis in here is on long-term performance after waste has been emplaced and the repository has been closed. This distinction between pre- and postclosure aspects of the repository is consistent with the U.S. regulatory framework defined by the U.S. Environmental Protection Agency (Chapter 40 of the Code of Federal Regulations, Part 197, or 40 CFR 197) [2] and implemented by the U.S. Nuclear Regulatory Commission (Chapter 10 of the Code of Federal Regulations, Part 63, or 10 CFR 63) [3]. The separation of the pre- and postclosure safety cases is also consistent with the way in which the U.S. Department of Energy has assigned responsibilities for developing the safety case. Bechtel SAIC Company is the Management and Operating contractor responsible for the design and operation of the Yucca Mountain facility and is therefore responsible for the preparation of the preclosure aspects of the safety case. Sandia National Laboratories has lead responsibility for scientific work evaluating post-closure performance, and therefore is responsible for developing the post-closure aspects of the safety case. In the context of the IAEA definitions, both preclosure and postclosure safety, including safety assessment and the safety case, will be documented in the license application being prepared for the

  5. Obturator Definitive Mandibula Post Hemimandibulectomy Sinistra

    Directory of Open Access Journals (Sweden)

    Paul Sugiyo

    2012-12-01

    the mandible, various surgical treatment modalities like marginal, segmental, hemimandibulectomy, or total mandibulectomy. Purpose. This study was to deteminated of rehabilitation treatment by mandible definitive obturator. The clinicians must wait for extensive period of the time for completion of healing before considering the definitive prosthesis. During this initial healing period prosthodontic intervention is required for preventing the mandibular deviation. This case report describes management of a patient who has undergone a reconstructed hemimandibulectomy with mandible definitive obturator. The prosthesis help patient moving the mandible normally without deviation during functions like speech, mastication, and aesthetic. Case Report. On March 2012, a 46 years old man was referred from Dr. Sardjito Hospital Oral Surgery Department to Department of Prosthodontics RSGM Faculty of Dentistry Gadjah Mada University Yogyakarta, for prosthetic rehabilitation following a hemimandibulectomy sinintra reconstructed with plate reconstruction three months ago. Patient felt speech function, masticatory function, and impaired performance, lower lip frequently bitten. Results. After treated while 8 months till now by mandible definitive obturator, patient felt more comfortable and confident with recovery function of speech, mastication, and aesthetic. Conclusion. The deviation of mandible after hemimandibulectomy was reconstructed by reconstruction plate surgery. During this initial healing period early prosthodontic intervention by mandible definitive obturator.

  6. Pragmatic criteria of the definition of neonatal near miss: a comparative study.

    Science.gov (United States)

    Kale, Pauline Lorena; Jorge, Maria Helena Prado de Mello; Laurenti, Ruy; Fonseca, Sandra Costa; Silva, Kátia Silveira da

    2017-12-04

    The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals. A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births. A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition. The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies

  7. Effect of the MCNP model definition on the computation time

    International Nuclear Information System (INIS)

    Šunka, Michal

    2017-01-01

    The presented work studies the influence of the method of defining the geometry in the MCNP transport code and its impact on the computational time, including the difficulty of preparing an input file describing the given geometry. Cases using different geometric definitions including the use of basic 2-dimensional and 3-dimensional objects and theirs combinations were studied. The results indicate that an inappropriate definition can increase the computational time by up to 59% (a more realistic case indicates 37%) for the same results and the same statistical uncertainty. (orig.)

  8. On the definition of the partition function in quantum Regge calculus

    International Nuclear Information System (INIS)

    Nishimura, Jun

    1995-01-01

    We argue that the definition of the partition function used recently to demonstrate the failure of Regge calculus is wrong. In fact, in the one-dimensional case, we show that there is a more natural definition, with which one can reproduce the correct results. (author)

  9. The improvement of environmental performances by applying ISO 14001 standard: A case study

    Directory of Open Access Journals (Sweden)

    Živković Snežana

    2013-01-01

    Full Text Available This paper presents the analysis of the advantages of applying ISO 14001 system in an environmental protection management system. The environmental protection management system which is not licensed, i.e., compatible with the principles and standard pre-conditions considerably increases the plausibility for ecological risk. There are some issues that remain to be solved in the areas which are not expressed by financial values only but also have a non-financial character with the aim of expanding markets, company image improvement and improvement of the environmental performance indicators. By improving a company’s environmental management system efficiency we expect to achieve the minimization and elimination of damaging influences on the environment which are the consequence of company’s activities. A case study in the Oil Refinery Belgrade (RNB analyses the implementation of the standard ISO 14001:2004 into its environment protection management system, particularly emphasizing the company’s own way of evaluating the environment aspects with the aim of establishing results of ecological performances indicators improvement. The average values of the first ecological indicator of the plant, the total amount of the waste waters in m3 per a ton of product, clearly show the downturn trend, which is confirmed by the proportional reduction of the second ecological plant indicator, that is by the flocculants consumption (Al2(SO43, Na2CO3 in kg per m3 of the waste water of the Oil Refinery of Belgrade for the given period 2008-2010. Case study RNB confirms the improvement of environmental performances using the ISO 14001 standard.

  10. Upgrading the definition of early gastric cancer: better staging means more appropriate treatment.

    Science.gov (United States)

    Saragoni, Luca

    2015-12-01

    Since Murakami defined early gastric cancer (EGC) as a "carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status", several authors have focused on the most influential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. The introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved definitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection (ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association (JGCA) identified in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer fitting the definition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama's classification, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological drafts. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami's definition is still being used. This definition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.

  11. 21 CFR 170.10 - Food additives in standardized foods.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Food additives in standardized foods. 170.10... (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVES General Provisions § 170.10 Food additives... the Act, which proposes the inclusion of a food additive in such definition and standard of identity...

  12. Positive animal welfare states and reference standards for welfare assessment.

    Science.gov (United States)

    Mellor, D J

    2015-01-01

    Developments in affective neuroscience and behavioural science during the last 10-15 years have together made it increasingly apparent that sentient animals are potentially much more sensitive to their environmental and social circumstances than was previously thought to be the case. It therefore seems likely that both the range and magnitude of welfare trade-offs that occur when animals are managed for human purposes have been underestimated even when minimalistic but arguably well-intentioned attempts have been made to maintain high levels of welfare. In light of these neuroscience-supported behaviour-based insights, the present review considers the extent to which the use of currently available reference standards might draw attention to these previously neglected areas of concern. It is concluded that the natural living orientation cannot provide an all-embracing or definitive welfare benchmark because of its primary focus on behavioural freedom. However assessments of this type, supported by neuroscience insights into behavioural motivation, may now carry greater weight when used to identify management practices that should be avoided, discontinued or substantially modified. Using currently accepted baseline standards as welfare reference points may result in small changes being accorded greater significance than would be the case if they were compared with higher standards, and this could slow the progress towards better levels of welfare. On the other hand, using "what animals want" as a reference standard has the appeal of focusing on the specific resources or conditions the animals would choose themselves and can potentially improve their welfare more quickly than the approach of making small increments above baseline standards. It is concluded that the cautious use of these approaches in different combinations could lead to recommendations that would more effectively promote positive welfare states in hitherto neglected areas of concern.

  13. On variational definition of quantum entropy

    International Nuclear Information System (INIS)

    Belavkin, Roman V.

    2015-01-01

    Entropy of distribution P can be defined in at least three different ways: 1) as the expectation of the Kullback-Leibler (KL) divergence of P from elementary δ-measures (in this case, it is interpreted as expected surprise); 2) as a negative KL-divergence of some reference measure ν from the probability measure P; 3) as the supremum of Shannon’s mutual information taken over all channels such that P is the output probability, in which case it is dual of some transportation problem. In classical (i.e. commutative) probability, all three definitions lead to the same quantity, providing only different interpretations of entropy. In non-commutative (i.e. quantum) probability, however, these definitions are not equivalent. In particular, the third definition, where the supremum is taken over all entanglements of two quantum systems with P being the output state, leads to the quantity that can be twice the von Neumann entropy. It was proposed originally by V. Belavkin and Ohya [1] and called the proper quantum entropy, because it allows one to define quantum conditional entropy that is always non-negative. Here we extend these ideas to define also quantum counterpart of proper cross-entropy and cross-information. We also show inequality for the values of classical and quantum information

  14. A definition of background independence

    International Nuclear Information System (INIS)

    Gryb, Sean

    2010-01-01

    We propose a definition for background (in)/dependence in dynamical theories of the evolution of configurations that have a continuous symmetry and test this definition on particle models and on gravity. Our definition draws from Barbour's best matching framework developed for the purpose of implementing spatial and temporal relationalism. Among other interesting theories, general relativity can be derived within this framework in novel ways. We study the detailed canonical structure of a wide range of best matching theories and show that their actions must have a local gauge symmetry. When gauge theory is derived in this way, we obtain at the same time a conceptual framework for distinguishing between background-dependent and -independent theories. Gauge invariant observables satisfying Kuchar's criterion are identified and, in simple cases, explicitly computed. We propose a procedure for inserting a global background time into temporally relational theories. Interestingly, using this procedure in general relativity leads to unimodular gravity.

  15. 78 FR 23289 - Public Review of Draft National Shoreline Data Content Standard

    Science.gov (United States)

    2013-04-18

    ..., efficient and applicable to a broad base of government and private sector uses. Current practices have led... organizations from State, local and tribal governments, the academic community, and the private sector. The... definition of data models, schemas, entities, relationships, definitions, and crosswalks to related standards...

  16. Observation of environmental radioactivity at definite time and definite point

    International Nuclear Information System (INIS)

    Inokoshi, Yukio; Fukuchi, Ryoichi; Irie, Takayuki; Hosoda, Nagako; Okano, Yasuhiro; Shindo, Koutaro

    1990-01-01

    The measurement of environmental radioactivity in Tokyo Metropolis was carried out. The objects of measurement were rainwater, atmospheric floating dusts, spatial dose and the activated sludge in sewage treatment plants. Rainwater, atmospheric floating dusts and spatial dose were analyzed mainly considering radioactive fallout, and activated sludge was analyzed mainly considering radioactive medical matters. For the analysis of nuclides, a Ge(Li) semiconductor detector was used, and spatial dose rate was measured with a DBM type dose rate meter. In activated sludge, the nuclides used for radioactive medicines were found, but in rainwater, atmospheric floating dusts and spatial dose, particular abnormality was not found. The objective of this investigation is to collect over long period at definite time and definite points the data on environmental radioactivity in Tokyo, thus to grasp the level of normal values, and in abnormal case, to clarify the cause and to evaluate the exposure dose. The instruments used, the method of measuring each object and the results are reported. (K.I.)

  17. Standardized Technical Specifications for Westinghouse PWRs

    International Nuclear Information System (INIS)

    1978-01-01

    This Standard Technical Specification (STS) has been structured for the broadest possible use on Westinghouse plants currently being reviewed for an Operating License. Accordingly, the document contains specifications applicable to plants (1) with either 3 or 4 loops and (2) with and without loop stop valves. In addition, four separate and discrete containment specification sections are provided for each of the following containment types: Atmospheric, Ice Condenser, Sub-Atmospheric, and Dual. Optional specifications are provided for those features and systems which may be included in individual plant designs but are not generic in their scope of application. Alternate specifications are provided in a limited number of cases to cover situations where alternate specification requirements are necessary on a generic basis because of design differences. The format of the STS addresses the categories required by 10 CFR 50 and consists of six sections covering the areas of: Definitions, Safety Limits and Limiting Safety System Settings, Limiting Conditions for Operation, Surveillance Requirements, Design Features, and Administrative Controls

  18. Elements of Morphology: Standard Terminology for the Nose and Philtrum

    NARCIS (Netherlands)

    Hennekam, Raoul C. M.; Cormier-Daire, Valerie; Hall, Judith G.; Méhes, Károly; Patton, Michael; Stevenson, Roger E.

    2009-01-01

    An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions

  19. 76 FR 27935 - Small Business Size Standards: Transportation and Warehousing

    Science.gov (United States)

    2011-05-13

    ... assistance, SBA establishes small business definitions (referred to as size standards) for private sector... SMALL BUSINESS ADMINISTRATION 13 CFR Part 121 RIN 3245-AG08 Small Business Size Standards: Transportation and Warehousing AGENCY: U.S. Small Business Administration. ACTION: Proposed rule. SUMMARY: The U...

  20. Three suggestions on the definition of terms for the safety and reliability analysis of digital systems

    International Nuclear Information System (INIS)

    Kim, Man Cheol; Smidts, Carol S.

    2015-01-01

    As digital instrumentation and control systems are being progressively introduced into nuclear power plants, a growing number of related technical issues are coming to light needing to be resolved. As a result, an understanding of relevant terms and basic concepts becomes increasingly important. Under the framework of the OECD/NEA WGRISK DIGREL Task Group, the authors were involved in reviewing definitions of terms forming the supporting vocabulary for addressing issues related to the safety and reliability analysis of digital instrumentation and control (SRA of DI and C). These definitions were extracted from various standards regulating the disciplines that form the technical and scientific basis of SRA DI and C. The authors discovered that different definitions are provided by different standards within a common discipline and used differently across various disciplines. This paper raises the concern that a common understanding of terms and basic concepts has not yet been established to address the very specific technical issues facing SRA DI and C. Based on the lessons learned from the review of the definitions of interest and the analysis of dependency relationships existing between these definitions, this paper establishes a set of recommendations for the development of a consistent terminology for SRA DI and C. - Highlights: ●We reviewed definitions of terms used in reliability analysis of digital systems. ●Different definitions are provided by different standards within a common discipline. ●Acyclic and cyclic structures of dependency in defining terms are compared. ●Three recommendations for the development of a consistent terminology provided