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. 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.

  5. 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...

  6. 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.

  7. 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...

  8. 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

  9. 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.

  10. 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 ...

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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)

  16. 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…

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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...

  8. 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…

  9. 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

  10. 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

  11. 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

  12. 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...

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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...

  6. 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...

  7. 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.

  8. 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....

  9. 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.

  10. 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.

  11. 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.

  12. 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...

  13. 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.

  14. 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.

  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. 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.

  17. 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).

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  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. 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.

  8. 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...

  9. 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.

  10. 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

  11. 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…

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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...

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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...

  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. 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

  7. 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.

  8. 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.

  9. 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.

  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. 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.

  12. 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

  13. 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 ...

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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%

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. Pressure ulcers and Charcot's definitions: report on two cases

    Directory of Open Access Journals (Sweden)

    Hélio Afonso Ghizoni Teive

    Full Text Available CONTEXT AND OBJECTIVE: Pressure ulcers are lesions caused by inadequate blood flow and tissue malnourishment secondary to prolonged pressure on skin, soft connective tissues, muscle and/or bones. The authors report two distinct clinical situations of severely compromised neurological patients who shared several predisposing factors for pressure ulcers, but with opposite outcomes regarding the development of pressure ulcers. CASE REPORTS: The first case was a young patient in a persistent vegetative state who developed pressure ulcers that resulted in secondary sepsis and death. The second case was a patient with a diagnosis of amyotrophic lateral sclerosis who, in spite of being bedridden for several months with severe immobility, never developed pressure ulcers. These intriguing contrary clinical situations had already been defined by Charcot in the nineteenth century, with his creation of the expression "decubitus ominosus". He indicated that patients with amyotrophic lateral sclerosis usually did not develop this form of complication, as was illustrated by the cases presented here.

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. Evaluating the offensive definition zone in football: a case study ...

    African Journals Online (AJOL)

    New technological solutions have greatly improved match analysis systems for investigating players' performance. Nevertheless, there still remains a large gap in the collective analysis where improvements need to be made, mainly in the use of automated information gathering. Thus, the aim of this case study was to ...

  20. Definition and compositions of standard wastestreams for evaluation of Buried Waste Integrated Demonstration treatment technologies

    International Nuclear Information System (INIS)

    Bates, S.O.

    1993-06-01

    The Buried Waste Integrated Demonstration (BWID) Project was organized at the Idaho National Engineering Laboratory to support research, development, demonstration, testing, and evaluation of emerging technologies that offer promising solutions to remediation of buried waste. BWID will identify emerging technologies, screen them for applicability to the identified needs, select technologies for demonstration, and then evaluate the technologies based on prescribed performance objectives. The technical objective of the project is to establish solutions to Environmental Restoration and Waste Management's technological deficiencies and improve baseline remediation systems. This report establishes a set of standard wastestream compositions that will be used by BWID to evaluate the emerging technologies. Five wastestreams are proposed that use four types of waste and a nominal case that is a homogenized combination of the four wastes. The five wastestreams will provide data on the compositional extremes and indicate the technologies' effectiveness over the complete range of expected wastestream compositions

  1. Sustainable geothermal utilization - Case histories; definitions; research issues and modelling

    International Nuclear Information System (INIS)

    Axelsson, Gudni

    2010-01-01

    Sustainable development by definition meets the needs of the present without compromising the ability of future generations to meet their own needs. The Earth's enormous geothermal resources have the potential to contribute significantly to sustainable energy use worldwide as well as to help mitigate climate change. Experience from the use of numerous geothermal systems worldwide lasting several decades demonstrates that by maintaining production below a certain limit the systems reach a balance between net energy discharge and recharge that may be maintained for a long time (100-300 years). Modelling studies indicate that the effect of heavy utilization is often reversible on a time-scale comparable to the period of utilization. Thus, geothermal resources can be used in a sustainable manner either through (1) constant production below the sustainable limit, (2) step-wise increase in production, (3) intermittent excessive production with breaks, and (4) reduced production after a shorter period of heavy production. The long production histories that are available for low-temperature as well as high-temperature geothermal systems distributed throughout the world, provide the most valuable data available for studying sustainable management of geothermal resources, and reservoir modelling is the most powerful tool available for this purpose. The paper presents sustainability modelling studies for the Hamar and Nesjavellir geothermal systems in Iceland, the Beijing Urban system in China and the Olkaria system in Kenya as examples. Several relevant research issues have also been identified, such as the relevance of system boundary conditions during long-term utilization, how far reaching interference from utilization is, how effectively geothermal systems recover after heavy utilization and the reliability of long-term (more than 100 years) model predictions. (author)

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. Axillary node metastatic carcinoma without definitive primary: a case report

    Directory of Open Access Journals (Sweden)

    Spencer R. Anderson

    2016-01-01

    Full Text Available Cancer of unknown primary (CUP is the finding of a metastatic cancerous lesion without an established primary source localized within the body. CUP can be of any cancer cell type, however, adenocarcinoma is most often identified by histology. Up to 5% of all malignant diagnoses are classified as CUP. PET is an imaging modality often utilized to distinguish a primary source in the setting of CUP, yet often a primary is never identified. CUP can be further stratified using specific qualifiers as favorable and unfavorable, indicating the potential therapeutic response to treatment regimens. Treatment approach to CUP relies heavily on the cell type identified by histology, the location of the lesion, and the amount of spread within the body. In the typical setting and presentation, per current literature, CUP arises in the 7th decade of life in patients with multiple comorbidities, and often has a poor prognostic value. This case report identifies an atypical presentation of CUP, a 38-year-old Caucasian female with an axillary mobile mass, and no associated systemic symptoms. Biopsy of the node and immunohistochemical staining showed histology consistent with metastatic carcinoma. Mammography, MRI, and PET scan found no evidence of tumor primary or distant metastasis. Further staining confirmed metastatic carcinoma consistent with breast origin, without an established breast primary. As in this case, CUP may present in an atypical manner, warranting a thorough investigation aiming to identify the tumor primary to aid in identification of a proper treatment regimen and approach.

  12. 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.

  13. 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.

  14. 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,

  15. 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

  16. 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.

  17. 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,

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. Standardizing terms, definitions and concepts for describing and interpreting unwanted immunogenicity of biopharmaceuticals

    DEFF Research Database (Denmark)

    Rup, B; Pallardy, M; Sikkema, D

    2015-01-01

    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...... 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...

  8. 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.

  9. Monopolization by "Raising Rivals' Costs": The Standard Oil Case.

    OpenAIRE

    Granitz, Elizabeth; Klein, Benjamin

    1996-01-01

    Standard monopolized the petroleum industry during the 1870s by cartelizing the stage of production where entry was difficult--petroleum transportation. Standard enforced the transportation cartel by shifting its refinery shipments among railroads to stabilize individual railroad market shares at collusively agreed-on levels. This method of cartel policing was effective because Standard possessed a dominant share of refining, a dominance made possible with the assistance of the railroads. The...

  10. The case for regime-based water quality standards

    Science.gov (United States)

    G.C. Poole; J.B. Dunham; D.M. Keenan; S.T. Sauter; D.A. McCullough; C. Mebane; J.C. Lockwood; D.A. Essig; M.P. Hicks; D.J. Sturdevant; E.J. Materna; S.A. Spalding; J. Risley; M. Deppman

    2004-01-01

    Conventional water quality standards have been successful in reducing the concentration of toxic substances in US waters. However, conventional standards are based on simple thresholds and are therefore poorly structured to address human-caused imbalances in dynamic, natural water quality parameters, such as nutrients, sediment, and temperature. A more applicable type...

  11. Guest Editorial: The "NGSS" Case Studies: All Standards, All Students

    Science.gov (United States)

    Miller, Emily; Januszyk, Rita

    2014-01-01

    To teachers of diverse classrooms, more rigorous standards in science may seem intimidating, as the past years of rigid accountability have failed to close the achievement gap. However, the "Next Generation Science Standards" ("NGSS") were written with all students in mind, with input and full review by a diversity and equity…

  12. Integrating standardization into engineering education: the case of forerunner Korea

    NARCIS (Netherlands)

    D.G. Choi (Dong Geun); H.J. de Vries (Henk)

    2013-01-01

    textabstractThe Republic of Korea is a forerunner in integrating the topic of standardization into engineering education at the academic level. This study investigates developments and evolutions in the planning and operating of the University Education Promotion on Standardization (UEPS) in Korea.

  13. Essential patents in industry standards : the case of UMTS

    NARCIS (Netherlands)

    Bekkers, R.N.A.; Bongard, R.; Nuvolari, A.

    2009-01-01

    We study the determinants of essential patents in industry standards. In particular, we assess the role of two main factors: the significance of the technological solution contained in the patent and the involvement of the applicant of the patent in the standardization process. To this end, we

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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...

  19. A single standard for memory: the case for reconsolidation.

    Science.gov (United States)

    Nader, Karim; Hardt, Oliver

    2009-03-01

    Consolidated memories can re-enter states of transient instability following reactivation, from which they must again stabilize in order to persist, contradicting the previously dominant view that memory and its associated plasticity mechanisms progressively and irreversibly decline with time. We witness exciting times, as neuroscience begins embracing a position, long-held in cognitive psychology, that recognizes memory as a principally dynamic process. In light of remaining controversy, we here establish that the same operational definitions and types of evidence underpin the deduction of both reconsolidation and consolidation, thus validating the extrapolation that post-retrieval memory plasticity reflects processes akin to those that stabilized the memory following acquisition.

  20. 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.

  1. Standard CMMIsm Appraisal Method for Process Improvement (SCAMPIsm), Version 1.1: Method Definition Document

    National Research Council Canada - National Science Library

    2001-01-01

    The Standard CMMI Appraisal Method for Process Improvement (SCAMPI(Service Mark)) is designed to provide benchmark quality ratings relative to Capability Maturity Model(registered) Integration (CMMI(Service Mark)) models...

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. Beyond Externalising and Finalising Definitions: Standards for Teachers of English Language and Literacy in Australia (STELLA)

    Science.gov (United States)

    Doecke, Brenton

    2007-01-01

    This article explores issues relating to the development of the Standards for Teachers of English Language and Literacy in Australia (STELLA). STELLA is the product of work by members of the Australian Association for the Teaching of English (AATE) and the Australian Literacy Educators' Association (ALEA), the two key professional bodies in…

  8. 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.

  9. Making the Case for Standards of Conduct in Clinical Training

    Science.gov (United States)

    Homrich, Alicia M.; DeLorenzi, Leigh D.; Bloom, Zachary D.; Godbee, Brandi

    2014-01-01

    The authors examined a proposed set of standards for the personal and professional conduct of counseling trainees. Eighty-two counselor educators and supervisors from programs accredited by the Council for Accreditation of Counseling and Related Educational Programs ranked 55 behaviors divided across 3 categories (i.e., professional,…

  10. 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...

  11. 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

  12. Analysing public relations education through international standards: The Portuguese case

    OpenAIRE

    Gonçalves, Gisela Marques Pereira; Spínola, Susana de Carvalho; Padamo, Celma

    2013-01-01

    By using international reports on PR education as a benchmark we analyse the status of PR higher education in Portugal. Despite differences among the study programs, the findings reveal that the standard five courses recommendation by the Commission on Public Relations Education (CPRE) are a part of Portuguese undergraduate curriculum. This includes 12 of the 14 content field guidelines needed to achieve the ideal master's program. Data shows, however, the difficulty of positioning public rel...

  13. 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.

  14. Automatic Conversion of a Conceptual Model to a Standard Multi-view Web Services Definition

    Directory of Open Access Journals (Sweden)

    Anass Misbah

    2018-03-01

    Full Text Available Information systems are becoming more and more heterogeneous and here comes the need to have more generic transformation algorithms and more automatic generation Meta rules. In fact, the large number of terminals, devices, operating systems, platforms and environments require a high level of adaptation. Therefore, it is becoming more and more difficult to validate, generate and implement manually models, designs and codes.Web services are one of the technologies that are used massively nowadays; hence, it is considered as one of technologies that require the most automatic rules of validation and automation. Many previous works have dealt with Web services by proposing new concepts such as Multi-view Web services, standard WSDL implementation of Multi-view Web services and even further Generic Meta rules for automatic generation of Multi-view Web services.In this work we will propose a new way of generating Multi-view Web ser-vices, which is based on an engine algorithm that takes as input both an initial Conceptual Model and user’s matrix and then unroll a generic algorithm to gen-erate dynamically a validated set of points of view. This set of points of view will be transformed to a standard WSDL implementation of Multi-view Web services by means of the automatic transformation Meta rules.

  15. 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/

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. 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...

  1. 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

  2. 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.

  3. 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.

  4. 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…

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. 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.

  13. [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.

  14. 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.

  15. 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…

  16. 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.

  17. 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

  18. Updated standardized endpoint definitions for transcatheter aortic valve implantation: The Valve Academic Research Consortium-2 consensus document

    NARCIS (Netherlands)

    A.P. Kappetein (Arie Pieter); S.J. Head (Stuart); P. Généreux (Philippe); N. Piazza (Nicolo); N.M. van Mieghem (Nicolas); E.H. Blackstone (Eugene); T.G. Brott (Thomas); D.J. Cohen (David J.); D.E. Cutlip (Donald); G.A. van Es (Gerrit Anne); R.T. Hahn (Rebecca); A.J. Kirtane (Ajay); M. Krucoff (Mitchell); S. Kodali (Susheel); M.J. Mack (Michael); R. Mehran (Roxana); J. Rodés-Cabau (Josep); P. Vranckx (Pascal); J.G. Webb (John); S.W. Windecker (Stephan); P.W.J.C. Serruys (Patrick); M.B. Leon (Martin)

    2012-01-01

    textabstractObjectives: The aim of the current Valvular Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)- clinical endpoints to make them more suitable to the present and future needs of clinical trials.

  19. 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.

  20. 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

  1. Definition of sampling units begets conclusions in ecology: the case of habitats for plant communities

    OpenAIRE

    M?rsdorf, Martin A.; Ravolainen, Virve T.; St?vern, Leif Einar; Yoccoz, Nigel G.; J?nsd?ttir, Ingibj?rg Svala; Br?then, Kari Anne

    2015-01-01

    In ecology, expert knowledge on habitat characteristics is often used to define sampling units such as study sites. Ecologists are especially prone to such approaches when prior sampling frames are not accessible. Here we ask to what extent can different approaches to the definition of sampling units influence the conclusions that are drawn from an ecological study? We do this by comparing a formal versus a subjective definition of sampling units within a study design which is ...

  2. 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/

  3. [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.

  4. 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.

  5. DICOM Standard Conformance in Veterinary Medicine in Germany: a Survey of Imaging Studies in Referral Cases.

    Science.gov (United States)

    Brühschwein, Andreas; Klever, Julius; Wilkinson, Tom; Meyer-Lindenberg, Andrea

    2018-02-01

    In 2016, the recommendations of the DICOM Standards Committee for the use of veterinary identification DICOM tags had its 10th anniversary. The goal of our study was to survey veterinary DICOM standard conformance in Germany regarding the specific identification tags veterinarians should use in veterinary diagnostic imaging. We hypothesized that most veterinarians in Germany do not follow the guidelines of the DICOM Standards Committee. We analyzed the metadata of 488 imaging studies of referral cases from 115 different veterinary institutions in Germany by computer-aided DICOM header readout. We found that 25 (5.1%) of the imaging studies fully complied with the "veterinary DICOM standard" in this survey. The results confirmed our hypothesis that the recommendations of the DICOM Standards Committee for the consistent and advantageous use of veterinary identification tags have found minimal acceptance amongst German veterinarians. DICOM does not only enable connectivity between machines, DICOM also improves communication between veterinarians by sharing correct and valuable metadata for better patient care. Therefore, we recommend that lecturers, universities, societies, authorities, vendors, and other stakeholders should increase their effort to improve the spread of the veterinary DICOM standard in the veterinary world.

  6. ESIP's Emerging Provenance and Context Content Standard Use Cases: Developing Examples and Models for Data Stewardship

    Science.gov (United States)

    Ramdeen, S.; Hills, D. J.

    2013-12-01

    Earth science data collections range from individual researchers' private collections to large-scale data warehouses, from computer-generated data to field or lab based observations. These collections require stewardship. Fundamentally, stewardship ensures long term preservation and the provision of access to the user community. In particular, stewardship includes capturing appropriate metadata and documentation--and thus the context of the data's creation and any changes they underwent over time --to enable data reuse. But scientists and science data managers must translate these ideas into practice. How does one balance the needs of current and (projected) future stakeholders? In 2011, the Data Stewardship Committee (DSC) of the Federation of Earth Science Information Partners (ESIP) began developing the Provenance and Context Content Standard (PCCS). As an emerging standard, PCCS provides a framework for 'what' must be captured or preserved as opposed to describing only 'how' it should be done. Originally based on the experiences of NASA and NOAA researchers within ESIP, the standard currently provides data managers with content items aligned to eight key categories. While the categories and content items are based on data life cycles of remote sensing missions, they can be generalized to cover a broader set of activities, for example, preservation of physical objects. These categories will include the information needed to ensure the long-term understandability and usability of earth science data products. In addition to the PCCS, the DSC is developing a series of use cases based on the perspectives of the data archiver, data user, and the data consumer that will connect theory and practice. These cases will act as specifications for developing PCCS-based systems. They will also provide for examination of the categories and content items covered in the PCCS to determine if any additions are needed to cover the various use cases, and also provide rationale and

  7. 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.

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

    OpenAIRE

    Myriam Cano-Rubio; Guadalupe Fuentes-Lombardo; Manuel Carlos Vallejo-Martos

    2017-01-01

    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, involvemen...

  9. 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.

  10. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report

    Directory of Open Access Journals (Sweden)

    Servadei Franco

    2010-04-01

    Full Text Available Abstract Background Management of glioblastoma multiforme (GBM has been difficult using standard therapy (radiation with temozolomide chemotherapy. The ketogenic diet is used commonly to treat refractory epilepsy in children and, when administered in restricted amounts, can also target energy metabolism in brain tumors. We report the case of a 65-year-old woman who presented with progressive memory loss, chronic headaches, nausea, and a right hemisphere multi-centric tumor seen with magnetic resonance imaging (MRI. Following incomplete surgical resection, the patient was diagnosed with glioblastoma multiforme expressing hypermethylation of the MGMT gene promoter. Methods Prior to initiation of the standard therapy, the patient conducted water-only therapeutic fasting and a restricted 4:1 (fat: carbohydrate + protein ketogenic diet that delivered about 600 kcal/day. The patient also received the restricted ketogenic diet concomitantly during the standard treatment period. The diet was supplemented with vitamins and minerals. Steroid medication (dexamethasone was removed during the course of the treatment. The patient was followed using MRI and positron emission tomography with fluoro-deoxy-glucose (FDG-PET. Results After two months treatment, the patient's body weight was reduced by about 20% and no discernable brain tumor tissue was detected using either FDG-PET or MRI imaging. Biomarker changes showed reduced levels of blood glucose and elevated levels of urinary ketones. MRI evidence of tumor recurrence was found 10 weeks after suspension of strict diet therapy. Conclusion This is the first report of confirmed GBM treated with standard therapy together with a restricted ketogenic diet. As rapid regression of GBM is rare in older patients following incomplete surgical resection and standard therapy alone, the response observed in this case could result in part from the action of the calorie restricted ketogenic diet. Further studies are needed

  11. 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.

  12. 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.

  13. The problem of epistemic jurisdiction in global governance: The case of sustainability standards for biofuels.

    Science.gov (United States)

    Winickoff, David E; Mondou, Matthieu

    2017-02-01

    While there is ample scholarly work on regulatory science within the state, or single-sited global institutions, there is less on its operation within complex modes of global governance that are decentered, overlapping, multi-sectorial and multi-leveled. Using a co-productionist framework, this study identifies 'epistemic jurisdiction' - the power to produce or warrant technical knowledge for a given political community, topical arena or geographical territory - as a central problem for regulatory science in complex governance. We explore these dynamics in the arena of global sustainability standards for biofuels. We select three institutional fora as sites of inquiry: the European Union's Renewable Energy Directive, the Roundtable on Sustainable Biomaterials, and the International Organization for Standardization. These cases allow us to analyze how the co-production of sustainability science responds to problems of epistemic jurisdiction in the global regulatory order. First, different problems of epistemic jurisdiction beset different standard-setting bodies, and these problems shape both the content of regulatory science and the procedures designed to make it authoritative. Second, in order to produce global regulatory science, technical bodies must manage an array of conflicting imperatives - including scientific virtue, due process and the need to recruit adoptees to perpetuate the standard. At different levels of governance, standard drafters struggle to balance loyalties to country, to company or constituency and to the larger project of internationalization. Confronted with these sometimes conflicting pressures, actors across the standards system quite self-consciously maneuver to build or retain authority for their forum through a combination of scientific adjustment and political negotiation. Third, the evidentiary demands of regulatory science in global administrative spaces are deeply affected by 1) a market for standards, in which firms and states can

  14. 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.

  15. Description of children identified as suffering from MAM in Bangladesh: Varying results based on case definitions

    International Nuclear Information System (INIS)

    Waid, Jillian

    2014-01-01

    Full text: Background: There is a wide discrepancy between the proportion of children classified as acutely malnourished when MUAC criteria are used compared to weight for height. This has greatly complicated setting targets for the coverage of SAM and MAM programs in Bangladesh. This difference is much larger for children identified with MAM than for those with SAM, largely because identification as MAM can overlap both with SAM and with children not identified as acutely malnourished. Objective: To review existing data sets in order to determine the relationship between MUAC and other anthropometric measures, helping to provide a better understanding of the implications of different admission criteria to therapeutic and supplementary feeding programs. Methodology: This study uses data collected through national nutritional surveillance projects over multiple seasons in Bangladesh. For the years 1990 to 2006, sub-samples of data from the Nutritional Surveillance Project were pulled from areas of the country that remained constant over a set period. Data from 2010 to 2012 was pulled from the Food Security and Nutrition Surveillance Project. Case definition: Cases of moderate acute malnutrition were identified using MUAC- for-age z-scores (-3>z-score>-2), MUAC cut-offs (115mm>MUAC>125mm), and weight-for-height z-scores (-3>z-score>-2). Results: In all years more than 50% of all children identified as moderately malnourished were classified as such by only one measure (1990 selected sub-districts: 52%, 2012 national sample: 69%) In 1990 a higher proportion of children were categorized as moderately malnourished based on MUAC-for-age z-scores than by weight for height z-scores, but since 2000 the opposite has been true. This change is closely tied to the increasing height of children sampled, due to the declining rates of stunting in the country. After controlling for age and weight-for-height z-scores, an increase in height of one cm was associated with an increase

  16. Using standardized patients versus video cases for representing clinical problems in problem-based learning.

    Science.gov (United States)

    Yoon, Bo Young; Choi, Ikseon; Choi, Seokjin; Kim, Tae-Hee; Roh, Hyerin; Rhee, Byoung Doo; Lee, Jong-Tae

    2016-06-01

    The quality of problem representation is critical for developing students' problem-solving abilities in problem-based learning (PBL). This study investigates preclinical students' experience with standardized patients (SPs) as a problem representation method compared to using video cases in PBL. A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM) responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum.

  17. Proposed standardized definitions for vertical resolution and uncertainty in the NDACC lidar ozone and temperature algorithms - Part 3: Temperature uncertainty budget

    Science.gov (United States)

    Leblanc, Thierry; Sica, Robert J.; van Gijsel, Joanna A. E.; Haefele, Alexander; Payen, Guillaume; Liberti, Gianluigi

    2016-08-01

    A standardized approach for the definition, propagation, and reporting of uncertainty in the temperature lidar data products contributing to the Network for the Detection for Atmospheric Composition Change (NDACC) database is proposed. One important aspect of the proposed approach is the ability to propagate all independent uncertainty components in parallel through the data processing chain. The individual uncertainty components are then combined together at the very last stage of processing to form the temperature combined standard uncertainty. The identified uncertainty sources comprise major components such as signal detection, saturation correction, background noise extraction, temperature tie-on at the top of the profile, and absorption by ozone if working in the visible spectrum, as well as other components such as molecular extinction, the acceleration of gravity, and the molecular mass of air, whose magnitudes depend on the instrument, data processing algorithm, and altitude range of interest. The expression of the individual uncertainty components and their step-by-step propagation through the temperature data processing chain are thoroughly estimated, taking into account the effect of vertical filtering and the merging of multiple channels. All sources of uncertainty except detection noise imply correlated terms in the vertical dimension, which means that covariance terms must be taken into account when vertical filtering is applied and when temperature is integrated from the top of the profile. Quantitatively, the uncertainty budget is presented in a generic form (i.e., as a function of instrument performance and wavelength), so that any NDACC temperature lidar investigator can easily estimate the expected impact of individual uncertainty components in the case of their own instrument. Using this standardized approach, an example of uncertainty budget is provided for the Jet Propulsion Laboratory (JPL) lidar at Mauna Loa Observatory, Hawai'i, which is

  18. 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…

  19. Development of a foundation for a case definition of post-treatment Lyme disease syndrome.

    Science.gov (United States)

    Aucott, John N; Crowder, Lauren A; Kortte, Kathleen B

    2013-06-01

    The study objective is to demonstrate the clinical and research utility of an operationalized definition of post-treatment Lyme disease syndrome (PTLDS), as proposed by the Infectious Diseases Society of America. Seventy-four patients with confirmed erythema migrans and 14 controls were enrolled. Patient-reported symptoms and health function (SF-36) were collected pre-treatment and at follow-up visits over 6 months post-treatment. Eight (11%) patients met our operationalized definition of PTLDS, which included self-reported symptoms of fatigue, widespread musculoskeletal pain or cognitive complaints, and functional impact as measured by a T score of definition of PTLDS allows for identification of those patients who are treated for early Lyme disease and have significant post-treatment illness, as they have both residual symptoms and impact on daily life functioning. With further refinement and improvement of this operationalized definition, the true incidence of PTLDS can be determined and future studies can be designed to examine its pathophysiology and treatment. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  20. Interpreting Definiteness in a Second Language without Articles: The Case of L2 Russian

    Science.gov (United States)

    Cho, Jacee; Slabakova, Roumyana

    2014-01-01

    This article investigates the second language (L2) acquisition of two expressions of the semantic feature [definite] in Russian, a language without articles, by English and Korean native speakers. Within the Feature Reassembly approach (Lardiere, 2009), Slabakova (2009) has argued that reassembling features that are represented overtly in the…

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. Definition of a process standardization framework for a scientific journal based on a literature review and its performance objectives

    Directory of Open Access Journals (Sweden)

    José Augusto Campos Garcia

    2014-12-01

    Full Text Available This work presents the results of a study that aimed to establish a framework to standardize the process of a scientific journal. It has a team that performs operational routines regulated by standards (external and patterns (internal and external. The high turnover rate of the supportive team has generated information loss and increased service variability. The research started from the assumption that the process standardization (which includes the formalization could be a way to reduce this secondary effect. Standardization techniques were identified through a literature review of the main national and international databases of journals and congresses. The identified standardization techniques were analyzed considering the number of times they appeared in the papers analyzed and performance objectives proposed by Slack et al. (2009. As result of this research, a framework was obtained for the standardization of processes adapted to the needs of the journal studied. The model is feasible to be used more widely, given its structural similarity to the one proposed by Campos (2004, a Brazilian model that is a reference in the field.

  6. Building a gold standard to construct search filters: a case study with biomarkers for oral cancer.

    Science.gov (United States)

    Frazier, John J; Stein, Corey D; Tseytlin, Eugene; Bekhuis, Tanja

    2015-01-01

    To support clinical researchers, librarians and informationists may need search filters for particular tasks. Development of filters typically depends on a "gold standard" dataset. This paper describes generalizable methods for creating a gold standard to support future filter development and evaluation using oral squamous cell carcinoma (OSCC) as a case study. OSCC is the most common malignancy affecting the oral cavity. Investigation of biomarkers with potential prognostic utility is an active area of research in OSCC. The methods discussed here should be useful for designing quality search filters in similar domains. The authors searched MEDLINE for prognostic studies of OSCC, developed annotation guidelines for screeners, ran three calibration trials before annotating the remaining body of citations, and measured inter-annotator agreement (IAA). We retrieved 1,818 citations. After calibration, we screened the remaining citations (n = 1,767; 97.2%); IAA was substantial (kappa = 0.76). The dataset has 497 (27.3%) citations representing OSCC studies of potential prognostic biomarkers. The gold standard dataset is likely to be high quality and useful for future development and evaluation of filters for OSCC studies of potential prognostic biomarkers. The methodology we used is generalizable to other domains requiring a reference standard to evaluate the performance of search filters. A gold standard is essential because the labels regarding relevance enable computation of diagnostic metrics, such as sensitivity and specificity. Librarians and informationists with data analysis skills could contribute to developing gold standard datasets and subsequent filters tuned for their patrons' domains of interest.

  7. 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....

  8. 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.

  9. 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 ...

  10. The use of definitive implant abutments for the fabrication of provisional crowns: a case series.

    Science.gov (United States)

    Bilhan, Hakan; Geckili, Onur; Mumcu, Emre

    2011-10-01

    The anterior region is a challenge for most clinicians to achieve optimal esthetics with dental implants. The provisional crown is a key factor in the success of obtaining pink esthetics around restorations with single implants, by soft tissue and inter-proximal papilla shaping. Provisional abutments bring additional costs and make the treatment more expensive. Since one of the aims of the clinician is to reduce costs and find more economic ways to raise patient satisfaction, this paper describes a practical method for chair-side fabrication of non-occlusal loaded provisional crowns used by the authors for several years successfully. Twenty two patients (9 males, 13 females; mean age, 36,72 years) with one missing anterior tooth were treated by using the presented method. Metal definitive abutments instead of provisional abutments were used and provisional crowns were fabricated on the definitive abutments for all of the patients. The marginal fit was finished on a laboratory analogue and temporarily cemented to the abutments. The marginal adaptation of the crowns was evaluated radiographically. The patients were all satisfied with the final appearance and no complications occurred until the implants were loaded with permanent restorations. The use of the definitive abutments for provisional crowns instead of provisional abutments reduces the costs and the same results can be obtained.

  11. Realizing business benefits from company IT standardization : Case study research into the organizational value of IT standards, towards a company IT standardization management framework

    NARCIS (Netherlands)

    van Wessel, R.M.

    2008-01-01

    From a practical point of view, this research provides insight into how company IT standards affect business process performance. Furthermore it gives recommendations on how to govern and manage such standards successfully with regard to their selection, implementation and usage. After evaluating

  12. 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.

  13. Differences in safety margins between nuclear and conventional design standards with regards to seismic hazard definition and design criteria

    International Nuclear Information System (INIS)

    Elgohary, M.; Saudy, A.; Orbovic, N.; Dejan, D.

    2006-01-01

    With the surging interest in new build nuclear all over the world and a permanent interest in earthquake resistance of nuclear plants, there is a need to quantify the safety margins in nuclear buildings design in comparison to conventional buildings in order to increase the public confidence in the safety of nuclear power plants. Nuclear (CAN3-N289 series) and conventional (NBCC 2005) seismic standards have different approaches regarding the design of civil structures. The origin of the differences lays in the safety philosophy behind the seismic nuclear and conventional standards. Conventional seismic codes contain the minimal requirement destined primarily to safeguard against major structural failure and loss of life. It doesn't limit damage to a certain acceptable degree or maintain function. Nuclear seismic code requires that structures, systems and components important to safety, withstand the effects of earthquakes. The requirement states that for equipment important to safety, both integrity and functionality should be ascertained. The seismic hazard is generally defined on the basis of the annual probability of exceedence (return period). There is a major difference on the return period and the confidence level for design earthquakes between the conventional and the nuclear seismic standards. The seismic design criteria of conventional structures are based on the use of Force Modification Factors to take into account the energy dissipation by incursion in non-elastic domain and the reserve of strength. The use of such factors to lower intentionally the seismic input is consistent with the safety philosophy of the conventional seismic standard which is the 'non collapse' rather than the integrity and/or the operability of the structures or components. Nuclear seismic standard requires that the structure remain in the elastic domain; energy dissipation by incursion in non-elastic domain is not allowed for design basis earthquake conditions. This is

  14. 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.

  15. 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.

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

    Science.gov (United States)

    Batzias, Dimitris F.; Karvounis, Sotirios

    2012-12-01

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

  17. 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.

  18. Comparison of Vital Statistics Definitions of Suicide against a Coroner Reference Standard: A Population-Based Linkage Study.

    Science.gov (United States)

    Gatov, Evgenia; Kurdyak, Paul; Sinyor, Mark; Holder, Laura; Schaffer, Ayal

    2018-03-01

    We sought to determine the utility of health administrative databases for population-based suicide surveillance, as these data are generally more accessible and more integrated with other data sources compared to coroners' records. In this retrospective validation study, we identified all coroner-confirmed suicides between 2003 and 2012 in Ontario residents aged 21 and over and linked this information to Statistics Canada's vital statistics data set. We examined the overlap between the underlying cause of death field and secondary causes of death using ICD-9 and ICD-10 codes for deliberate self-harm (i.e., suicide) and examined the sociodemographic and clinical characteristics of misclassified records. Among 10,153 linked deaths, there was a very high degree of overlap between records coded as deliberate self-harm in the vital statistics data set and coroner-confirmed suicides using both ICD-9 and ICD-10 definitions (96.88% and 96.84% sensitivity, respectively). This alignment steadily increased throughout the study period (from 95.9% to 98.8%). Other vital statistics diagnoses in primary fields included uncategorised signs and symptoms. Vital statistics records that were misclassified did not differ from valid records in terms of sociodemographic characteristics but were more likely to have had an unspecified place of injury on the death certificate ( P statistics and coroner classification of suicide deaths suggests that health administrative data can reliably be used to identify suicide deaths.

  19. 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.)

  20. 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.

  1. 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.

  2. Natural Hazard Problem and Solution Definition in the News Media: the Case of Tropical Storm Allison

    Science.gov (United States)

    Lindquist, Eric; Mosher-Howe, Katrina

    2010-05-01

    Focusing events such as natural or technological disasters can have significant impacts on public policy and planning in both the near and long term. These impacts can manifest at different temporal scales ranging from the period of immediate attention and disaster relief through the period of recovery and reconstruction and beyond. These impacts and associated decisions can be studied in retrospect and understood as not only short-term reactions, but as long-term components of subsequent natural hazard planning and public policy. By studying in detail how an event was defined, and the policy and planning alternatives that were raised or recommended in response to a disaster event, we can better understand the role that disaster-related focusing events play in the long-term evolution of a community's public policy, infrastructural planning efforts, and responses to natural disasters. This paper will use a focusing event framework to explore the local and regional policy impacts over time of a major urban flood in Houston, Texas, Tropical Storm Allison. Tropical Storm Allison (TSA), dropped 36 inches of rain on Houston over a period of four days in early June 2001, and was responsible for 22 deaths, 70,000 flood damaged homes, and 5 billion in damage to the region. The primary data source for this effort is a database of 500 articles from the major regional newspaper, the Houston Chronicle, over the period of 2001 through 2008. These articles were coded for multiple variables, including, cause, effect and impact (financial and social), blame, problem and solution definition and solution acceptance). This paper focuses primarily on the measures of problem definition (how was TSA, as an event, defined in the media, for example, as an act of God, or as a result of poor planning or decision making, etc), and on solution definition (what solutions were proposed to mitigate or adapt to future storms of this magnitude, how were they linked to the definition of the problem

  3. The Diffusion of Labour Standards: The Case of the US and Guatemala

    Directory of Open Access Journals (Sweden)

    Gerda van Roozendaal

    2015-05-01

    Full Text Available The number of free trade agreements (FTAs concluded by the United States of America (US has grown vastly over the past two decades. While FTAs contribute to increased global competition and as such may also contribute to socially-undesirable practices in the area of working conditions and the environment, the proliferation in FTAs has paradoxically also augmented the potential for making free trade more fair as some of these agreements now include labour provisions. However, the question is whether these trade agreements have also actually diffused internationally recognised labour standards. This article studies the FTA the US signed in 2004 with a number of Central American countries and which, at a later stage, also included the Dominican Republic. This FTA is commonly referred to as CAFTA-DR and includes a chapter on labour standards. The article argues that the effects of the inclusion of labour standards in CAFTA-DR have been limited and therefore should be viewed as an unsuccessful attempt at policy transfer. This is illustrated by the case of Guatemala, a country known for its lack of respect for labour standards and which is currently the subject of a complaints procedure under the CAFTA-DR. It is maintained that this lack of effectiveness is the result of many factors. Among these is the weakness of the labour chapter of CAFTA-DR resulting from the fact that the chapter is the outcome of bargaining processes both within the US and between the US and Guatemala, where symbolic results were valued more highly than actual substance.

  4. New definition of complexity for self-gravitating fluid distributions: The spherically symmetric, static case

    Science.gov (United States)

    Herrera, L.

    2018-02-01

    We put forward a new definition of complexity, for static and spherically symmetric self-gravitating systems, based on a quantity, hereafter referred to as complexity factor, that appears in the orthogonal splitting of the Riemann tensor, in the context of general relativity. We start by assuming that the homogeneous (in the energy density) fluid, with isotropic pressure is endowed with minimal complexity. For this kind of fluid distribution, the value of complexity factor is zero. So, the rationale behind our proposal for the definition of complexity factor stems from the fact that it measures the departure, in the value of the active gravitational mass (Tolman mass), with respect to its value for a zero complexity system. Such departure is produced by a specific combination of energy density inhomogeneity and pressure anisotropy. Thus, zero complexity factor may also be found in self-gravitating systems with inhomogeneous energy density and anisotropic pressure, provided the effects of these two factors, on the complexity factor, cancel each other. Some exact interior solutions to the Einstein equations satisfying the zero complexity criterium are found, and prospective applications of this newly defined concept, to the study of the structure and evolution of compact objects, are discussed.

  5. Incorporating Lean Construction agent into the Building Standards Act: the Spanish case study

    Directory of Open Access Journals (Sweden)

    Brioso Xavier

    2016-12-01

    Full Text Available There is a demand for lean construction in Europe; even though lean construction is still an emerging field and there is growing interest, there are no regulations on this topic. The main objective of this research is to regulate this role when in a project and to define and develop a building agent structure, according to the Building Standards Act (LOE by its acronym in Spanish, to be able to incorporate it into the Spanish law, protecting it from civil liabilities. In Spain, there is jurisprudence in civil jurisdiction based on the LOE to acquit or convict building agents, who are defined in the courts as “constructive managers” or similar. For this reason, courts could establish in the future several liabilities for the lean construction specialist and other agents of the project, depending on their actions and based on the implementation of the lean project delivery system, the target value design and the integrated project delivery. Conversely, it is possible that the level of action of the lean construction specialist may comprise design management, construction management and contract management. Accordingly, one or more building agents should be appropriately incorporated into the LOE according to their functions and responsibilities and based on the levels of action of the lean construction specialist. The creation of the following agents is proposed: design manager, construction manager and contract manager, definitions that are developed in this study. These agents are loosely defined, because any project manager, building information modeling manager or similar may act as one or as more-than-one of them. Finally, the creation of the lean construction manager is also proposed, as the agent who takes on the role of the design manager, construction manager and contract manager, but focused on the lean production principles.

  6. The legitimacy of transnational private governance arrangements related to nanotechnologies: the case of international organization for standardization

    NARCIS (Netherlands)

    Kica, Evisa

    2015-01-01

    The core of this thesis consists of developing a comprehensive empirical assessment on the legitimacy of nanotechnology related transnational private governance arrangements (TPGAs), explored through the case study of the International Organization for Standardization (ISO) Technical Committee on

  7. Using standardized video cases for assessment of medical communication skills: reliability of an objective structured video examination by computer

    NARCIS (Netherlands)

    Hulsman, R. L.; Mollema, E. D.; Oort, F. J.; Hoos, A. M.; de Haes, J. C. J. M.

    2006-01-01

    OBJECTIVE: Using standardized video cases in a computerized objective structured video examination (OSVE) aims to measure cognitive scripts underlying overt communication behavior by questions on knowledge, understanding and performance. In this study the reliability of the OSVE assessment is

  8. Strategies for using international domain standards within a national context: The case of the Dutch temporary staffing industry

    NARCIS (Netherlands)

    Folmer, Erwin Johan Albert; van Bekkum, Michael; Verhoosel, Jack

    2009-01-01

    This paper will discuss strategies for using international domain standards within a national context. The various strategies are illustrated by means of a case study of the temporary staffing industry.

  9. Intelligence and Security Standards on Industrial Facilities Protection in Case of Terrorism and Military Attack

    International Nuclear Information System (INIS)

    Stipetic, D.

    2007-01-01

    Industrial facilities, which use toxic chemicals in their production processes, are tempting targets for military and terrorist strategists. They know that these facilities when attacked could produce effects not realizable with conventional weapons. The resulting legal, policy and political consequences would be minimal as compared to that of disseminating toxic chemicals or chemical agents as weapons on enemy territory. At this time there is no clear definition of the legality or illegality of these types of actions used against specific industrial targets for the purpose of mass destruction or disruption. Without clearly defined international regulations covering these actions, we must depend solely on national defense systems. Not only are these regulation not defined, there are no implementation tools, which would be available if the various treaties (CWC/BWC) etc., were able to incorporate needed legislative action. Consequently we must depend on and put into practice defense security standards for industrial facilities for protection against both possible terrorist and military attacks. Emergency responses to incidents involving violent criminals and terrorists are extremely dangerous. Incidents involving weapons of mass destruction, firearms, and hazardous materials have resulted in the injury and death of many firefighters, police officers and medical personnel. We wish to intend display place and role of intelligence and counter intelligence system to prevention potential target and military attack. Security needs to be incorporated into the public safety culture and it must become the routine for how we operate. The recognition and identification process is an important skill that needs continual refinement. The use of transportation or facility paperwork assists in recognizing what potential hazards. A key factor in the successful command and management of a hazmat incident or terrorism event is the ability of public safety agencies to function as a

  10. 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.

  11. 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.

  12. 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.

  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

    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...

  14. Thoughtflow: Standards and Tools for Provenance Capture and Workflow Definition to Support Model-Informed Drug Discovery and Development.

    Science.gov (United States)

    Wilkins, J J; Chan, Pls; Chard, J; Smith, G; Smith, M K; Beer, M; Dunn, A; Flandorfer, C; Franklin, C; Gomeni, R; Harnisch, L; Kaye, R; Moodie, S; Sardu, M L; Wang, E; Watson, E; Wolstencroft, K; Cheung, Sya

    2017-05-01

    Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error-prone, and time-consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model-informed drug discovery and development (MID3), as well as to support reproducibility: "Thoughtflow." A prototype software implementation is provided. © 2017 The Authors CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  15. A case of recurrent esophageal cancer treated with salvage lymphadenectomy after definitive chemoradiotherapy

    International Nuclear Information System (INIS)

    Kano, Kazuki; Sato, Tsutomu; Maezawa, Yukio

    2016-01-01

    A 74-year-old man admitted with dysphagia was found to have advanced esophageal squamous cell carcinoma, clinical stage 4 (T4N2M0). We initiated definitive chemoradiotherapy (dCRT) with combined 5-fluorouracil and cisplatin chemotherapy (FP therapy) and 50.4 Gy irradiation, followed by boost FP therapy, to which the patient showed confirmed complete response (CR). Local recurrence was detected in the scar of the primary lesion at 4 months after the boost FP therapy. Photodynamic therapy (PDT) for this lesion resulted in CR. Thirteen months later, right hilar and right pericardial lymph node metastases were found. The right hilar lymph node metastases were not visible on CT after triweekly docetaxel therapy, but the pericardial lesions remained. The patient underwent salvage lymphadenectomy without further chemotherapy, and at 5 months after surgery, he was alive and recurrence-free. (author)

  16. Global case studies of soft-sediment deformation structures (SSDS: Definitions, classifications, advances, origins, and problems

    Directory of Open Access Journals (Sweden)

    G. Shanmugam

    2017-10-01

    Problems that hinder our understanding of SSDS still remain. They are: (1 vague definitions of the phrase “soft-sediment deformation”; (2 complex factors that govern the origin of SSDS; (3 omission of vital empirical data in documenting vertical changes in facies using measured sedimentological logs; (4 difficulties in distinguishing depositional processes from tectonic events; (5 a model-driven interpretation of SSDS (i.e., earthquake being the singular cause; (6 routine application of the genetic term “seismites” to the “SSDS”, thus undermining the basic tenet of process sedimentology (i.e., separation of interpretation from observation; (7 the absence of objective criteria to differentiate 21 triggering mechanisms of liquefaction and related SSDS; (8 application of the process concept “high-density turbidity currents”, a process that has never been documented in modern oceans; (9 application of the process concept “sediment creep” with a velocity connotation that cannot be inferred from the ancient record; (10 classification of pockmarks, which are hollow spaces (i.e., without sediments as SSDS, with their problematic origins by fluid expulsion, sediment degassing, fish activity, etc.; (11 application of the Earth's climate-change model; and most importantly, (12 an arbitrary distinction between depositional process and sediment deformation. Despite a profusion of literature on SSDS, our understanding of their origin remains muddled. A solution to the chronic SSDS problem is to utilize the robust core dataset from scientific drilling at sea (DSDP/ODP/IODP with a constrained definition of SSDS.

  17. Definition of sampling units begets conclusions in ecology: the case of habitats for plant communities.

    Science.gov (United States)

    Mörsdorf, Martin A; Ravolainen, Virve T; Støvern, Leif Einar; Yoccoz, Nigel G; Jónsdóttir, Ingibjörg Svala; Bråthen, Kari Anne

    2015-01-01

    In ecology, expert knowledge on habitat characteristics is often used to define sampling units such as study sites. Ecologists are especially prone to such approaches when prior sampling frames are not accessible. Here we ask to what extent can different approaches to the definition of sampling units influence the conclusions that are drawn from an ecological study? We do this by comparing a formal versus a subjective definition of sampling units within a study design which is based on well-articulated objectives and proper methodology. Both approaches are applied to tundra plant communities in mesic and snowbed habitats. For the formal approach, sampling units were first defined for each habitat in concave terrain of suitable slope using GIS. In the field, these units were only accepted as the targeted habitats if additional criteria for vegetation cover were fulfilled. For the subjective approach, sampling units were defined visually in the field, based on typical plant communities of mesic and snowbed habitats. For each approach, we collected information about plant community characteristics within a total of 11 mesic and seven snowbed units distributed between two herding districts of contrasting reindeer density. Results from the two approaches differed significantly in several plant community characteristics in both mesic and snowbed habitats. Furthermore, differences between the two approaches were not consistent because their magnitude and direction differed both between the two habitats and the two reindeer herding districts. Consequently, we could draw different conclusions on how plant diversity and relative abundance of functional groups are differentiated between the two habitats depending on the approach used. We therefore challenge ecologists to formalize the expert knowledge applied to define sampling units through a set of well-articulated rules, rather than applying it subjectively. We see this as instrumental for progress in ecology as only rules

  18. Definition of sampling units begets conclusions in ecology: the case of habitats for plant communities

    Directory of Open Access Journals (Sweden)

    Martin A. Mörsdorf

    2015-03-01

    Full Text Available In ecology, expert knowledge on habitat characteristics is often used to define sampling units such as study sites. Ecologists are especially prone to such approaches when prior sampling frames are not accessible. Here we ask to what extent can different approaches to the definition of sampling units influence the conclusions that are drawn from an ecological study? We do this by comparing a formal versus a subjective definition of sampling units within a study design which is based on well-articulated objectives and proper methodology. Both approaches are applied to tundra plant communities in mesic and snowbed habitats. For the formal approach, sampling units were first defined for each habitat in concave terrain of suitable slope using GIS. In the field, these units were only accepted as the targeted habitats if additional criteria for vegetation cover were fulfilled. For the subjective approach, sampling units were defined visually in the field, based on typical plant communities of mesic and snowbed habitats. For each approach, we collected information about plant community characteristics within a total of 11 mesic and seven snowbed units distributed between two herding districts of contrasting reindeer density. Results from the two approaches differed significantly in several plant community characteristics in both mesic and snowbed habitats. Furthermore, differences between the two approaches were not consistent because their magnitude and direction differed both between the two habitats and the two reindeer herding districts. Consequently, we could draw different conclusions on how plant diversity and relative abundance of functional groups are differentiated between the two habitats depending on the approach used. We therefore challenge ecologists to formalize the expert knowledge applied to define sampling units through a set of well-articulated rules, rather than applying it subjectively. We see this as instrumental for progress in

  19. 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

  20. Obsolete Laws: Economic and Moral Aspects, Case Study-Composting Standards.

    Science.gov (United States)

    Vochozka, Marek; Maroušková, Anna; Šuleř, Petr

    2017-12-01

    From the early days of philosophy, ethics and justice, there is wide consensus that the constancy of the laws establishes the legal system. On the other hand, the rate at which we accumulate knowledge is gaining speed like never before. Due to the recently increased attention of academics to climate change and other environmental issues, a lot of new knowledge has been obtained about carbon management, its role in nature and mechanisms regarding the formation and degradation of organic matter. A multidisciplinary techno-economic assessment of current composting standards and laws that took into account the current state of knowledge about carbon management was carried out as a case study. Economic and environmental damage caused by outdated laws was revealed. In addition, it was found that the introduction of the best composts into the market is permitted, causing additional negative environmental as well as economic impacts.

  1. 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.

  2. Punica granatum L. Hydrogel for Wound Care Treatment: From Case Study to Phytomedicine Standardization.

    Science.gov (United States)

    Fleck, Aline; Cabral, Patrik F G; Vieira, Felipe F M; Pinheiro, Deo A; Pereira, Carlos R; Santos, Wilson C; Machado, Thelma B

    2016-08-22

    The pharmacological activities of many Punica granatum L. components suggest a wide range of clinical applications for the prevention and treatment of diseases where chronic inflammation is believed to play an essential etiologic role. The current work reports a case study analyzing the effect produced by a magistral formulation of ethanolic extracts of Punica granatum peels on a non-healing chronic ulcer. The complete closure of the chronic ulcer that was initially not responsive to standard medical care was observed. A 2% (w/w) P. granatum peels ethanolic extract hydrogel-based formulation (PGHF) was standardized and subjected to physicochemical studies to establish the quality control parameters using, among others, assessment criteria such as optimum appearance, pH range, viscosity and hydrogel disintegration. The stability and quantitative chromatographic data was assessed in storage for six months under two temperature regimes. An efficient HPLC-DAD method was established distinguishing the biomarkers punicalin and punicalagin simultaneously in a single 8 min run. PGHF presented suitable sensorial and physicochemical performance, showing that punicalagin was not significantly affected by storage (p > 0.05). Formulations containing extracts with not less than 0.49% (w/w) total punicalagin might find good use in wound healing therapy.

  3. The case for improved HEPA-filter mechanical performance standards revisited

    Energy Technology Data Exchange (ETDEWEB)

    Ricketts, C.I.; Smith, P.R. [New Mexico State Univ., Las Cruces, NM (United States)

    1997-08-01

    Under benign operating conditions, High Efficiency Particulate Air (HEPA) filter units serve as reliable and relatively economical components in the air cleaning systems of nuclear facilities worldwide. Despite more than four decades of filter-unit evaluation and improvements, however, the material strength characteristics of the glass fiber filter medium continue to ultimately limit filter functional reliability. In worst-case scenarios involving fire suppression, loss-of-coolant accidents (LOCA`s), or exposure to shock waves or tornado induced flows, rupture of the filter medium of units meeting current qualification standards cannot be entirely ruled out. Even under so-called normal conditions of operation, instances of filter failure reported in the literature leave open questions of filter-unit reliability. Though developments of filter units with improved burst strengths have been pursued outside the United States, support for efforts in this country has been comparatively minimal. This despite user requests for filters with greater moisture resistance, for example. Or the fact that conventional filter designs result in not only the least robust component to be found in a nuclear air cleaning system, but also the one most sensitive to the adverse effects of conditions deviating from those of normal operation. Filter qualification-test specifications of current codes, standards, and regulatory guidelines in the United States are based primarily upon research performed in a 30-year period beginning in the 1950`s. They do not seem to reflect the benefits of the more significant developments and understanding of filter failure modes and mechanisms achieved since that time. One overseas design, based on such knowledge, has proven reliability under adverse operating conditions involving combined and serial challenges. Its widespread use, however, has faltered on a lack of consensus in upgrading filter performance standards. 34 refs., 2 figs., 3 tabs.

  4. High-definition fiber tracking for assessment of neurological deficit in a case of traumatic brain injury: finding, visualizing, and interpreting small sites of damage.

    Science.gov (United States)

    Shin, Samuel S; Verstynen, Timothy; Pathak, Sudhir; Jarbo, Kevin; Hricik, Allison J; Maserati, Megan; Beers, Sue R; Puccio, Ava M; Boada, Fernando E; Okonkwo, David O; Schneider, Walter

    2012-05-01

    For patients with traumatic brain injury (TBI), current clinical imaging methods generally do not provide highly detailed information about the location of axonal injury, severity of injury, or expected recovery. In a case of severe TBI, the authors applied a novel high-definition fiber tracking (HDFT) to directly visualize and quantify the degree of axonal fiber damage and predict functional deficits due to traumatic axonal injury and loss of cortical projections. This 32-year-old man sustained a severe TBI. Computed tomography and MRI revealed an area of hemorrhage in the basal ganglia with mass effect, but no specific information on the location of axonal injury could be obtained from these studies. Examinations of the patient at Week 3 and Week 8 after TBI revealed motor weaknesses of the left extremities. Four months postinjury, 257-direction diffusion spectrum imaging and HDFT analysis was performed to evaluate the degree of axonal damage in the motor pathway and quantify asymmetries in the left and right axonal pathways. High-definition fiber tracking was used to follow corticospinal and corona radiata pathways from the cortical surface to the midbrain and quantify projections from motor areas. Axonal damage was then localized by assessing the number of descending fibers at the level of the cortex, internal capsule, and midbrain. The motor deficit apparent in the clinical examinations correlated with the axonal losses visualized using HDFT. Fiber loss estimates at 4 months postinjury accurately predicted the nature of the motor deficits (severe, focal left-hand weakness) when other standard clinical imaging modalities did not. A repeat scan at 10 months postinjury, when edema and hemorrhage had receded, replicated the fiber loss. Using HDFT, the authors accurately identified the presence and location of damage to the underlying white matter in this patient with TBI. Detailed information of injury provided by this novel technique holds future potential for

  5. Identification of ecological thresholds from variations in phytoplankton communities among lakes: contribution to the definition of environmental standards.

    Science.gov (United States)

    Roubeix, Vincent; Danis, Pierre-Alain; Feret, Thibaut; Baudoin, Jean-Marc

    2016-04-01

    In aquatic ecosystems, the identification of ecological thresholds may be useful for managers as it can help to diagnose ecosystem health and to identify key levers to enable the success of preservation and restoration measures. A recent statistical method, gradient forest, based on random forests, was used to detect thresholds of phytoplankton community change in lakes along different environmental gradients. It performs exploratory analyses of multivariate biological and environmental data to estimate the location and importance of community thresholds along gradients. The method was applied to a data set of 224 French lakes which were characterized by 29 environmental variables and the mean abundances of 196 phytoplankton species. Results showed the high importance of geographic variables for the prediction of species abundances at the scale of the study. A second analysis was performed on a subset of lakes defined by geographic thresholds and presenting a higher biological homogeneity. Community thresholds were identified for the most important physico-chemical variables including water transparency, total phosphorus, ammonia, nitrates, and dissolved organic carbon. Gradient forest appeared as a powerful method at a first exploratory step, to detect ecological thresholds at large spatial scale. The thresholds that were identified here must be reinforced by the separate analysis of other aquatic communities and may be used then to set protective environmental standards after consideration of natural variability among lakes.

  6. Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system

    Directory of Open Access Journals (Sweden)

    Juliana P. Santos

    2015-12-01

    Full Text Available In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.

  7. Green and sustainable remediation (GSR) evaluation: framework, standards, and tool. A case study in Taiwan.

    Science.gov (United States)

    Huang, Wen-Yen; Hung, Weiteng; Vu, Chi Thanh; Chen, Wei-Ting; Lai, Jhih-Wei; Lin, Chitsan

    2016-11-01

    Taiwan has a large number of poorly managed contaminated sites in need of remediation. This study proposes a framework, a set of standards, and a spreadsheet-based evaluation tool for implementing green and sustainable principles into remediation projects and evaluating the projects from this perspective. We performed a case study to understand how the framework would be applied. For the case study, we used a spreadsheet-based evaluation tool (SEFA) and performed field scale cultivation tests on a site contaminated with total petroleum hydrocarbons (TPHs). The site was divided into two lots: one treated by chemical oxidation and the other by bioremediation. We evaluated five core elements of green and sustainable remediation (GSR): energy, air, water resources, materials and wastes, and land and ecosystem. The proposed evaluation tool and field scale cultivation test were found to efficiently assess the effectiveness of the two remediation alternatives. The framework and related tools proposed herein can potentially be used to support decisions about the remediation of contaminated sites taking into account engineering management, cost effectiveness, and social reconciliation.

  8. Definition of a Learning Object from Perspectives of In-Service Teachers (Case of Duzce Province

    Directory of Open Access Journals (Sweden)

    Kürşat ARSLAN

    2016-08-01

    Full Text Available Learning objects, as a relatively new technological concept, have drawn much attention from educators because these dijital resources are easily accessible, relatively easy to use due to their limited size and focus, interactive, and adaptable to many different educational contexts. Despite the fact that learning objects have the great potential to improve teaching and learning experiences by providing teachers reusable learning materials and reducing costs, the lack of a “working and clear” definition of these materials has restricted their effective and efficient use. This study aimed to explore elementary school teacher perceptions of their use of learning objects from a qualitative research paradigm in order to reveal the extent to which teachers understand concept of learning object and its instruction approach. The method of the study was based on descriptive phenomenology. Data were collected using multiple methods, including the semi-structured interview, field observation reports, and photos from nine in-service elementary school teachers from different departments in Duzce, Turkey. Methods of data analysis were based on Giorgi’s method of descriptive phenomenology including four stages of content analysis: data coding, developing themes, organizing code and themes, describing findings. Overall findings of the study indicate that teachers use learning objects in their lesson activities without explicit recognition; however they generally fail to understand the exact meaning of a learning object approach and its applications in the classroom. Participants understood different properties of learning objects. Almost all participants perceive objectivity as the most important characteristic of the learning object.  In addition, a majority of the teachers recognized the value of a learning object’s reusability. In-service teachers’ vague perceptions of the definition and usage of learning objects indicated that they used these

  9. Definition of the OPERA safety case for radioactive waste disposal in the Netherlands

    International Nuclear Information System (INIS)

    Hart, Jaap; Wildenborg, Ton; Davis, Paul; Becker, Dirk-Alexander; Verhoef, Ewoud

    2014-01-01

    This paper first gives a short introduction on OPERA, the current Dutch five-year research programme on disposal of radioactive waste. It then zooms in on OPERA WP (Work Package) 2 Safety Case - the OSCAR project, and presents (preliminary) results on the structure of the OPERA safety case, the subject of safety statements, and the OPERA safety assessment methodology. The structure of the initial long-term, post-closure safety case for a disposal facility for radioactive waste in Boom Clay in the Netherlands is being developed in the OSCAR project. Hereto a selection of relevant national and international efforts concerning the set-up of a safety case for geological disposal of radioactive waste (safety case structure, safety assessment methodology, FEP database) has been reviewed considering the objectives and outlines of the OPERA programme described in the OPERA research plan. Not surprisingly, it turned out that the guidelines and databases of the IAEA and NEA developed by the international community pretty well covered all aspects of nationally developed safety cases. Although in OPERA only 'initial and conditional' safety cases (for disposal in low permeable clay and rock salt) will be developed, the programme objective is detailing a first road-map for the long-term research on geological disposal of radioactive waste in the Netherlands. The safety case being developed will serve as a basis for the further development of the subsequent stages of the Dutch radioactive waste disposal programme. The focus of OSCAR is, therefore, to develop and propose a 'future proof' structure for the safety case, drawing on the NEA and IAEA/PRISM methodologies. The OPERA safety case structure being developed will encompass all relevant aspects, or components, of a modern safety case and will link the different components in a practical and transparent way. It will assist in steering the flow of information generated within the different OPERA and as such provide a structured

  10. A functional interaction approach to the definition of meso regions: The case of the Czech Republic

    Directory of Open Access Journals (Sweden)

    Erlebach Martin

    2016-06-01

    Full Text Available The definition of functional meso regions for the territory of the Czech Republic is articulated in this article. Functional regions reflect horizontal interactions in space and are presented as a useful tool for various types of geographical analyses, and also for spatial planning, economic policy designs, etc. This paper attempts to add to the discussion on the need to delineate areal units at different hierarchical levels, and to understand the functional flows and spatial behaviours of the population in a given space. Three agglomerative methods are applied in the paper (the CURDS regionalisation algorithm, Intramax, and cluster analysis, and they have not been used previously in Czech geography for the delineation of functional meso regions. Existing functional regions at the micro-level, based on daily travel-to-work flows from the 2001 census, have served as the building blocks. The analyses have produced five regional systems at the meso level, based on daily labour commuting movements of the population. Basic statistics and a characterisation of these systems are provided in this paper.

  11. Relationship between autonomic cardiovascular control, case definition, clinical symptoms, and functional disability in adolescent chronic fatigue syndrome: an exploratory study.

    Science.gov (United States)

    Wyller, Vegard B; Helland, Ingrid B

    2013-02-07

    Chronic Fatigue Syndrome (CFS) is characterized by severe impairment and multiple symptoms. Autonomic dysregulation has been demonstrated in several studies. We aimed at exploring the relationship between indices of autonomic cardiovascular control, the case definition from Centers for Disease Control and Prevention (CDC criteria), important clinical symptoms, and disability in adolescent chronic fatigue syndrome. 38 CFS patients aged 12-18 years were recruited according to a wide case definition (ie. not requiring accompanying symptoms) and subjected to head-up tilt test (HUT) and a questionnaire. The relationships between variables were explored with multiple linear regression analyses. In the final models, disability was positively associated with symptoms of cognitive impairments (p<0.001), hypersensitivity (p<0.001), fatigue (p=0.003) and age (p=0.007). Symptoms of cognitive impairments were associated with age (p=0.002), heart rate (HR) at baseline (p=0.01), and HR response during HUT (p=0.02). Hypersensitivity was associated with HR response during HUT (p=0.001), high-frequency variability of heart rate (HF-RRI) at baseline (p=0.05), and adherence to the CDC criteria (p=0.005). Fatigue was associated with gender (p=0.007) and adherence to the CDC criteria (p=0.04). In conclusion, a) The disability of CFS patients is not only related to fatigue but to other symptoms as well; b) Altered cardiovascular autonomic control is associated with certain symptoms; c) The CDC criteria are poorly associated with disability, symptoms, and indices of altered autonomic nervous activity.

  12. Histopathology case definition of naturally acquired Salmonella enterica serovar Dublin infection in young Holstein cattle in the northeastern United States.

    Science.gov (United States)

    Pecoraro, Heidi L; Thompson, Belinda; Duhamel, Gerald E

    2017-11-01

    Salmonella enterica subsp. enterica serovar Dublin ( Salmonella Dublin) is a host-adapted bacterium that causes high morbidity and mortality in dairy cattle worldwide. A retrospective search of archives at the New York Animal Health Diagnostic Center revealed 57 culture-confirmed Salmonella Dublin cases from New York and Pennsylvania in which detailed histology of multiple tissues was available. Tissues routinely submitted by referring veterinarians for histologic evaluation included sections of heart, lungs, liver, spleen, and lymph nodes. Of the 57 S almonella Dublin-positive cases, all were Holstein breed, 53 were female (93%), and 49 (86%) were 90% (45 of 49) of lungs, 90% (28 of 31) of livers, 50% (11 of 22) of spleens, and 62% (18 of 29) of lymph nodes examined had moderate-to-severe inflammation with or without necrosis. Inconstant lesions were seen in 48% (10 of 21) of hearts examined, and consisted of variable inflammatory infiltrates and rare areas of necrosis. We propose a histopathology case definition of Salmonella Dublin in cattle that includes a combination of pulmonary alveolar capillary neutrophilia with or without hepatocellular necrosis and paratyphoid granulomas, splenitis, and lymphadenitis. These findings will assist in the development of improved protocols for the diagnosis of infectious diseases of dairy cattle.

  13. Standardizing data exchange for clinical research protocols and case report forms: An assessment of the suitability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM).

    Science.gov (United States)

    Huser, Vojtech; Sastry, Chandan; Breymaier, Matthew; Idriss, Asma; Cimino, James J

    2015-10-01

    Efficient communication of a clinical study protocol and case report forms during all stages of a human clinical study is important for many stakeholders. An electronic and structured study representation format that can be used throughout the whole study life-span can improve such communication and potentially lower total study costs. The most relevant standard for representing clinical study data, applicable to unregulated as well as regulated studies, is the Operational Data Model (ODM) in development since 1999 by the Clinical Data Interchange Standards Consortium (CDISC). ODM's initial objective was exchange of case report forms data but it is increasingly utilized in other contexts. An ODM extension called Study Design Model, introduced in 2011, provides additional protocol representation elements. Using a case study approach, we evaluated ODM's ability to capture all necessary protocol elements during a complete clinical study lifecycle in the Intramural Research Program of the National Institutes of Health. ODM offers the advantage of a single format for institutions that deal with hundreds or thousands of concurrent clinical studies and maintain a data warehouse for these studies. For each study stage, we present a list of gaps in the ODM standard and identify necessary vendor or institutional extensions that can compensate for such gaps. The current version of ODM (1.3.2) has only partial support for study protocol and study registration data mainly because it is outside the original development goal. ODM provides comprehensive support for representation of case report forms (in both the design stage and with patient level data). Inclusion of requirements of observational, non-regulated or investigator-initiated studies (outside Food and Drug Administration (FDA) regulation) can further improve future revisions of the standard. Published by Elsevier Inc.

  14. Hydrogen peroxide plasma sterilization of a waterproof, high-definition video camera case for intraoperative imaging in veterinary surgery.

    Science.gov (United States)

    Adin, Christopher A; Royal, Kenneth D; Moore, Brandon; Jacob, Megan

    2018-06-13

    To evaluate the safety and usability of a wearable, waterproof high-definition camera/case for acquisition of surgical images by sterile personnel. An in vitro study to test the efficacy of biodecontamination of camera cases. Usability for intraoperative image acquisition was assessed in clinical procedures. Two waterproof GoPro Hero4 Silver camera cases were inoculated by immersion in media containing Staphylococcus pseudointermedius or Escherichia coli at ≥5.50E+07 colony forming units/mL. Cases were biodecontaminated by manual washing and hydrogen peroxide plasma sterilization. Cultures were obtained by swab and by immersion in enrichment broth before and after each contamination/decontamination cycle (n = 4). The cameras were then applied by a surgeon in clinical procedures by using either a headband or handheld mode and were assessed for usability according to 5 user characteristics. Cultures of all poststerilization swabs were negative. One of 8 cultures was positive in enrichment broth, consistent with a low level of contamination in 1 sample. Usability of the camera was considered poor in headband mode, with limited battery life, inability to control camera functions, and lack of zoom function affecting image quality. Handheld operation of the camera by the primary surgeon improved usability, allowing close-up still and video intraoperative image acquisition. Vaporized hydrogen peroxide sterilization of this camera case was considered effective for biodecontamination. Handheld operation improved usability for intraoperative image acquisition. Vaporized hydrogen peroxide sterilization and thorough manual washing of a waterproof camera may provide cost effective intraoperative image acquisition for documentation purposes. © 2018 The American College of Veterinary Surgeons.

  15. 77 FR 76939 - Defense Federal Acquisition Regulation Supplement: Definition of Cost or Pricing Data (DFARS Case...

    Science.gov (United States)

    2012-12-31

    ... cost or pricing data'' in its place. PART 217--SPECIAL CONTRACTING METHODS 217.7401 [Amended] 0 11... Cost or Pricing Data (DFARS Case 2011-D040) AGENCY: Defense Acquisition Regulations System, Department... ``certified cost or pricing data'' and ``data other than certified cost or pricing data.'' The DFARS changes...

  16. Standardization of whole slide image morphologic assessment with definition of a new application: Digital slide dynamic morphometry

    Directory of Open Access Journals (Sweden)

    Giacomo Puppa

    2011-01-01

    Full Text Available Background: In histopathology, the quantitative assessment of various morphologic features is based on methods originally conceived on specific areas observed through the microscope used. Failure to reproduce the same reference field of view using a different microscope will change the score assessed. Visualization of a digital slide on a screen through a dedicated viewer allows selection of the magnification. However, the field of view is rectangular, unlike the circular field of optical microscopy. In addition, the size of the selected area is not evident, and must be calculated. Materials and Methods: A digital slide morphometric system was conceived to reproduce the various methods published for assessing tumor budding in colorectal cancer. Eighteen international experts in colorectal cancer were invited to participate in a web-based study by assessing tumor budding with five different methods in 100 digital slides. Results: The specific areas to be tested by each method were marked by colored circles. The areas were grouped in a target-like pattern and then saved as an .xml file. When a digital slide was opened, the .xml file was imported in order to perform the measurements. Since the morphometric tool is composed of layers that can be freely moved on top of the digital slide, the technique was named digital slide dynamic morphometry. Twelve investigators completed the task, the majority of them performing the multiple evaluations of each of the cases in less than 12 minutes. Conclusions: Digital slide dynamic morphometry has various potential applications and might be a useful tool for the assessment of histologic parameters originally conceived for optical microscopy that need to be quantified.

  17. Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.

    Science.gov (United States)

    Ashktorab, Hassan; Etaati, Firoozeh; Rezaeean, Farahnaz; Nouraie, Mehdi; Paydar, Mansour; Namin, Hassan Hassanzadeh; Sanderson, Andrew; Begum, Rehana; Alkhalloufi, Kawtar; Brim, Hassan; Laiyemo, Adeyinka O

    2016-07-28

    To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar. Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

  18. Managing Effectively National and Regional projects-A Case of Kenya Bureau of Standards

    International Nuclear Information System (INIS)

    Kioko, J

    2009-01-01

    Discusses the functions of Kenya Bureau of Standards as standards development, testing,metrology,implementation of standards in commerce and industry, accredit ion,certification,inspection of imports and exports,training and education in Metrology,standards,testing and quality assurance

  19. 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.

  20. Indeterminacy of definitions and criteria in mental health: case study of emotional disorders.

    Science.gov (United States)

    Nikolaidis, George

    2013-06-01

    such as the ones of theorists like Solomon, Nash, Rey, Pugmire and Lyons) as well as in comprehensive theoretical schemes combining experimental data (such as the ones provided by the works of Schachter and Singer, Ekman and Friesen, Panksepp, Damasio and Griffiths), there seems to be a radical indeterminacy of conceptual content and fundamental features of emotions in general, as well as of particular emotional states. Furthermore, there is an apparent conceptual incapability to include each and every feature of emotional states within a single comprehensive definition without making reference to contingent particularities of their biological instantiation. At least in the crucial concept of emotional states, when examined carefully, it seems that (1) there are substantial barriers to the ambitious quest for a scientific grounding of taxonomies and definitions of phenomena like emotions, due to the inability to provide an independent verification of scientific propositions; (2) all major approaches in Psychology and Psychiatry seem to have serious shortcomings in defining emotions; (3) such shortcomings have to do with fundamental issues such as the nature of mental states; (4) most ordinary concepts of emotions utilized by clinicians and researchers tend to be circular and question begging when scrutinized theoretically; and (5) historically dominant beliefs, values and cultural systems tend to influence heavily both the acceptability of such representations of emotions as well as their very nature. © 2013 John Wiley & Sons Ltd.

  1. Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study.

    Science.gov (United States)

    Fancourt, Nicholas; Deloria Knoll, Maria; Barger-Kamate, Breanna; de Campo, John; de Campo, Margaret; Diallo, Mahamadou; Ebruke, Bernard E; Feikin, Daniel R; Gleeson, Fergus; Gong, Wenfeng; Hammitt, Laura L; Izadnegahdar, Rasa; Kruatrachue, Anchalee; Madhi, Shabir A; Manduku, Veronica; Matin, Fariha Bushra; Mahomed, Nasreen; Moore, David P; Mwenechanya, Musaku; Nahar, Kamrun; Oluwalana, Claire; Ominde, Micah Silaba; Prosperi, Christine; Sande, Joyce; Suntarattiwong, Piyarat; O'Brien, Katherine L

    2017-06-15

    Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials. The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1-59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion. A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively). Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  2. Regional recurrence of oropharyngeal cancer after definitive radiotherapy: a case control study

    International Nuclear Information System (INIS)

    Söderström, Karin; Nilsson, Per; Dalianis, Tina; Kjellén, Elisabeth; Zackrisson, Björn

    2015-01-01

    Elective treatment of lymph nodes in oropharyngeal cancer (OPC) has impact on both regional recurrences (RR) and risk of late side effects. This study was performed to quantify the dose-dependent impact on RR and overall survival (OS) in a prospectively collected cohort of OPC from the ARTSCAN study with emphasis on elective treatment. ARTSCAN is a previously published prospective, randomized, multicentre study of altered radiotherapy (RT) fractionation in head and neck cancer. In ARTSCAN the elective treatment volume for node positive OPC varied significantly between centres due to local treatment principles. All patients with OPC in complete response after primary treatment were eligible for the present case–control study. Cases were patients with RR during five years follow-up. Patients with no recurrence were eligible as controls. Four controls per case were matched according to T- and N-stage. Mean (D mean ) and median (D 50% ) dose for the lymph node level (LNL) of RR in the cases and the corresponding LNL in the controls were analysed with conditional logistic regression. OS was estimated with the Kaplan-Meier method and evaluated by multivariate Cox regression analysis. There was a dose-dependent risk reduction for D 50% in the interval that represented elective treatment (40–50 Gy) (OR = 0.18, p < 0.05) and a trend in the same dose interval for D mean (OR = 0.19, p = 0.07). OS rates at five years were 0.39 (0.24-0.65) for cases and 0.70 (0.62–0.81) for controls (p < 0.001). The Kaplan-Meier and the Cox regression analysis for cases categorised by delivered dose showed an inverse relationship between dose and survival. The cases with RR in a LNL outside planning target volume (PTV) (D mean < 40 Gy) had an OS rate comparable to that of all patients, and those with RR in a LNL in PTV elective (D mean 40–60 Gy) or PTV tumour (D mean >60 Gy) did significantly worse (p < 0.05). The same inverse relationship was also shown for a small subset of patient

  3. Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

    Science.gov (United States)

    Christodoulidis, Georgios; Kundoor, Vishwa; Kaluski, Edo

    2017-08-28

    BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery. Of the four patients identified, the mean age was 59 years; three patients were women and two patients had underlying psychiatric history. Electrocardiogram revealed ST elevation in the anterior leads in three patients; QTc was prolonged in all cases. All patients had ≤ moderately elevated troponin. Single culprit lesion was found uniformly in the proximal or mid left anterior descending artery. Initial echocardiography revealed severely reduced ejection fraction with relative sparing of the basal segments, whereas early repeat echocardiography revealed significant improvement in the left ventricular function in all patients. CONCLUSIONS This is the first case series demonstrating that acute myocardial infarction can trigger stress induced cardiomyopathy. Extensive reversible wall motion abnormalities, beyond the ones expected from angiography, accompanied by modest elevation in troponin and marked QTc prolongation, suggest superimposed stress induced cardiomyopathy.

  4. A Case of Definitive Therapy for Localised Prostate Cancer: Report of a Urological Nightmare

    Directory of Open Access Journals (Sweden)

    Andreas Sommerhuber

    2012-01-01

    Full Text Available Radical prostatectomy, external beam radiotherapy and permanent brachytherapy are the most common treatment options for nonmetastatic localised adenocarcinoma of the prostate (PCa. Accurate pretherapeutic clinical staging is difficult, the number of positive cores after biopsy does not imperatively represent the extension of the cancer. Furthermore postoperative upgrading in Gleason score is frequently observed. Even in a localised setting a certain amount of patients with organ-confined PCa will develop biochemical progression. In case of a rise in PSA level after radiation the majority of patients will receive androgen deprivation therapy what must be considered as palliative. If local or systemic progressive disease is associated with evolving neuroendocrine differentiation hormonal manipulation is increasingly ineffective; radiotherapy and systemic chemotherapy with a platinum agent and etoposide are recommended. In case of local progression complications such as pelvic pain, gross haematuria, infravesical obstruction and rectal invasion with obstruction and consecutive ileus can possibly occur. In this situation palliative radical surgery is a therapy option especially in the absence of distant metastases. A case with local and later systemic progression after permanent brachytherapy is presented here.

  5. Parkinson's disease-related fatigue: A case definition and recommendations for clinical research.

    Science.gov (United States)

    Kluger, Benzi M; Herlofson, Karen; Chou, Kelvin L; Lou, Jau-Shin; Goetz, Christopher G; Lang, Anthony E; Weintraub, Daniel; Friedman, Joseph

    2016-05-01

    Fatigue is one of the most common and disabling symptoms in Parkinson's disease (PD). Since fatigue was first described as a common feature of PD 20 years ago, little progress has been made in understanding its causes or treatment. Importantly, PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. In response, the Parkinson Disease Foundation and ProjectSpark assembled an international team of experts to create recommendations for clinical research to advance this field. The working group identified several areas in which shared standards would improve research quality and foster progress including terminology, diagnostic criteria, and measurement. Terminology needs to (1) clearly distinguish fatigue from related phenomena (eg, sleepiness, apathy, depression); (2) differentiate subjective fatigue complaints from objective performance fatigability; and (3) specify domains affected by fatigue and causal factors. We propose diagnostic criteria for PD-related fatigue to guide participant selection for clinical trials and add rigor to mechanistic studies. Recommendations are made for measurement of subjective fatigue complaints, performance fatigability, and neurophysiologic changes. We also suggest areas in which future research is needed to address methodological issues and validate or optimize current practices. Many limitations in current PD-related fatigue research may be addressed by improving methodological standards, many of which are already being successfully applied in clinical fatigue research in other medical conditions (eg, cancer, multiple sclerosis). © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  6. Standardizing evaluation process: Necessary for achieving SDGs - A case study of India.

    Science.gov (United States)

    Srivastava, Alok

    2018-05-09

    A set of 17 Sustainable Development Goals (SDGs) adopted by the United Nations General Assembly in September 2015 are to be implemented and achieved in every country from the year 2016 to 2030. In Indian context, all these goals are very relevant and critical, as India missed the target on many components of the Millennium Development Goals (MDGs). The author strongly feels that one of the key reasons was lack of an in-built robust system for measuring the progress and achievements of MDGs. Monitoring and Evaluation of programmes and schemes, aiming at different SDGs, in a robust and regular manner is therefore need of the hour. A National evaluation policy (NEP) would set the tone in the right direction from the very beginning for achieving SDGs. The paper taking India as a case study discusses different critical factors pertinent for having a well laid down national level policy towards standardizing evaluation. Using real examples under different components of an evaluation policy, the paper discusses and questions the credibility and acceptance of the present evaluation system in place. The paper identifies five core mantras or pre-requisites of a national evaluation guideline. The paper emphasizes the importance of an evaluation policy in India and other countries as well, to provide authentic data gathered through a well-designed evaluation process and take corrective measures well on time to achieve SDGs. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Improved worst-case and liely accident definition in complex facilities for 40 CFR 68 compliance

    International Nuclear Information System (INIS)

    O'Kula, K.R., Taylor, Robert P., Jr; Hang, P.

    1997-04-01

    Many DOE facilities potentially subject to compliance with offsite consequence criteria under the 40 CFR 68 Risk Management Program house significant inventories of toxic and flammable chemicals. The accident progression event tree methodology is suggested as a useful technical basis to define Worst-Case and Alternative Release Scenarios in facilities performing operations beyond simple storage and/or having several barriers between the chemical hazard and the environment. For multiple chemical release scenarios, a chemical mixture methodology should be applied to conservatively define concentration isopleths. In some instances, the region requiring emergency response planning is larger under this approach than if chemicals are treated individually

  8. Infection by rhinovirus: similarity of clinical signs included in the case definition of influenza IAn/H1N1.

    Science.gov (United States)

    de Oña Navarro, Maria; Melón García, Santiago; Alvarez-Argüelles, Marta; Fernández-Verdugo, Ana; Boga Riveiro, Jose Antonio

    2012-08-01

    Although new influenza virus (IAn/H1N1) infections are mild and indistinguishable from any other seasonal influenza virus infections, there are few data on comparisons of the clinical features of infection with (IAn/H1N1) and with other respiratory viruses. The incidence, clinical aspects and temporal distribution of those respiratory viruses circulating during flu pandemic period were studied. Respiratory samples from patients with acute influenza-like symptoms were collected from May 2009 to December 2009. Respiratory viruses were detected by conventional culture methods and genome amplification techniques. Although IAn/H1N1 was the virus most frequently detected, several other respiratory viruses co-circulated with IAn/H1N1 during the pandemic period, especially rhinovirus. The similarity between clinical signs included in the clinical case definition for influenza and those caused by other respiratory viruses, particularly rhinovirus, suggest that a high percentage of viral infections were clinically diagnosed as case of influenza. Our study offers useful information to face future pandemics caused by influenza virus, indicating that differential diagnoses are required in order to not overestimate the importance of the pandemic. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  9. 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.

  10. A Case for Common Core State Standards: Gifted Curriculum 3.0

    Science.gov (United States)

    VanTassel-Baska, Joyce

    2012-01-01

    The Common Core State Standards (CCSS) is the most successful attempt to gain consensus across states for 21st century standards in language arts and mathematics. So far, 46 states have accepted these standards, with two consortia organized to translate them into resources and sample activities. A consultant firm has been hired to develop the…

  11. 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.

  12. Proposed standardized definitions for vertical resolution and uncertainty in the NDACC lidar ozone and temperature algorithms - Part 2: Ozone DIAL uncertainty budget

    Science.gov (United States)

    Leblanc, Thierry; Sica, Robert J.; van Gijsel, Joanna A. E.; Godin-Beekmann, Sophie; Haefele, Alexander; Trickl, Thomas; Payen, Guillaume; Liberti, Gianluigi

    2016-08-01

    A standardized approach for the definition, propagation, and reporting of uncertainty in the ozone differential absorption lidar data products contributing to the Network for the Detection for Atmospheric Composition Change (NDACC) database is proposed. One essential aspect of the proposed approach is the propagation in parallel of all independent uncertainty components through the data processing chain before they are combined together to form the ozone combined standard uncertainty. The independent uncertainty components contributing to the overall budget include random noise associated with signal detection, uncertainty due to saturation correction, background noise extraction, the absorption cross sections of O3, NO2, SO2, and O2, the molecular extinction cross sections, and the number densities of the air, NO2, and SO2. The expression of the individual uncertainty components and their step-by-step propagation through the ozone differential absorption lidar (DIAL) processing chain are thoroughly estimated. All sources of uncertainty except detection noise imply correlated terms in the vertical dimension, which requires knowledge of the covariance matrix when the lidar signal is vertically filtered. In addition, the covariance terms must be taken into account if the same detection hardware is shared by the lidar receiver channels at the absorbed and non-absorbed wavelengths. The ozone uncertainty budget is presented as much as possible in a generic form (i.e., as a function of instrument performance and wavelength) so that all NDACC ozone DIAL investigators across the network can estimate, for their own instrument and in a straightforward manner, the expected impact of each reviewed uncertainty component. In addition, two actual examples of full uncertainty budget are provided, using nighttime measurements from the tropospheric ozone DIAL located at the Jet Propulsion Laboratory (JPL) Table Mountain Facility, California, and nighttime measurements from the JPL

  13. Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition.

    Science.gov (United States)

    Reardon, Joseph M; Harmon, Katherine J; Schult, Genevieve C; Staton, Catherine A; Waller, Anna E

    2016-02-08

    Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning. 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate. This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.

  14. 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.

  15. 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.

  16. Validation of administrative and clinical case definitions for gestational diabetes mellitus against laboratory results.

    Science.gov (United States)

    Bowker, S L; Savu, A; Donovan, L E; Johnson, J A; Kaul, P

    2017-06-01

    To examine the validity of International Classification of Disease, version 10 (ICD-10) codes for gestational diabetes mellitus in administrative databases (outpatient and inpatient), and in a clinical perinatal database (Alberta Perinatal Health Program), using laboratory data as the 'gold standard'. Women aged 12-54 years with in-hospital, singleton deliveries between 1 October 2008 and 31 March 2010 in Alberta, Canada were included in the study. A gestational diabetes diagnosis was defined in the laboratory data as ≥2 abnormal values on a 75-g oral glucose tolerance test or a 50-g glucose screen ≥10.3 mmol/l. Of 58 338 pregnancies, 2085 (3.6%) met gestational diabetes criteria based on laboratory data. The gestational diabetes rates in outpatient only, inpatient only, outpatient or inpatient combined, and Alberta Perinatal Health Program databases were 5.2% (3051), 4.8% (2791), 5.8% (3367) and 4.8% (2825), respectively. Although the outpatient or inpatient combined data achieved the highest sensitivity (92%) and specificity (97%), it was associated with a positive predictive value of only 57%. The majority of the false-positives (78%), however, had one abnormal value on oral glucose tolerance test, corresponding to a diagnosis of impaired glucose tolerance in pregnancy. The ICD-10 codes for gestational diabetes in administrative databases, especially when outpatient and inpatient databases are combined, can be used to reliably estimate the burden of the disease at the population level. Because impaired glucose tolerance in pregnancy and gestational diabetes may be managed similarly in clinical practice, impaired glucose tolerance in pregnancy is often coded as gestational diabetes. © 2016 Diabetes UK.

  17. 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.

  18. Removal of foot-and-mouth disease virus infectivity in salted natural casings by minor adaptation of standardized industrial procedures.

    Science.gov (United States)

    Wijnker, J J; Haas, B; Berends, B R

    2007-04-10

    Intestines are used for the production of natural casings as edible sausage containers. Derived from animals (pigs and sheep) experimentally infected with FMDV (initial dosage 10(7.3) PFU/ml, strain O(1Kaufbeuren)), these natural casings were treated with sodium chloride or a phosphate salts/sodium chloride mixture and the residual FMDV titres measured. After storage at about 20 degrees C, no remaining infectivity was found after either treatment, whereas casings stored at 4 degrees C still contained infectivity. Storage of salted casings at about 20 degrees C for 30 days is already part of the Standard Operating Procedures (included in HACCP) of the international casing industry and can therefore be considered as a protective measure for the international trade in natural casings.

  19. Influence of case definition on incidence and outcome of acute coronary syndromes.

    Science.gov (United States)

    Torabi, Azam; Cleland, John G F; Sherwi, Nasser; Atkin, Paul; Panahi, Hossein; Kilpatrick, Eric; Thackray, Simon; Hoye, Angela; Alamgir, Farqad; Goode, Kevin; Rigby, Alan; Clark, Andrew L

    2016-01-01

    Acute coronary syndromes (ACS) are common, but their incidence and outcome might depend greatly on how data are collected. We compared case ascertainment rates for ACS and myocardial infarction (MI) in a single institution using several different strategies. The Hull and East Yorkshire Hospitals serve a population of ∼560 000. Patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses during 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and, independently, from Myocardial Infarction National Audit Project (MINAP) records. The hospital laboratory identified all patients with an elevated serum troponin-T (TnT) by contemporary criteria (>0.03 µg/L in 2005). The prospective survey identified 1731 admissions (1439 patients) with ACS, including 764 admissions (704 patients) with MIs. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to the MINAP. Using all 3 strategies, 934 admissions (873 patients) for MI were identified, for which TnT was >1 µg/L in 443, 0.04-1.0 µg/L in 435, ≤0.03 µg/L in 19 and not recorded in 37. A further 823 patients had TnT >0.03 µg/L, but did not have ACS ascertained by any survey method. Of the 873 patients with MI, 146 (16.7%) died during admission and 218 (25.0%) by 1 year, but ranging from 9% for patients enrolled in the MINAP to 27% for those identified by the hospital information department. MINAP and hospital statistics grossly underestimated the incidence of MI managed by our hospital. The 1-year mortality was highly dependent on the method of ascertainment.

  20. Effect of the new standards for case logging on resident operative volume: doing better cases or better numbers?

    Science.gov (United States)

    Murthy, Raghav; Shepard, Alex; Swartz, Andrew; Woodward, Ann; Reickert, Craig; Horst, Mathilda; Rubinfeld, Ilan

    2012-01-01

    The Accreditation Council for Graduate Medical Education (ACGME) modified the designation of major (index) operative cases to include those previously considered "minor." This study assessed the potential effect of these changes on resident operative experience. With Institutional Review Board approval, we analyzed National Surgical Quality Improvement Program participant use files for 2005-2008 for general and vascular surgery cases. Primary CPT case coding was mapped to the ACGME major case category using both the old and new classification schemes. The variables were analyzed using χ(2) analysis in SPSS IBM 19 (IBM, Armonk, New York). A total of 576,019 cases were reviewed. Major cases as defined by the new classification represented an increasing proportion of the cases each year, rising from 88.3% in 2005 to 95% by 2008 (p top procedures to include excision of breast lesion (22,175 [12.7%]), laparoscopic gastric bypass (18,825 [10.8%]), ventral hernia repair (14,732 [8.5%]), and appendectomy (10,190 [5.9%]). Of these newly designated major cases, the proportion not covered by residents increased from 22% in 2005 to 44% in 2007 and 2008 (p quality. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. A case study: forming an effective quality management system according to ISO 9000 standards

    OpenAIRE

    Zağyapan, Orhan

    1995-01-01

    Ankara : The Faculty of Management and the Graduate School of Business Administration of Bilkent Univ., 1995. Thesis (Master's) -- Bilkent University, 1995. Includes bibliographical references leaves 87-88 In today's world, companies which adopt themselves to certain internationally recognized standards are one step ahead of their competitors. ISO 9000 Quality System Standards captured the most attention among all. The aim of the standard is to provide an international bench...

  2. Definitive radiotherapy for locally advanced squamous cell carcinoma of the vulva and technical issues: a case report

    International Nuclear Information System (INIS)

    Kumar, Gokula; Norhafizah, I; Shazril, I; Nursyatina, AR; Abdul Aziz, MZ; Zin, Hafiz M; Zakir, MK; Norjayadi; Norliza, AS; Khairun, N; Ismail, A

    2017-01-01

    This case report describes a complex radical 3D-Conformal Radiotherapy treatment planning, dosimetric issues and outcome of definitive treatment of un-resectable carcinoma of the vulvar in a 42-year old lady. The patient presented with large fungating mass of the vulva which was biopsy confirmed as Keratinizing Squamous Cell Carcinoma. Further staging investigation revealed locally advanced disease (T4), with bilateral inguinal lymph nodes involvement. There is no systemic metastasis or intra-pelvic nodes. The patient was seen by Gynae-Oncology team and the disease was deemed un-resectable without significant morbidity. She was treated to a total dose of 64.8Gy in 36 fractions over 7 weeks with concurrent weekly Cisplatinum in 2 phases. 3D-Conformal radiotherapy technique using the modified segmental boost technique (MSBT, large PA and small AP photon fields with inguinal electron matching) was used. TLD chips were used for in-vivo dose verification in phase 1 and 2 of the treatment. At completion of planned radiotherapy, patient had a complete clinical response, grade 2-3 skin toxicity, grade 2 rectal toxicity, and grade 2 dysuria Vulval Squamous Cell Carcinomas are very radiosensitive tumours and the skills of the treating Radiation Oncologist, Dosimetrists, Physicist, Radiation Therapist and also nurses is of foremost importance is ensuring good clinical outcomes. (paper)

  3. 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

  4. Developing K-16 Student Standards for Language Learning: A Critical Examination of the Case of Esperanto

    Science.gov (United States)

    Fonseca-Greber, Bonnie; Reagan, Timothy

    2008-01-01

    In light of the ongoing attention to standards-based education in U.S. schools and the concern over how to effectively develop literacy skills in a first, let alone a second, language, this article reports on the drafting of the K-16 Student Standards for Learning Esperanto in the United States. Esperanto is ideally suited to aid children in the…

  5. Identifying Professional Teaching Standards Using Rasch Model Analysis: The Case of Northern Cyprus

    Science.gov (United States)

    Alibaba Erden, Hale; Özer, Bekir

    2013-01-01

    Problem Statement: The Teacher's-Act defined for the state-school teachers of North Cyprus shows that teachers are not selected according to any specific standards. In North Cyprus, apart from the exam topics defined at the teacher's exam regulations, there is not any kind of identified standard for teachers. Training qualified teachers based upon…

  6. Assessing the Impact of Stricter Alcohol Advertising Standards: The Case of Beam Global Spirits.

    Science.gov (United States)

    Ross, Craig S; Sparks, Alicia; Jernigan, David H

    2016-08-01

    Reducing youth exposure to alcohol advertising is a global health priority. In most countries around the world, the alcohol industry is given the opportunity to regulate itself with respect to advertising practices. Generally, the alcohol industry self-regulations are lax, allowing youth to be disproportionately exposed to alcohol advertising. However, Beam Global Spirits and Wine (Beam) voluntarily adopted more restrictive advertising standards in the United States in 2007. This study assessed Beam's compliance with their new standard and estimates its effect on youth exposure and advertising costs. We found that Beam's compliance with its more restrictive standards was imperfect, but never-the-less, we estimated that youth exposure to alcohol advertising was reduced compared to other spirits brands. Beam's more restrictive standards did not increase their advertising costs and therefore other alcohol companies should consider adopting similar standards around the world.

  7. 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.

  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

    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

  9. Development and evaluation of standardized narrative cases depicting the general surgery professionalism milestones.

    Science.gov (United States)

    Rawlings, Arthur; Knox, Aaron D C; Park, Yoon Soo; Reddy, Shalini; Williams, Sarah R; Issa, Nabil; Jameel, Abid; Tekian, Ara

    2015-08-01

    Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones. In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties. The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case. The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.

  10. 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.

  11. Unintended consequences of changing accounting standards: the case of fair value accounting and mandatory dividends

    NARCIS (Netherlands)

    Goncharov, I.; van Triest, S.

    2014-01-01

    A growing body of literature investigates the interaction of changes in accounting standards with institutions such as investor protection laws and corporate governance mechanisms. We examine the unintended consequences of fair value accounting in determining mandated preferred dividends. We study

  12. Standardization of SOPs to Evaluations: Impacts on Regulatory Decisions using Learning and Memory as Case Studies

    Science.gov (United States)

    In an era of global trade and regulatory cooperation, consistent and scientifically based interpretation of developmental neurotoxicity (DNT) studies is essential, particularly for non­ standard assays and variable endpoints. Because there is flexibility in the selection of ...

  13. Trade, Food Standards and Poverty: The Case of High-Value Vegetable Exports from Senegal

    OpenAIRE

    Maertens, Miet

    2006-01-01

    Agricultural supply chains are changing globally with pervasive food standards and increased vertical coordination. The impact of these changes for developing countries and for small farmers in those countries is not yet well understood. We analyze the developments in high-standards FFV supply chains and the effects for small farmers and rural households in Senegal. We use a unique dataset derived from company level interviews and household surveys in the main horticulture zone in Senegal. Su...

  14. The role of global data identification standards for supply chain visibility: the case of GS1

    OpenAIRE

    Semianiaka, Natallia; Silina, Ekaterina

    2012-01-01

    Purpose. Supply chain visibility is among the top concerns expressed by many supply chain leaders. While the traditional enablers of supply chain visibility are information sharing, IT implementation, and relationships between supply chain partners; the role of global supply chain standards as an integral part of each of these enablers is often underestimated. The purpose of this thesis is to investigate the adoption and applicability of global supply chain standards within the provisions of ...

  15. 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.

  16. Invasive liver abscess syndrome caused by Klebsiella pneumoniae with definite K2 serotyping in Japan: a case report.

    Science.gov (United States)

    Seo, Ryota; Kudo, Daisuke; Gu, Yoshiaki; Yano, Hisakazu; Aoyagi, Tetsuji; Omura, Taku; Irino, Shigemi; Kaku, Mitsuo; Kushimoto, Shigeki

    2016-12-01

    Klebsiella pneumonia is a well-known human pathogen, and recently, a distinct invasive syndrome caused by K. pneumoniae serotypes K1 and K2 has been recognized in Southeast Asia. This syndrome is characterized by primary liver abscess and extrahepatic complications resulting from bacteremic dissemination. We report the first adult case of primary liver abscess caused by the definite K2 serotyped pathogen, with endogenous endophthalmitis in Japan. A 64-year-old woman was admitted to a nearby hospital for a high fever and diarrhea. She had visual loss of her right eye, renal dysfunction, and thrombocytopenia within 24 h from admission. She was transferred to our institution. On admission, she had no alteration of mental status and normal vital signs; however, she had almost complete ablepsia of the right eye. Laboratory data showed severe inflammation, liver dysfunction, thrombocytopenia, an increased serum creatinine level, and coagulopathy. Computed tomography showed a low density area in the right lobe of the liver. Invasive liver abscess syndrome probably caused by K. pneumonia was highly suspected and immediately administered broad-spectrum antibiotics for severe sepsis. Concurrently, endogenous endophthalmitis was diagnosed, and we performed vitrectomy on the day of admission. The blood culture showed K. pneumoniae infection. Percutaneous drainage of the liver abscess was also performed. Although she was discharged in a good general condition on day 22, she had complete ablepsia of the right eye. The K2A gene was detected by polymerase chain reaction (PCR), which is consistent with the K2 serotype. PCR was also positive for the virulence-associated gene rmpA. Final diagnosis was invasive liver abscess syndrome caused by K2 serotype K. pneumonia. Although the primary liver abscess caused by K. pneumoniae with a hypermucoviscous phenotype is infrequently reported outside Southeast Asia, physicians should recognize this syndrome, and appropriate diagnosis and

  17. Public relations: a re-examination of definition, role, and function based on community relations of the Standard Oil (Indiana) refinery at Sugar Creek, MO

    Energy Technology Data Exchange (ETDEWEB)

    Kruckeberg, D.A.

    1985-01-01

    This study describes public relations as it is commonly practiced today as: a vocation utilizing persuasive communication to obtain a vested nonmarketing goal on behalf of a represented client. It argues that public relation is better defined and practiced as: the active attempt to restore/maintain a sense of community. To illustrate what this dissertation advocates, a case study is used. Probably no organization had designed a community relations program with the specific and express purpose of fostering a sense of community, at least to the extent this dissertation calls for. However, the Standard Oil Company (Indiana) refinery at Sugar Creek, MO, has done this sufficiently to merit study. Based on the findings of the case study, which covers a 75-year period of time, specific recommendations are made in practicing public relations as advocated in this dissertation: the active attempt to restore/maintain a sense of community. The theoretical basis comes from the writings of the Chicago School of Social Thought. It is demonstrated that the Chicago School can provide an excellent theoretical basis to provide insight into public relations practice from a perspective that eliminates the problems that now exist in the role and function of public relations.

  18. A Case Study in Integrating Multiple E-commerce Standards via Semantic Web Technology

    Science.gov (United States)

    Yu, Yang; Hillman, Donald; Setio, Basuki; Heflin, Jeff

    Internet business-to-business transactions present great challenges in merging information from different sources. In this paper we describe a project to integrate four representative commercial classification systems with the Federal Cataloging System (FCS). The FCS is used by the US Defense Logistics Agency to name, describe and classify all items under inventory control by the DoD. Our approach uses the ECCMA Open Technical Dictionary (eOTD) as a common vocabulary to accommodate all different classifications. We create a semantic bridging ontology between each classification and the eOTD to describe their logical relationships in OWL DL. The essential idea is that since each classification has formal definitions in a common vocabulary, we can use subsumption to automatically integrate them, thus mitigating the need for pairwise mappings. Furthermore our system provides an interactive interface to let users choose and browse the results and more importantly it can translate catalogs that commit to these classifications using compiled mapping results.

  19. Effect of an 8K ultra-high-definition television system in a case of laparoscopic gynecologic surgery.

    Science.gov (United States)

    Aoki, Yoichi; Matsuura, Masahiko; Chiba, Toshio; Yamashita, Hiromasa

    2017-09-01

    Various endoscopic devices have been developed for advanced minimally invasive surgery. We recently applied a new 8K ultra-high-definition television system during laparoscopic treatment of endometriosis. The procedure, which is described in detail, stands as the first reported application of an 8K ultra-high-definition system for laparoscopic gynecologic surgery. Comparison is made between depiction of the lesion by the new system and depiction by a full high-definition system. Improved diagnostic accuracy resulted from the increased image resolution, and we believe that this and other advantages will lead to widespread acceptance and further application of 8K ultra-high-definition systems in the field of gynecologic surgery.

  20. Standardization and optimization of arthropod inventories-the case of Iberian spiders

    DEFF Research Database (Denmark)

    Bondoso Cardoso, Pedro Miguel

    2009-01-01

    and optimization of sampling protocols, especially for mega-diverse arthropod taxa. This study had two objectives: (1) propose guidelines and statistical methods to improve the standardization and optimization of arthropod inventories, and (2) to propose a standardized and optimized protocol for Iberian spiders......, by finding common results between the optimal options for the different sites. The steps listed were successfully followed in the determination of a sampling protocol for Iberian spiders. A protocol with three sub-protocols of varying degrees of effort (24, 96 and 320 h of sampling) is proposed. I also...

  1. Patent pool analysis based on technical standards: A case study of indigenous alliances in China

    Directory of Open Access Journals (Sweden)

    DUAN Yuzhen

    2013-07-01

    Full Text Available China has set up only two sorts of patent pools (PLs with technical standards, namely, the AVS alliance and IGRS alliance. Both PLs are applied in the IT industry. Statistics of patent alliances with global technical standards show that Chinese enterprises cannot easily form and develop an international PL. This study analyzes the formation process of the AVS and IGRS patent alliance, and points out the challenges in building and developing Chinese PL. The study offers suggestions on alliance management, government guidance, and international cooperation.

  2. Report About a New Standard for Radiation Protection Training of Intervention Persons. In the Case of Radiological emergency Situations

    International Nuclear Information System (INIS)

    Geringer, T.; Steurer, A.; Schmitzer, C.

    2004-01-01

    In autumn 2003 the Austrian standard OENORM S 5207 with the title R adiation protection training of intervention persons in the case of radiological emergency situations w ill be published. The standard is directed to persons who have to invent in case of a radiological emergency, security forces and as well training centres. The standard has to fulfil three objectives: 1. Regulation of the minimum requirements for the radiation protection training and education of intervention persons. 2. Harmonization of the radiation protection and training of different security forces, for instance Austrian army, Red Cross Austria, Fire Department, Police Department. 3. Mutual recognition of parts of the education between the different security forces. To fulfil these aims the standard is structured in different education modules. If , for instance, a person attended a special training module at the Austrian military, this part of the education is also valid for a career at the Fire Department. Further the modular structure of the education gives the possibility for persons of a special security force to attend one or more modules at another security force. This will lead to an improved cooperation between the different security forces in case of a radiological emergency situation. The education is structured in four levels. The topics of the standard are: 1. Requirements for training centres 2. Guidelines for the examinations of the candidates 3. Topics and goals of the basic education 4. Topics and goals of the advanced education level one 5. Topics and goals of the advanced education level two 6. Topics and examples of specialised education 7. Obligatory further education once every year. (Author)

  3. 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).

  4. Evaluating spoken dialogue systems according to de-facto standards: A case study

    NARCIS (Netherlands)

    Möller, S.; Smeele, P.; Boland, H.; Krebber, J.

    2007-01-01

    In the present paper, we investigate the validity and reliability of de-facto evaluation standards, defined for measuring or predicting the quality of the interaction with spoken dialogue systems. Two experiments have been carried out with a dialogue system for controlling domestic devices. During

  5. Big is beautiful: the case for Federal leadership on a national renewable portfolio standard

    Energy Technology Data Exchange (ETDEWEB)

    Sovacool, Benjamin K.; Cooper, Christopher

    2007-05-15

    State-based renewable portfolio standards (RPS) create regulatory uncertainty for investors and inherent inequities among ratepayers. Ultimately, federal legislation can help create a more just, diverse and predictable national market for renewable resources without significantly increasing aggregate electricity prices. (author)

  6. A Case Study of Implications and Applications of Standardized Nomenclature for Asset Management in Healthcare

    Science.gov (United States)

    DeFrancesco, Jennifer A.

    2016-01-01

    Healthcare organizations strive to adapt to the continuous change in what has become a fast-paced, high technology environment. Many organizations are charged to find efficiencies to better manage medical device assets. Increasingly, healthcare leaders opt to adopt a standardized medical device nomenclature under the purview of a set of national…

  7. The Impact of Standards-Based Reform on Teachers: The Case of "No Child Left Behind"

    Science.gov (United States)

    Smith, Jason M.; Kovacs, Philip E.

    2011-01-01

    Standards-based reform is a trend affecting the educational systems of nations around the world, driven by desires to create educational systems suited to increasing economic productivity. In the USA, The No Child Left Behind (NCLB) Act of 2001 includes goals of reducing achievement gaps and getting "highly qualified" teachers in all…

  8. Setting standards for CSR : a comparative case study on criteria-formulating organizations

    NARCIS (Netherlands)

    Ingenbleek, P.T.M.; Binnekamp, M.H.A.; Goddijn, S.T.

    2007-01-01

    Though criteria-formulating organizations (CFOs) ¿ organizations in which business and community stakeholders cooperate to formulate standards for ethical issues ¿ play an important role in the relationship between firms and society, they receive scant attention from CSR researchers. Adopting an

  9. The determinants of voluntary traceability standards. The case of the wine sector

    Directory of Open Access Journals (Sweden)

    Stefanella Stranieri

    2018-06-01

    Full Text Available The aim of this paper is to study the determinants leading firms to choose among different kinds of voluntary traceability standards in the wine sector. To achieve this goal, we referred both to individual and institutional-level determinants, which are identified to play an important role in the literature related to the implementation of quality and safety standards. In specific, we referred to two theoretical approaches to better understand the industry behaviour towards the adoption of voluntary traceability, i.e. the Theory of Reasoned Action and the Institutional Theory. We developed a vis-à-vis survey through a questionnaire on a sample of Italian wineries approached during the most important Italian wine exhibitions in 2016. The results suggest that when wineries show positive cognitive beliefs towards voluntary traceability standards, they will probably implement complex traceability systems, which require high investments and efforts for their management. On the contrary, when the institutional environment plays a key role in the perception of wine processors, a simple and flexible traceability system seems to be preferred. Keywords: Voluntary traceability standards, Institutional determinants, Cognitive determinants

  10. Differences in Students' Reading Comprehension of International Financial Reporting Standards: A South African Case

    Science.gov (United States)

    Coetzee, Stephen A.; Janse van Rensburg, Cecile; Schmulian, Astrid

    2016-01-01

    This study explores differences in students' reading comprehension of International Financial Reporting Standards in a South African financial reporting class with a heterogeneous student cohort. Statistically significant differences were identified for prior academic performance, language of instruction, first language and enrolment in the…

  11. 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.

  12. 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.

  13. Spatial divergence of living standards during the economic growth phase in the periphery: A case study of North Karelia

    Directory of Open Access Journals (Sweden)

    Olli Lehtonen

    2011-01-01

    Full Text Available The advisability of an urban-centred growth strategy in sparsely populated parts of Europe has not been much analysed at micro-levels such as that of the postcode area. This paper investigates how regional disparities in living standards continued to increase during the technology-driven growth phase of 1993−2003, as exemplified by the case of North Karelia in Finland. Urban sprawl conveyed the spread effects of the rise in incomes, and the upsurge of living standards was concentrated in the neighbourhood of the provincial centre, Joensuu. Living standards faced a process of double divergence: between the central district of Joensuu and its commuter belt, and between the provincial core area and its hinterland, the latter consisting of rural areas and small towns dependent largely on natural resources. The spatial outcome of this socio-economic reorganization is a three-zone core-periphery pattern. As the economy grew, geographical shifts in wealth were consequences of the growth and mobility of certain social groups and strata. A wave of high living standards towards the outskirts of the provincial centre was generated by an expansion in commuting. The relative decline in living standards in the periphery was due to long-term rural decline and involved spatial restructuring.

  14. Understanding the case of international labour standards – methodological insights into an ongoing debate

    OpenAIRE

    Schmidt, Oliver

    2005-01-01

    "By globalization, national economies strengthen their ties towards each other; the same process causes growing interdependence" (Duwendag 2003, p. 119). Internationally agreed standards are regularly called for to guide and direct the process of globalisation. E. g. the German Vice-chancellor (who is also the minister responsible for labour market regulation) warned that profit-orientation threatened democracy if it would not allow for social responsibility of employers (Muentefering 2005). ...

  15. Impact of European standard EN15251 in the energy certification of services buildings-A Portuguese study case

    International Nuclear Information System (INIS)

    Alexandre, J.L.; Freire, A.; Teixeira, A.M.; Silva, M.; Rouboa, A.

    2011-01-01

    In Europe, about 40% of the energy is consumed in buildings, more than by industry or transport. However, there is a great potential for energy savings in this field, often at little cost. A new European directive and several European standards, including the comfort standard EN15251, were created to develop comfortable and efficient buildings. This paper presents the interaction of this specific standard with the application of energy efficiency regulations. In order to evaluate the impact of the EN15251 application in commercial buildings, a case study was analyzed using the dynamic simulation software TRNSYS-The Transient Energy System Simulation Tool. The building was set according to the standard conditions specified by the national regulation, and the assessment of comfort requirements of EN15251 was verified. It was found that the current comfort requirements of the Portuguese regulation are not sufficient to achieve by themselves the comfort categories specified in the EN15251. About 55% of the comfort hours could not be assured. Furthermore, reaching the main comfort requirements (temperature/fresh air rates) of the EN15251 does not lead directly to the assessment of the corresponding categories. Results showed that the building stayed one comfort category behind from the desired when the correspondent operative temperatures were secured. On the other hand, it was found possible to achieve the comfort categories by increasing the operative temperature ranges, imposed by the standard, about 1 deg. C. This has a negative consequence, which is the increment of energy consumption. However, there is a large room for maneuver to reduce this consumption into acceptable levels according to the EPBD. - Highlights: → We study the interaction of European standard with energy efficiency regulations. → We evaluate the impact of the EN15251 application in commercial buildings. → Buildings were set according to the standards specified by the national regulation.

  16. Updating Standard Procedures for Diagnosis and Treatment of Congenital Rubella Case

    Directory of Open Access Journals (Sweden)

    W. Buffolano

    2013-06-01

    Full Text Available Congenital Rubella is the dramatic consequence of rubella during gestation. A combined strategy of Measles and Rubella universal vaccination on children and selective vaccination of susceptible women has been shown effective in the elimination of congenital rubella requiring an incidence of <1 case of CRS per 100,000 live births. Verification processes of rubella elimination require that physicians early and appropriately diagnose all cases of congenital rubella, including those unpatent at birth. The paper highlights clinical and laboratory aspects channeling diagnosis of congenital rubella infection or syndrome even after the first year of life, and the short- and long-term management criteria.

  17. A Case Study of Academic Writing Development Through Principled Versus Standard Clt Method at Binus University

    Directory of Open Access Journals (Sweden)

    Almodad Biduk Asmani

    2013-10-01

    Full Text Available The purpose of the research project is to investigate how far the academic writing skills of Binus University students can be developed through two conflicting CLT methods: standard and principled. The research project is expected to result in computer-animated format which can be used as one of the main tools in teaching and learning grammar at Binus University. The research project uses the qualitative approach, and thus uses verbal data. The research project involves two subject groups (experimental and control. The experimental group will receive the treatment of grammar learning by using the Principled CLT approach, while the control group receives the standard CLT approach. Survey is then conducted to the two groups so as to find out their comments on the two teaching methods. From the results of the questionnaires, it is found that Principled CLT method is favored for its knowledge and accuracy factors, while the Standard CLT is preferred for its fun and independence factors.   

  18. Carbon-ion radiotherapy for marginal lymph node recurrences of cervical cancer after definitive radiotherapy: a case report

    International Nuclear Information System (INIS)

    Tamaki, Tomoaki; Nakano, Takashi; Ohno, Tatsuya; Kiyohara, Hiroki; Noda, Shin-ei; Ohkubo, Yu; Ando, Ken; Wakatsuki, Masaru; Kato, Shingo; Kamada, Tadashi

    2013-01-01

    Recurrences of cervical cancer after definitive radiotherapy often occur at common iliac or para-aortic lymph nodes as marginal lymph node recurrences. Patients with these recurrences have a chance of long-term survival by optimal re-treatment with radiotherapy. However, the re-irradiation often overlaps the initial and the secondary radiotherapy fields and can result in increased normal tissue toxicities in the bowels or the stomach. Carbon-ion radiotherapy, a form of particle beam radiotherapy using accelerated carbon ions, offers more conformal and sharp dose distribution than X-ray radiotherapy. Therefore, this approach enables the delivery of high radiation doses to the target while sparing its surrounding normal tissues. Marginal lymph node recurrences in common iliac lymph nodes after radiotherapy were treated successfully by carbon-ion radiotherapy in two patients. These two patients were initially treated with a combination of external beam radiotherapy and intracavitary and interstitial brachytherapy. However, the diseases recurred in the lymph nodes near the border of the initial radiotherapy fields after 22 months and 23 months. Because re-irradiation with X-ray radiotherapy may deliver high doses to a section of the bowels, carbon-ion radiotherapy was selected to treat the lymph node recurrences. A total dose of 48 Gy (RBE) in 12 fractions over 3 weeks was given to the lymph node recurrences, and the tumors disappeared completely with no severe acute toxicities. The two patients showed no evidence of disease for 75 months and 63 months after the initial radiotherapy and for 50 months and 37 months after the carbon-ion radiotherapy, respectively. No severe late adverse effects are observed in these patients. The two presented cases suggest that the highly conformal dose distribution of carbon-ion radiotherapy may be beneficial in the treatment of marginal lymph node recurrences after radiotherapy. In addition, the higher biological effect of carbon

  19. 18 CFR 4.106 - Standard terms and conditions of case-specific exemption from licensing.

    Science.gov (United States)

    2010-04-01

    ... LICENSES, PERMITS, EXEMPTIONS, AND DETERMINATION OF PROJECT COSTS Exemption of Small Hydroelectric Power... licensing. Any case-specific exemption from licensing granted for a small hydroelectric power project is... falsehoods were made by or on behalf of the applicant. (h) Article 8. Any exempted small hydroelectric power...

  20. The giving standard: conditional cooperation in the case of charitable giving

    NARCIS (Netherlands)

    P. Wiepking (Pamala); M. Heijnen (Merijn)

    2011-01-01

    textabstractIn this study, we make a first attempt to investigate the mechanisms of conditional cooperation in giving outside experiments, using retrospective survey data on charitable giving (the Giving the Netherlands Panel Study 2005 (GINPS05, 2005 ; N  = 1474)). Our results show that in the case

  1. Adoption of the Spanish eco design standard UNE 150301. A case study; Adopcion de la norma UNE 150301 de ecodeseno. Un estudio de casos

    Energy Technology Data Exchange (ETDEWEB)

    Arana-Landin, G.; Heras-Saizarbitoria, I.

    2010-07-01

    This article analyses the implementation of the Spanish National Standard UNE 150301 launched by AENOR in 2003. After studying the framework of this standard, its objectives and potential impact, for the first time the actual process of its implementation is examined using three Spanish industrial companies as case studies, all of which are pioneers in the adoption of this environmental standard. (Author)

  2. HARMONIZATION OF NATIONAL REGULATION AND INTERNATIONAL FINANCIAL REPORTING STANDARDS – PARTICULAR CASE OF NONCURRENT ASSETS

    Directory of Open Access Journals (Sweden)

    Coste Andreea Ioana

    2013-07-01

    Full Text Available In the scientific literature, accounting harmonization is a top topic because it helps to increase the comparability of financial statements. Also in Romania in the last 10 years becames a topic that is very often debated. The harmonization is trying to reduce differences of financial reporting statements between countries or, in the other words, it is trying to bring to a common denominator of existing rules when appear conflicts of comparability between them. The purpose of this paper is to measure the harmonisation between national and international regulation for a significant element of financial position statement, such as noncurrent assets. This paper provides an empirical research of information that must be presented by entities which apply national accounting standards or international ones when financial statements are prepared, trying to measure the harmonization between the two referential. Thus, in trying to determine the harmonisation, we use the Jaccard coefficient in order to provide an overview of the degree of harmonization of accounting practice. When measuring the degree of comparability of Romanian accounting regulations with International Accounting Standards we analyzed noncurrent assets and impairment of assets using the Jaccard coefficient for accounting treatments and we calculated an average of similarities between the two regulations. Further, the results suggest that there is an average level of harmonization for the accounting treatment of noncurrent assets and for determining the impairment of the assets, the methods are the same. The study contributes to the development of accounting literature about the harmonisation between national regulation and international standards regarding the noncurrent assets and impairment of the assets, which together with the other elements define the activity of the business. In addition, the study provides an analysis of how the regulations treats noncurrent assets, during the

  3. 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...

  4. Investigating the Concentration of Heavy Metals in Bottled Water and Comparing with its Standard: Case Study

    Directory of Open Access Journals (Sweden)

    Mohammad Hossien Salmani

    2017-09-01

    Results: Brand No. 1, the concentration of zinc ion was larger in Brand 2 while in Brand No. 2 had larger copper, nickel, and aluminum ions. The results indicated that the concentration of the measured metal ions were below the allowable limit of drinking water standard across all of the studied samples. Conclusion: Based on the obtained results from the investigated parameters, it can be concluded that the bottled water of both brands poses no health issue and is drinkable. Considering the changes in the concentration of ions and the increasing trend of consumption of bottled waters, their monitoring and qualitative control of pollutants are very crucial in terms of public health.

  5. Physician consensus on preventability and predictability of readmissions based on standard case scenarios

    DEFF Research Database (Denmark)

    van Galen, L. S.; Cooksley, T; Merten, H

    2016-01-01

    Background: Policy makers struggle with unplanned readmissions as a quality indicator since integrating preventability in such indicators is difficult. Most studies on the preventability of readmissions questioned physicians whether they consider a given readmission to be preventable, from which...... conclusions on factors predicting preventable readmissions were derived. There is no literature on the interobserver agreement of physician judgement. Aim: To assess the degree of agreement among physicians regarding predictability and preventability of medical readmissions. Design: An online survey based...... on eight real-life case scenarios was distributed to European physicians. Methods: Physicians were requested to rate from the first four (index admission) scenarios whether they expected these patients to be readmitted within 30 days (the predictability). The remaining four cases, describing a readmission...

  6. Process' standardization and change management in higher education. The case of TEI of Athens

    Science.gov (United States)

    Chalaris, Ioannis; Chalaris, Manolis; Gritzalis, Stefanos; Belsis, Petros

    2015-02-01

    The establishment of mature operational procedures and the effort of standardizing and certifying these procedures is a particularly arduous and demanding task which requires strong commitment from management to the existing objectives, administrative stability and continuity, availability of resources, an adequate implementation team with support from all stakeholders and of course great tolerance until tangible results of the investment are shown. Ensuring these conditions, particularly in times of economic crisis, is an extremely difficult task for large organizations such as TEI of Athens where there is heterogeneity in personnel and changes in the administrative hierarchy arise plethora of additional difficulties and require an effective change management. In this work we depict the path of standardization and certification of administrative functions of TEI of Athens, with emphasis on difficulties encountered and how to address them and in particular issues of change management and the culture related to this effort. The requirement for infrastructure needed to be maintained in processes and tools process & strategic management is embodied, in order to evolve mechanisms for continuous improvement processes and storage / recovery of the resulting knowledge. The work concludes with a general design of a road map of internal audit and continuous improvement processes for a large institution of higher education.

  7. Source Authenticity in the UMLS – A Case Study of the Minimal Standard Terminology

    Science.gov (United States)

    Elhanan, Gai; Huang, Kuo-Chuan; Perl, Yehoshua

    2010-01-01

    As the UMLS integrates multiple source vocabularies, the integration process requires that certain adaptation be applied to the source. Our interest is in examining the relationship between the UMLS representation of a source vocabulary and the source vocabulary itself. We investigated the integration of the Minimal Standard Terminology (MST) into the UMLS in order to examine how close its UMLS representation is to the source MST. The MST was conceived as a “minimal” list of terms and structure intended for use within computer systems to facilitate standardized reporting of gastrointestinal endoscopic examinations. Although the MST has an overall schema and implied relationship structure, many of the UMLS integrated MST terms were found to be hierarchically orphaned, and with lateral relationships that do not closely adhere to the source MST. Thus, the MST representation within the UMLS significantly differs from that of the source MST. These representation discrepancies may affect the usability of the MST representation in the UMLS for knowledge acquisition. Furthermore, they pose a problem from the perspective of application developers. While these findings may not necessarily apply to other source terminologies, they highlight the conflict between preservation of authentic concept orientation and the UMLS overall desire to provide fully specified names for all source terms. PMID:20692366

  8. HAVE WE REALLY BEEN USING THE INTERNATIONAL FINANCIAL REPORTING STANDARDS (IFRS SINCE 2005? CASE OF TURKEY

    Directory of Open Access Journals (Sweden)

    Melissa N. Cagle

    2015-01-01

    Full Text Available Starting from the year 2002, the Turkish national regulatory agency hasundertaken an extensive role in the convergence efforts towards IFRS. In order tosupport the transition, the Turkish Capital Markets Board (TCMB implementedseveralversionsof IFRS,regulatory practices and compliance requirements- allover the course of 15 years. The first effort undertaken in the road to IFRStransition was the issuance of Series XI, No: 25 by the TCMB. However, SeriesXI, No: 25 was not fully compatible with the international standard set and SeriesXI, No: 27 was put into effect in order to allow the companies to refer to theoriginal IFRS when necessary. This has created three groups of reportingcompanies; Series XI, no: 25 users, IAS/IFRS users and mixed usersof both sets.Nobes (2006 states that there is a risk that the process of translation will changeor lose meaning from the original version of the standard and as these variousIFRS are given legal status in various countries, this approach can potentially leadto application differences between jurisdictions. In line with this argument, theaim of the current study is to discuss impact of these differences on financialreport comparability and analysis in Turkey.

  9. The application of protection standards for foreign investments. A view from an argentine case perspective

    Directory of Open Access Journals (Sweden)

    Christian G. Sommer

    2014-02-01

    Full Text Available The guidelines of the Washington Covenant in the 90s, involved the political and economic transformation of the Latin American states due to the liberalization of the economy, government reform, deregulation and privatization. Following these guidelines, the term “foreign investment” became an imperative for economic growth and development, so that the states to achieve such purposes resorted to bilateral solutions, modifying national legislation and signing Bilateral Investment Treaties (bit. The incorporation of a series of protection standards as fair treatment, expropriation clauses, most favored nation, as a condition for the participation of foreign investors in the public services of the states, are a clear example of this new reality. The system for the promotion and protection of foreign investment has been becoming a new “subsystem” international law, with its own rules and its own enforcement mechanism for dispute resolution through international arbitration tribunals, although in some where collision States constitutional standards.

  10. Fertilizer standards for controlling groundwater nitrate pollution from agriculture: El Salobral-Los Llanos case study, Spain

    Science.gov (United States)

    Peña-Haro, S.; Llopis-Albert, C.; Pulido-Velazquez, M.; Pulido-Velazquez, D.

    2010-10-01

    would be required to reduce nitrate concentrations in groundwater below the standard of 50 mg/l. In this particular case, it is more cost-efficient to apply standards to fertilizer use than taxes, although the instrument of fertilizer standards is more difficult to implement and control.

  11. Will the changes proposed to the conceptual framework’s definitions and recognition criteria provide a better basis for the IASB standard setting?

    NARCIS (Netherlands)

    Brouwer, A.; Hoogendoorn, M.; Naarding, E.

    2015-01-01

    In this paper we evaluate the International Accounting Standards Board’s (IASB) efforts, in a discussion paper (DP) of 2013, to develop a new conceptual framework (CF) in the light of its stated ambition to establish a robust and consistent basis for future standard setting, thereby guiding standard

  12. Reliability of individual doses relating to the epidemiological studies on nuclear industry workers in Japan (1). Historical changes on definition of radiation dose, historical changes on technical standards of measurement and radiation workplace

    International Nuclear Information System (INIS)

    Numakunai, Takao; Ishiguro, Hideharu; Kawada, Yasushi; Minami, Kentaro; Yoshimoto, Yasuhiko.

    1997-01-01

    Records of radiation workers collected in the Research Organization for Information of Science and Technology, concerning individual doses from 1957 to 1992 were used for epidemiological studies for obtaining the scientific information of the effect of low dose radiation. Since many changes were made on definition of radiation dose, dosimetry technology and so on during such a long time period, reliability of recorded individual doses and of their measurement should be evaluated for validation, which is the purpose of this paper. Followings were discussed and validation was made. Historical changes on standards for radiation protection: ICRP Recommendation and ICRU Report, and changes of law concerning radiation dose in Japan and of dose standards. Changes on dosimetry for radiation protection: ICRP Recommendation and working place dosimetry, trends of investigations for introduction of measured practical doses, ICRU sphere as a receptor, and introduction of measured practical doses. Characteristics of radiation field and radiation exposure: Radiation source and characteristics of radiation field; Research and development organizations for atomic power, atomic power plants, facilities for nuclear fuel, Classification of radiation works and characteristics of the exposure; BWR, PWR, GCR. Changes on the standards of individual dosemeter and on its use: method to use individual dosemeter and its installation, measurement of individual dose and Japanese Industrial Standard (JIS); Standard of the film badge for X and gamma rays, Standard of the film badge for neutron, Standard for thermoluminescence dosemeter, and changes on selection of the major apparatus and on its use. (K.H.)

  13. Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments.

    Science.gov (United States)

    Martinez, I; Escayola, J; Martinez-Espronceda, M; Serrano, L; Trigo, J D; Led, S; Garcia, J

    2009-01-01

    Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

  14. Risk assessment of manual material handling activities (case study: PT BRS Standard Industry)

    Science.gov (United States)

    Deviani; Triyanti, V.

    2017-12-01

    The process of moving material manually has the potential for injury to workers. The risk of injury will increase if we do not pay attention to the working conditions. The purpose of this study is to assess and analyze the injury risk level in manual handling material activity, as well as to improve the condition. The observed manual material handling activities is pole lifting and goods loading. These activities were analyzed using Job Strain Index method, Rapid Entire Body Assessment, and Chaffin’s 2D Planar Static Model. The results show that most workers who perform almost all activities have a high level of risk level with the score of JSI and REBA exceeds 9 points. For some activities, the estimated compression forces in the lumbar area also exceed the standard limits of 3400 N. Concerning this condition, several suggestions for improvement were made, improving the composition of packing, improving body posture, and making guideline posters.

  15. Standard Rape Cases in the Criminal Justice System in Campinas, São Paulo

    Directory of Open Access Journals (Sweden)

    Joana Domingues Vargas

    2008-01-01

    Full Text Available This study presents a longitudinal analysis of the records found in the Women’s Defense Division of the Public Ministry and in the Criminal Courts of the municipality of Campinas, São Paulo State. The study identified both the characteristics of rape (the accused, victims and relations between them, as well as the processes of selection and filtering to which they are submit during their processing. The results found for Campinas reflect rape complaints found in international studies, which indicate that rape is a heterogeneous category, although the aggressors are invariably men and the victims young. On the other hand, when the criminal selection process is analyzed, a filtering of typologies is noticed, found in the complaint phase in three standards for the crime of rape: intrafamiliar, committed by an unknown aggressor and among youth who know each other.

  16. Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

    Science.gov (United States)

    Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

    2016-03-01

    As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. © 2016 American Society of Law, Medicine & Ethics.

  17. Institutionalizing environmental protection through self-regulation: the case of environmental standards adoption in Lithuania.

    Science.gov (United States)

    Bileisis, Mantas; Misiune, Ieva

    2017-04-01

    The impacts of human activity in the environment have a global dimension, but there are no effective global governance instruments to enforce environmental standards. At the same time, many national governments lack incentives to pursue strict environmental policies. In this context, self-regulation is seen as an alternative venue to address environmental challenges. This work aims to identify factors that influence companies to engage in environmental self-regulation? For this aim in March 2015 a survey of 482 companies was conducted. The target group were companies operating in Lithuania that hold ISO14001 certificates - one of the most prolific instruments for self-regulation. The questionnaire was designed to test assumptions developed in new institutionalist literature which claim that common practices can emerge through isomorphism.- The results showed that the main motive for environmental self-regulation is the desire to improve company image, rather than protecting the environment per se. Another important finding was that the main source of pressure to adopt self-regulation was based less on the perceived demands but the customers. Rather the driver for the adoption was a feeling of a need no to fall behind industry leaders. Thus, normative isomorphism is the main mechanism through which environmental self-regulation proliferates. We claim for a rapid proliferation of environmental self-regulation perceived industry leaders need to be identified and they need to be persuaded that environmental standards are key for the development of the industry. However, this also raises questions of sustainability. Few industries have long standing leaders, and through successful investment and technological development new actors can arise and this may risk stalling or even reversing self-regulation.

  18. Splenomegaly unresponsive to standard and salvage chemotherapy in Langerhans cell histiocytosis: a case of extramedullary hematopoiesis.

    Science.gov (United States)

    Christiansen, Ellen C; Ellwein, Marcine; Neglia, Joseph P

    2012-06-01

    Langerhans cell histiocytosis (LCH) is a proliferative disorder of dendritic cells which has evaded efforts to clearly define pathogenesis, diagnostic criteria, and therapeutic response markers. Strides have been made at classification with the recent development of a quantified score of disease severity. Splenic involvement is an indicator of poor prognosis, with spleen size its surrogate marker in evaluation and scoring. We describe a case of pediatric LCH with progressive splenomegaly despite treatment, which when examined at splenectomy revealed no LCH involvement but extramedullary hematopoiesis. These findings thus challenge our understanding of splenomegaly as a marker of disease. Copyright © 2011 Wiley Periodicals, Inc.

  19. Isolating DNA from sexual assault cases: a comparison of standard methods with a nuclease-based approach

    Science.gov (United States)

    2012-01-01

    Background Profiling sperm DNA present on vaginal swabs taken from rape victims often contributes to identifying and incarcerating rapists. Large amounts of the victim’s epithelial cells contaminate the sperm present on swabs, however, and complicate this process. The standard method for obtaining relatively pure sperm DNA from a vaginal swab is to digest the epithelial cells with Proteinase K in order to solubilize the victim’s DNA, and to then physically separate the soluble DNA from the intact sperm by pelleting the sperm, removing the victim’s fraction, and repeatedly washing the sperm pellet. An alternative approach that does not require washing steps is to digest with Proteinase K, pellet the sperm, remove the victim’s fraction, and then digest the residual victim’s DNA with a nuclease. Methods The nuclease approach has been commercialized in a product, the Erase Sperm Isolation Kit (PTC Labs, Columbia, MO, USA), and five crime laboratories have tested it on semen-spiked female buccal swabs in a direct comparison with their standard methods. Comparisons have also been performed on timed post-coital vaginal swabs and evidence collected from sexual assault cases. Results For the semen-spiked buccal swabs, Erase outperformed the standard methods in all five laboratories and in most cases was able to provide a clean male profile from buccal swabs spiked with only 1,500 sperm. The vaginal swabs taken after consensual sex and the evidence collected from rape victims showed a similar pattern of Erase providing superior profiles. Conclusions In all samples tested, STR profiles of the male DNA fractions obtained with Erase were as good as or better than those obtained using the standard methods. PMID:23211019

  20. 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.)

  1. Remembering over the short-term: the case against the standard model.

    Science.gov (United States)

    Nairne, James S

    2002-01-01

    Psychologists often assume that short-term storage is synonymous with activation, a mnemonic property that keeps information in an immediately accessible form. Permanent knowledge is activated, as a result of on-line cognitive processing, and an activity trace is established "in" short-term (or working) memory. Activation is assumed to decay spontaneously with the passage of time, so a refreshing process-rehearsal-is needed to maintain availability. Most of the phenomena of immediate retention, such as capacity limitations and word length effects, are assumed to arise from trade-offs between rehearsal and decay. This "standard model" of how we remember over the short-term still enjoys considerable popularity, although recent research questions most of its main assumptions. In this chapter I review the recent research and identify the empirical and conceptual problems that plague traditional conceptions of short-term memory. Increasingly, researchers are recognizing that short-term retention is cue driven, much like long-term memory, and that neither rehearsal nor decay is likely to explain the particulars of short-term forgetting.

  2. Double standard for traditional value of virginity and premarital sexuality in Turkey: a university students case.

    Science.gov (United States)

    Eşsizoğlu, Altan; Yasan, Aziz; Yildirim, Ejder Akgun; Gurgen, Faruk; Ozkan, Mustafa

    2011-03-01

    This study investigates the prevalence of myths regarding virginity and the hymen and their associations with sexuality prior to marriage. This study was conducted with 534 single, heterosexual male and female students from various faculties of Dicle University in Turkey. The findings demonstrated that the rates of masturbation (11.1%) and premarital sexual intercourse (4.3%) were much lower in women than in men (87.7% and 44.2% respectively) who were traditionally expected to maintain their virginity until marriage. A higher degree of commitment to religious faith was associated with a lower rate of masturbation and sexual contact experience. Also, the myth that the hymen symbolized virginity was slightly more prevalent among male students (74.2% vs. 72.1%). Female virginity was significantly more important among male students (76.7%) than females (11.1%), and male students more frequently (30.1% vs. 11.1%) stated that "the blood-stained bed sheet" should be displayed to the family on the day of marriage. Although some myths about virginity were frequently reported by females, less significance was attributed to virginity by females than by males. In conclusion, the traditional social structure that incites sexual double standards still prevails over the sexual attitudes and behaviors of university students in Turkey.

  3. 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%.

  4. 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.

  5. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

    Science.gov (United States)

    Scholz, Stefan M; Andermatt, Peter; Tobler, Benno L; Spinnler, Dieter

    2016-09-01

    Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p accident victims.

  6. Feasibility of U.S. renewable portfolio standards under cost caps and case study for Illinois

    International Nuclear Information System (INIS)

    Johnson, Sean D.; Moyer, Elisabeth J.

    2012-01-01

    Recently enacted state renewable portfolio standards (RPSs) collectively require that U.S. electricity generation by non-hydro renewables more than double by 2025. These goals are not certain to be met, however, because many RPSs apply cost caps that alter requirements if costs exceed targets. We analyze here the 2008 Illinois RPS, which is fairly typical, and find that at current electricity prices, complete implementation will require significant decreases in renewables costs even given the continuation of federal renewables subsidies. Full implementation is possible but not assured. The statutory design raises additional concerns about unintended potential consequences. The fact that windpower and solar carveouts fall under a single cost cap means that in failure mode, a less cost-effective technology can curtail deployment of a more cost-effective one. Adjacent-state provisions mean the bulk of the RPS can be met by existing wind facilities, and that new wind builds will likely occur in Iowa. The Illinois RPS, like that of many other states, appears to combine objectives inherently in conflict: preferences for local jobs, for specific technologies, for environmental benefits, and for low costs. Revisiting the legislation may be needed to make legislative success likely and to ensure that failure modes do not compromise goals. - Highlights: ► RPSs mandate that generation by non-hydro renewables in the U.S. double by 2025. ► Implementation of many RPSs is impossible without decreases in renewable costs. ► The Illinois wind requirement can largely be met by existing Iowa windpower. ► Placing technology carveouts under one cost cap allows pernicious interactions. ► The Illinois RPS statute combines different objectives inherently in conflict.

  7. Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan

    Directory of Open Access Journals (Sweden)

    Fushimi Kiyohide

    2010-05-01

    Full Text Available Abstract Background Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. Method We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index ≥ 0.8; hospitals with c-index Results The model demonstrated excellent discrimination as indicated by the high average c-index and small standard deviation (c-index = 0.88 ± 0.04. Expected mortality rate of each hospital was highly correlated with observed mortality rate (r = 0.693, p Conclusion The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

  8. Quantitative Analysis of Torso FDG-PET Scans by Using Anatomical Standardization of Normal Cases from Thorough Physical Examinations.

    Directory of Open Access Journals (Sweden)

    Takeshi Hara

    Full Text Available Understanding of standardized uptake value (SUV of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography (FDG-PET depends on the background accumulations of glucose because the SUV often varies the status of patients. The purpose of this study was to develop a new method for quantitative analysis of SUV of FDG-PET scan images. The method included an anatomical standardization and a statistical comparison with normal cases by using Z-score that are often used in SPM or 3D-SSP approach for brain function analysis. Our scheme consisted of two approaches, which included the construction of a normal model and the determination of the SUV scores as Z-score index for measuring the abnormality of an FDG-PET scan image. To construct the normal torso model, all of the normal images were registered into one shape, which indicated the normal range of SUV at all voxels. The image deformation process consisted of a whole body rigid registration of shoulder to bladder region and liver registration and a non-linear registration of body surface by using the thin-plate spline technique. In order to validate usefulness of our method, we segment suspicious regions on FDG-PET images manually, and obtained the Z-scores of the regions based on the corresponding voxels that stores the mean and the standard deviations from the normal model. We collected 243 (143 males and 100 females normal cases to construct the normal model. We also extracted 432 abnormal spots from 63 abnormal cases (73 cancer lesions to validate the Z-scores. The Z-scores of 417 out of 432 abnormal spots were higher than 2.0, which statistically indicated the severity of the spots. In conclusions, the Z-scores obtained by our computerized scheme with anatomical standardization of torso region would be useful for visualization and detection of subtle lesions on FDG-PET scan images even when the SUV may not clearly show an abnormality.

  9. 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.

  10. 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.

  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

    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

  12. TGLF Recalibration for ITER Standard Case Parameters FY2015: Theory and Simulation Performance Target Final Report

    International Nuclear Information System (INIS)

    Candy, J.

    2015-01-01

    This work was motivated by the observation, as early as 2008, that GYRO simulations of some ITER operating scenarios exhibited nonlinear zonal-flow generation large enough to effectively quench turbulence inside r /a ~ 0.5. This observation of flow-dominated, low-transport states persisted even as more accurate and comprehensive predictions of ITER profiles were made using the state-of-the-art TGLF transport model. This core stabilization is in stark contrast to GYRO-TGLF comparisons for modern-day tokamaks, for which GYRO and TGLF are typically in very close agreement. So, we began to suspect that TGLF needed to be generalized to include the effect of zonal-flow stabilization in order to be more accurate for the conditions of reactor simulations. While the precise cause of the GYRO-TGLF discrepancy for ITER parameters was not known, it was speculated that closeness to threshold in the absence of driven rotation, as well as electromagnetic stabilization, created conditions more sensitive the self-generated zonal-flow stabilization than in modern tokamaks. Need for nonlinear zonal-flow stabilization: To explore the inclusion of a zonal-flow stabilization mechanism in TGLF, we started with a nominal ITER profile predicted by TGLF, and then performed linear and nonlinear GYRO simulations to characterize the behavior at and slightly above the nominal temperature gradients for finite levels of energy transport. Then, we ran TGLF on these cases to see where the discrepancies were largest. The predicted ITER profiles were indeed near to the TGLF threshold over most of the plasma core in the hybrid discharge studied (weak magnetic shear, q > 1). Scanning temperature gradients above the TGLF power balance values also showed that TGLF overpredicted the electron energy transport in the low-collisionality ITER plasma. At first (in Q3), a model of only the zonal-flow stabilization (Dimits shift) was attempted. Although we were able to construct an ad hoc model of the zonal

  13. TGLF Recalibration for ITER Standard Case Parameters FY2015: Theory and Simulation Performance Target Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Candy, J. [General Atomics, San Diego, CA (United States)

    2015-12-01

    This work was motivated by the observation, as early as 2008, that GYRO simulations of some ITER operating scenarios exhibited nonlinear zonal-flow generation large enough to effectively quench turbulence inside r /a ~ 0.5. This observation of flow-dominated, low-transport states persisted even as more accurate and comprehensive predictions of ITER profiles were made using the state-of-the-art TGLF transport model. This core stabilization is in stark contrast to GYRO-TGLF comparisons for modern-day tokamaks, for which GYRO and TGLF are typically in very close agreement. So, we began to suspect that TGLF needed to be generalized to include the effect of zonal-flow stabilization in order to be more accurate for the conditions of reactor simulations. While the precise cause of the GYRO-TGLF discrepancy for ITER parameters was not known, it was speculated that closeness to threshold in the absence of driven rotation, as well as electromagnetic stabilization, created conditions more sensitive the self-generated zonal-flow stabilization than in modern tokamaks. Need for nonlinear zonal-flow stabilization: To explore the inclusion of a zonal-flow stabilization mechanism in TGLF, we started with a nominal ITER profile predicted by TGLF, and then performed linear and nonlinear GYRO simulations to characterize the behavior at and slightly above the nominal temperature gradients for finite levels of energy transport. Then, we ran TGLF on these cases to see where the discrepancies were largest. The predicted ITER profiles were indeed near to the TGLF threshold over most of the plasma core in the hybrid discharge studied (weak magnetic shear, q > 1). Scanning temperature gradients above the TGLF power balance values also showed that TGLF overpredicted the electron energy transport in the low-collisionality ITER plasma. At first (in Q3), a model of only the zonal-flow stabilization (Dimits shift) was attempted. Although we were able to construct an ad hoc model of the zonal

  14. 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...

  15. Hand 'stress' arthritis in young subjects: effects of Flexiqule (pharma-standard Boswellia extract). A preliminary case report.

    Science.gov (United States)

    Belcaro, G; Feragalli, B; Cornelli, U; Dugall, M

    2015-10-22

    This case report (supplement registry study) evaluated subjects with painful 'stress' arthritis of the hand mainly localized at the joints. The patients received a suggestion to follow a rehabilitation plan (standard management; SM). A second group also used the same SM in association with the oral, pharma-standard supplement FlexiQule (Alchem) a new standardized, phytosomal preparation manufactured from the Boswellia plant, which can be used for self-management in inflammatory conditions (150 mg / 3 times daily). The two resulting registry groups included 12 subjects using SM+Flexiqule and and 11 controls (SM only). The groups were comparable. Serology showed no significant alterations: only ESR was slightly elevated (minimal elevation). After 2 weeks, the ESR was normal in the supplement group and mildly elevated in controls (p<0.05%). The decrease in hypertermic areas was greater/faster (p<0.05) in the supplement group. The identification of a working stress and the localization to the dominant hand was comparable in both groups. At 2 weeks, the decrease in pain was significantly faster and more important with the supplement (p<0.05). The hand became more usable in time and the score was better with the supplement (p<0.05). No supplemented patient had to use other drugs, while in the control group 3 subjects eventually used NSAIDs to control pain and stiffness and one used corticosteroids. In conclusion, the natural extract Flexiqule was effective in controlling work-related stress arthritis (without inflammaìtory signs) over a 2 weeks period, better than only Standard Management. More prolonged and larger studies are needed.

  16. 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)

  17. CASE STUDIES ON THE ASSESSMENT OF A REAL ESTATE IN TOURISM BY APPLYING THE 2017 PROPERTY VALUATION STANDARDS AS COMPARED TO 2016 GOODS VALUATION STANDARDS

    Directory of Open Access Journals (Sweden)

    ENEA CONSTANTIN

    2017-12-01

    Full Text Available By means of evaluation, in the Romanian legislation, is the value estimation activity, materialized in a document, called an evaluation report, carried out in accordance with the standards specific to this activity and with professional ethics, by an authorized evaluator. By law, the competent authority to organize, coordinate and authorize the evaluation activity in Romania is the National Association of Authorized Assessors in Romania (ANEVAR or the Association, as an autonomous legal entity, Authorized evaluators are part of it. Due to the dynamic nature of the profession of assessor, the Romanian legislation and other professions with an impact on evaluation, evaluation standards require periodic review. The Standards Collection, 2017, is called the 2017 Property Valuation Standards and will enter into force on May 1, 2017. The structure of the standards of the previous edition has been retained in this edition.

  18. The Need for a Definition of Big Data for Nursing Science: A Case Study of Disaster Preparedness

    Science.gov (United States)

    Wong, Ho Ting; Chiang, Vico Chung Lim; Choi, Kup Sze; Loke, Alice Yuen

    2016-01-01

    The rapid development of technology has made enormous volumes of data available and achievable anytime and anywhere around the world. Data scientists call this change a data era and have introduced the term “Big Data”, which has drawn the attention of nursing scholars. Nevertheless, the concept of Big Data is quite fuzzy and there is no agreement on its definition among researchers of different disciplines. Without a clear consensus on this issue, nursing scholars who are relatively new to the concept may consider Big Data to be merely a dataset of a bigger size. Having a suitable definition for nurse researchers in their context of research and practice is essential for the advancement of nursing research. In view of the need for a better understanding on what Big Data is, the aim in this paper is to explore and discuss the concept. Furthermore, an example of a Big Data research study on disaster nursing preparedness involving six million patient records is used for discussion. The example demonstrates that a Big Data analysis can be conducted from many more perspectives than would be possible in traditional sampling, and is superior to traditional sampling. Experience gained from the process of using Big Data in this study will shed light on future opportunities for conducting evidence-based nursing research to achieve competence in disaster nursing. PMID:27763525

  19. Argon plasma coagulation for a patient with locoregional failure after definitive chemoradiotherapy for esophageal carcinoma. A case report

    International Nuclear Information System (INIS)

    Nomura, Tsutomu; Miyashita, Masao; Makino, Hiroshi; Okawa, Keiichi; Katsuta, Miwako; Tajiri, Takashi

    2008-01-01

    Patients who undergo definitive chemoradiotherapy (CRT) face a risk of residual resistant disease or disease recurrence at the primary site; therefore, salvage treatment may be required. An optimum strategy to minimize these risks clearly needs to be established. Argon plasma coagulation (APC) is a safe and convenient procedure now applied widely for therapeutic endoscopy. In this report we describe the successful use of APC over 6 years for the treatment of recurrent esophageal cancer after CRT. A 61-year-old Japanese man underwent CRT for a thoracic esophageal cancer. Pathological examination before CRT revealed a well-differentiated squamous cell carcinoma. Locoregional failure was observed 2 years after CRT, and an initial APC treatment was performed. The patient has now undergone APC ablation 7 times with no postoperative complications. No metastasis to lymph nodes or to other organs has been detected during the last 6 years. The usefulness of APC as a salvage treatment for locoregional failure after definitive CRT has not been established. In our experience, salvage APC is the best treatment option for some patients. (author)

  20. The Need for a Definition of Big Data for Nursing Science: A Case Study of Disaster Preparedness

    Directory of Open Access Journals (Sweden)

    Ho Ting Wong

    2016-10-01

    Full Text Available The rapid development of technology has made enormous volumes of data available and achievable anytime and anywhere around the world. Data scientists call this change a data era and have introduced the term “Big Data”, which has drawn the attention of nursing scholars. Nevertheless, the concept of Big Data is quite fuzzy and there is no agreement on its definition among researchers of different disciplines. Without a clear consensus on this issue, nursing scholars who are relatively new to the concept may consider Big Data to be merely a dataset of a bigger size. Having a suitable definition for nurse researchers in their context of research and practice is essential for the advancement of nursing research. In view of the need for a better understanding on what Big Data is, the aim in this paper is to explore and discuss the concept. Furthermore, an example of a Big Data research study on disaster nursing preparedness involving six million patient records is used for discussion. The example demonstrates that a Big Data analysis can be conducted from many more perspectives than would be possible in traditional sampling, and is superior to traditional sampling. Experience gained from the process of using Big Data in this study will shed light on future opportunities for conducting evidence-based nursing research to achieve competence in disaster nursing.

  1. The Need for a Definition of Big Data for Nursing Science: A Case Study of Disaster Preparedness.

    Science.gov (United States)

    Wong, Ho Ting; Chiang, Vico Chung Lim; Choi, Kup Sze; Loke, Alice Yuen

    2016-10-17

    The rapid development of technology has made enormous volumes of data available and achievable anytime and anywhere around the world. Data scientists call this change a data era and have introduced the term "Big Data", which has drawn the attention of nursing scholars. Nevertheless, the concept of Big Data is quite fuzzy and there is no agreement on its definition among researchers of different disciplines. Without a clear consensus on this issue, nursing scholars who are relatively new to the concept may consider Big Data to be merely a dataset of a bigger size. Having a suitable definition for nurse researchers in their context of research and practice is essential for the advancement of nursing research. In view of the need for a better understanding on what Big Data is, the aim in this paper is to explore and discuss the concept. Furthermore, an example of a Big Data research study on disaster nursing preparedness involving six million patient records is used for discussion. The example demonstrates that a Big Data analysis can be conducted from many more perspectives than would be possible in traditional sampling, and is superior to traditional sampling. Experience gained from the process of using Big Data in this study will shed light on future opportunities for conducting evidence-based nursing research to achieve competence in disaster nursing.

  2. Lay-screeners and use of WHO growth standards increase case finding of hospitalized Malawian children with severe acute malnutrition.

    Science.gov (United States)

    LaCourse, Sylvia M; Chester, Frances M; Preidis, Geoffrey; McCrary, Leah M; Maliwichi, Madalitso; McCollum, Eric D; Hosseinipour, Mina C

    2015-02-01

    Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality. From December 2011 to May 2012, we conducted a prospective study task-shifting inpatient malnutrition screening of Malawian children 6-60 months to lay-screeners and evaluated World Health Organization (WHO) criteria vs. the National Center for Health Statistics (NCHS) guidelines for SAM. Lay-screeners evaluated 3116 children, identifying 368 (11.8%) with SAM by WHO criteria, including 210 (6.7%) who met NCHS criteria initially missed by standard clinician NRU referrals. Overall case finding increased by 56.7%. Mid-upper arm circumference (MUAC) and bipedal edema captured 86% (181/210) NCHS/NRU-eligible children and 89% of those who died (17/19) meeting WHO criteria. Mortality of NCHS/NRU-eligible children was 10 times greater than those without SAM (odds ratio 10.5, 95% confidence interval 5.4-20.6). Ward-based lay-screeners and WHO guidelines identified high-risk children with SAM missed by standard NRU referral. MUAC and edema detected the majority of NRU-eligible children. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. 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.)

  4. Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan.

    Science.gov (United States)

    Miyata, Hiroaki; Hashimoto, Hideki; Horiguchi, Hiromasa; Fushimi, Kiyohide; Matsuda, Shinya

    2010-05-19

    Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index > or = 0.8; hospitals with c-index /=0.8 and were classified as the higher c-index group. A significantly higher proportion of hospitals in the lower c-index group were specialized hospitals and hospitals with convalescent wards. The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

  5. Conscious worst case definition for risk assessment, part I: a knowledge mapping approach for defining most critical risk factors in integrative risk management of chemicals and nanomaterials.

    Science.gov (United States)

    Sørensen, Peter B; Thomsen, Marianne; Assmuth, Timo; Grieger, Khara D; Baun, Anders

    2010-08-15

    This paper helps bridge the gap between scientists and other stakeholders in the areas of human and environmental risk management of chemicals and engineered nanomaterials. This connection is needed due to the evolution of stakeholder awareness and scientific progress related to human and environmental health which involves complex methodological demands on risk management. At the same time, the available scientific knowledge is also becoming more scattered across multiple scientific disciplines. Hence, the understanding of potentially risky situations is increasingly multifaceted, which again challenges risk assessors in terms of giving the 'right' relative priority to the multitude of contributing risk factors. A critical issue is therefore to develop procedures that can identify and evaluate worst case risk conditions which may be input to risk level predictions. Therefore, this paper suggests a conceptual modelling procedure that is able to define appropriate worst case conditions in complex risk management. The result of the analysis is an assembly of system models, denoted the Worst Case Definition (WCD) model, to set up and evaluate the conditions of multi-dimensional risk identification and risk quantification. The model can help optimize risk assessment planning by initial screening level analyses and guiding quantitative assessment in relation to knowledge needs for better decision support concerning environmental and human health protection or risk reduction. The WCD model facilitates the evaluation of fundamental uncertainty using knowledge mapping principles and techniques in a way that can improve a complete uncertainty analysis. Ultimately, the WCD is applicable for describing risk contributing factors in relation to many different types of risk management problems since it transparently and effectively handles assumptions and definitions and allows the integration of different forms of knowledge, thereby supporting the inclusion of multifaceted risk

  6. Efficient biological process characterization by definitive-screening designs: the formaldehyde treatment of a therapeutic protein as a case study.

    Science.gov (United States)

    Erler, Axel; de Mas, Nuria; Ramsey, Philip; Henderson, Grant

    2013-03-01

    As part of the process-characterization campaign of a candidate vaccine product, a recently developed class of three-level designs-definitive-screening designs-was employed to select a quadratic model that describes the effect of six input process parameters, including protein concentration, formaldehyde-to-protein ratio, lysine concentration, reaction duration, pH, and reaction temperature, on a formylation protein-crosslinking reaction. This design requires only 17 experimental runs. The resulting model was then used to simulate 10,000 runs that account for the variability in the inputs expected on manufacturing scale. The extent of protein polymerization was predicted to be within specifications for all simulated runs, demonstrating the robustness of the unit operation for subsequent process validation and future commercial manufacturing.

  7. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies : The Copenhagen Osteoarthritis Study

    DEFF Research Database (Denmark)

    Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K

    2010-01-01

    INTRODUCTION: The aims of the present study were threefold: to examine the distribution of knee joint osteoarthritis in a large, standardized radiological study; to examine the relationships between self reported knee pain and radiological OA; and to examine the natural history of radio-morpholog...

  8. Definitions of Frequency and Timing Terms, Satellite Navigation and Timing Systems, and the Behavior and Analyses of Precision Crystal and Atomic Frequency Standards and their Characteristics

    Science.gov (United States)

    2009-05-01

    expected value of a measurement or property when operating in a normal expected environment. For example, the nominal value of a 51 ohm, 20% resistor ...operating at room temperature is 51 ohms. However, the actual resistance of any single 51 ohm, 20% resistor may be any value between 46 and 56...NIST Technical Note 1337, March 1990. 6. Piezo Crystal Company, (September 1990). Frequency Sources That Set the Standard. RCC Document 214-09

  9. What is modern standard Arabic NLP? Definition and tools (or how to understand Arabic even if you do not know a word)

    OpenAIRE

    Serrano Morales, Mónica

    2017-01-01

    In the last few years, there has been an increase of the interest on Modern Standard Arabic. There is where computational linguistics fits in. This paper analyses the intersection between Arabic and computational linguistics, focusing on text processing and the tools developed for this purpose. The fundamental functions of Arabic computational processing are: sentence segmentation, tokenization, morphosyntactic tagging, lemmatization, diacritization and base phrase chunking. After analysing e...

  10. Diffuse chorioretinal atrophy after a single standard low- dose intravitreal melphalan injection in a child with retinoblastoma: a case report.

    Science.gov (United States)

    Chao, An- Ning; Kao, Ling-Yuh; Liu, Laura; Wang, Nan-Kai

    2016-03-15

    Controlling retinoblastoma with seeding is challenging despite advances in treatment modalities. Intravitreal melphalan is an alternative to external beam radiation or enucleation for recurrent or refractory vitreous seeds. Significant ocular side effects following intravitreal melphalan injections are uncommon. Complications have been reported in eyes receiving higher concentrations of melphalan and repetitive injections. We report a case in which diffuse chorioretinal atrophy was developed at the injection site after a single, standard low-dose intravitreal melphalan injection. A 12-month-old female child without a family history of retinoblastoma presented with unilateral group C retinoblastoma in her right eye. A solitary tumour with retinal breaks on the tumour surface, and vitreous seeds overlying the tumour were observed at the 8 o'clock position of the retina. After two cycles of intra-arterial chemotherapy with melphalan, the main tumour displayed significant regression, but the vitreous seeds overlying the main tumour were still active. Because of the persistence of vitreous seeds and the inadequate response to intra-arterial melphalan treatment, intravitreal melphalan (8 μg in 0.05 mL) was injected using a 32-gauge needle 2.5 mm from the 5 o'clock position of the limbus, the meridian opposite to the vitreous seeds. After 1 month, the retina around the injection site demonstrated diffuse retinal pigment epithelium alterations with dense hard exudates. Although the main retinal mass, and vitreous seeds resolved, the hard exudates persisted for more than 2 years after the single low-dose melphalan injection. Intravitreal melphalan injections should be cautiously used for eyes with refractory seeds, particularly when multiple injections are required to control retinoblastoma seeds. Dose- related retinal toxicity could occur in pre-treated eyes even when a relatively low standard dose is used. Such patients should be followed up closely to monitor the

  11. Lung recruitability is better estimated according to the Berlin definition of acute respiratory distress syndrome at standard 5 cm H2O rather than higher positive end-expiratory pressure: a retrospective cohort study.

    Science.gov (United States)

    Caironi, Pietro; Carlesso, Eleonora; Cressoni, Massimo; Chiumello, Davide; Moerer, Onner; Chiurazzi, Chiara; Brioni, Matteo; Bottino, Nicola; Lazzerini, Marco; Bugedo, Guillermo; Quintel, Michael; Ranieri, V Marco; Gattinoni, Luciano

    2015-04-01

    The Berlin definition of acute respiratory distress syndrome has introduced three classes of severity according to PaO2/FIO2 thresholds. The level of positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking acute respiratory distress syndrome severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that the assessment of acute respiratory distress syndrome severity at standardized low positive end-expiratory pressure may improve the association between the underlying lung injury, as detected by CT, and PaO2/FIO2-derived severity. Retrospective analysis. Four university hospitals (Italy, Germany, and Chile). One hundred forty-eight patients with acute lung injury or acute respiratory distress syndrome according to the American-European Consensus Conference criteria. Patients underwent a three-step ventilator protocol (at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure). Whole-lung CT scans were obtained at 5 and 45 cm H2O airway pressure. Nine patients did not fulfill acute respiratory distress syndrome criteria of the novel Berlin definition. Patients were then classified according to PaO2/FIO2 assessed at clinical, 5 cm H2O, or 15 cm H2O positive end-expiratory pressure. At clinical positive end-expiratory pressure (11±3 cm H2O), patients with severe acute respiratory distress syndrome had a greater lung tissue weight and recruitability than patients with mild or moderate acute respiratory distress syndrome (pBerlin definition of acute respiratory distress syndrome assessed at 5 cm H2O allows a better evaluation of lung recruitability and edema than at higher positive end-expiratory pressure clinically set.

  12. 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

  13. Socioepidemiological screening of serologically ineligible blood donors due to Chagas disease for the definition of inconclusive cases

    Directory of Open Access Journals (Sweden)

    Márcia M Ferreira-Silva

    2010-09-01

    Full Text Available Epidemiological screening combined with serological tests has become an important tool at blood banks for the characterization of donors with or without Trypanosoma cruzi infection. Thus, the objective of the present study was to describe the sociodemographic and epidemiological characteristics of blood donors with non-negative serology for T. cruzito determine possible risk factors associated with serological ineligibility. Sociodemographic and epidemiological data were collected by analysis of patient histories and interviews. The data were analyzed descriptively using absolute and relative frequencies and odds ratio (OR evaluation. The frequency of serological ineligibility was 0.28%, with a predominance of inconclusive reactions (52% and seropositivity among first-time donors (OR = 607, donors older than 30 years (OR = 3.7, females (OR = 1.9, donors from risk areas (OR = 4 and subjects living in rural areas (OR = 1.7. The risk of seropositivity was higher among donors who had contact with the triatomine vector (OR = 11.7 and those with a family history of Chagas disease (OR = 4.8. The results demonstrate the value of detailed clinical-epidemiological screening as an auxiliary tool for serological definition that, together with more specific and more sensitive laboratory methods, will guarantee a higher efficacy in the selection of donors at blood centres.

  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. Aiming for a holistic integrated service for men diagnosed with prostate cancer - Definitions of standards and skill sets for nurses and allied healthcare professionals.

    Science.gov (United States)

    Lamb, Alastair D; Thompson, Sue; Kinsella, Netty; Gerbitz, Ingmar; Chapman, Elaine; Putt, Lisa; Bennett, Sophie; Thankappannair, Vineetha; Geoghegan, Lisa; Wright, Naomi; Stirton-Croft, Alison; Nixon, Penny; Styling, Andrew; Whitney, Diane; Hodgson, Lindsay; Punt, Lisa; Longmore, Jenny; Carter, Mike; Petch, Bill; Rimmer, Yvonne; Russell, Simon; Hughes-Davies, Luke; Mazhar, Danish; Shah, Nimish C; Gnanapragasam, Vincent J; Doble, Andrew; Bratt, Ola; Kastner, Christof

    2017-08-01

    To establish a comprehensive set of recommendations for the service structure and skill set of nurses and allied healthcare professionals in prostate cancer care. Using components of formal consensus methodology, a 30-member multidisciplinary panel produced 53 items for discussion relating to the provision of care for prostate cancer patients by specialist nurses and allied healthcare professionals. Items were developed by two rounds of email correspondence in which, first, items were generated and, second, items refined to form the basis of a consensus meeting which constituted the third round of review. The fourth and final round was an email review of the consensus output. The panel agreed on 33 items that were appropriate for recommendations to be made. These items were grouped under categories of "Environment" and "Patient Pathway" and included comments on training, leadership, communication and quality assessment as well as specific items related to prostate diagnosis clinics, radical treatment clinics and follow-up survivor groups. Specialist nurses and allied healthcare professionals play a vital role alongside urologists and oncologists to provide care to men with prostate cancer and their families. We present a set of standards and consensus recommendations for the roles and skill-set required for these practitioners to provide gold-standard prostate cancer care. These recommendations could form the basis for development of comprehensive integrated prostate cancer pathways in prostate cancer centres as well as providing guidance for any units treating men with prostate cancer. Copyright © 2017. Published by Elsevier Ltd.

  5. Evaluation of Standard Concepts Design of Library Interior Physical Environment (Case Study at University of Ma Chung

    Directory of Open Access Journals (Sweden)

    Debri Haryndia Putri

    2016-12-01

    Full Text Available Currently the function of a room is not only used as a shelter, the function of the room itself to be increased as a refreshing or relaxation area for users to follow the development of creativity and technology in the field of design. The comfortable factor becomes the main factor that indicates a successful process of creating a space. No exception library. The nature of library seemed stiff because of its function as a place to read, now can be developed and made into more dynamic with the special design concepts or color patterns used. Libraries can be created a special concept that suits the characteristics of the users themselves. Most users of the library, especially in college libraries are teenagers. Naturally, teenagers like to gather with their friends and we have to facilitate this activity in our library design concept. In addition we can also determine the needs of users through research by questionnaire method. The answers of users can be mapped and drawn conclusions. To explore the research, the author reviewed some literature about library interior design and observed the library of Ma Chung University as a case study. The combined results of the method can be concluded and the discovery of ideal standards of physical environment. So, the library can be made as a comfortable reading environment so as to increased interest in reading behavior and the frequent visits of students in the library.

  6. 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.

  7. Managing Conflicting Stakeholder Interests: An Exploratory Case Analysis of the Formulation of Corporate Social Responsibility Standards in the Netherlands

    NARCIS (Netherlands)

    Ingenbleek, P.T.M.; Immink, V.M.

    2010-01-01

    The formulation of corporate social responsibility standards must deal with conflicting interests among stakeholders. The standards formulation process occurs at the junction between market stakeholders and special interest groups, which implies that it may help increase understanding of the

  8. An Evaluation of the Intended and Implemented Curricula’s Adherence to the NCTM Standards on the Mathematics Achievement of Third Grade Students: A Case Study

    OpenAIRE

    Griffin, Cynthia C.; Xin, Yan Ping; Jitendra, Asha

    2010-01-01

    This article describes the results of a case study evaluating the influence of the intended (textbook) and implemented curricula’s (teachers’ instructional practice) adherence to the National Council of Teachers of Mathematics’ (NCTM) Standards on student outcomes in mathematics. We collected data on 72 third-grade students from four classrooms in one elementary school. Textbook and teacher adherence to the standards were evaluated using content analysis and direct observation procedures, res...

  9. 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...

  10. Arguing about climate change. Judging the handling of climate risk to future generations by comparison to the general standards of conduct in the case of risk to contemporaries

    International Nuclear Information System (INIS)

    Davidson, M.D.

    2009-01-01

    Intergenerational justice requires that climate risks to future generations be handled with the same reasonable care deemed acceptable by society in the case of risks to contemporaries. Such general standards of conduct are laid down in tort law, for example. Consequently, the validity of arguments for or against more stringent climate policy can be judged by comparison to the general standards of conduct applying in the case of risk to contemporaries. That this consistency test is able to disqualify certain arguments in the climate debate is illustrated by a further investigation of the debate on the social discount rate, used in cost-benefit analysis of climate policy

  11. Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

    Science.gov (United States)

    2014-09-04

    This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

  12. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies. The Copenhagen osteoarthritis study

    International Nuclear Information System (INIS)

    Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K.; Sonne-Holm, Stig

    2010-01-01

    The aims of the present study were threefold: to examine the distribution of knee joint osteoarthritis in a large, standardized radiological study; to examine the relationships between self reported knee pain and radiological OA; and to examine the natural history of radio-morphological change over age in individuals without radiological features of OA. The Copenhagen Osteoarthritis Study - COS is a substudy of the Copenhagen City Heart Study, a longitudinal regional health survey. From the third inclusion of the CCHS (1992-1994) 4,151 subjects were selected for subsequent standardized radiography of the pelvis, the knees, the hands, the wrists, and the lumbar spine. Images were analyzed and knee joint osteoarthritis (OA) was classified according to the radiographic atlas of Kellgren and Lawrence. Joint space width (JSW) was measured at three sites within both the medial and the lateral compartment. For the entire cohort the prevalence of radiological knee joint OA of all grades was 38.7% for men and 44.2% for women. Age stratification documented increasing knee joint OA both in regard to prevalence and morphological severity. Knee pain was universally correlated to the Kellgren and Lawrence severity of OA. In a subgroup with no features of radiological OA, a significant and linear decline in JSW with increasing age was found. We found a clear relationship between self-reported knee pain and radiological osteoarthritis. Pain was proportionally related to the severity of change. We also demonstrated a significant diminishing of joint space width with increasing age in individuals without apparent radiological degeneration. (orig.)

  13. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies. The Copenhagen osteoarthritis study

    Energy Technology Data Exchange (ETDEWEB)

    Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K.; Sonne-Holm, Stig [Copenhagen University Hospital of Hvidovre (Denmark). Department of Orthopaedic Surgery

    2010-09-15

    The aims of the present study were threefold: to examine the distribution of knee joint osteoarthritis in a large, standardized radiological study; to examine the relationships between self reported knee pain and radiological OA; and to examine the natural history of radio-morphological change over age in individuals without radiological features of OA. The Copenhagen Osteoarthritis Study - COS is a substudy of the Copenhagen City Heart Study, a longitudinal regional health survey. From the third inclusion of the CCHS (1992-1994) 4,151 subjects were selected for subsequent standardized radiography of the pelvis, the knees, the hands, the wrists, and the lumbar spine. Images were analyzed and knee joint osteoarthritis (OA) was classified according to the radiographic atlas of Kellgren and Lawrence. Joint space width (JSW) was measured at three sites within both the medial and the lateral compartment. For the entire cohort the prevalence of radiological knee joint OA of all grades was 38.7% for men and 44.2% for women. Age stratification documented increasing knee joint OA both in regard to prevalence and morphological severity. Knee pain was universally correlated to the Kellgren and Lawrence severity of OA. In a subgroup with no features of radiological OA, a significant and linear decline in JSW with increasing age was found. We found a clear relationship between self-reported knee pain and radiological osteoarthritis. Pain was proportionally related to the severity of change. We also demonstrated a significant diminishing of joint space width with increasing age in individuals without apparent radiological degeneration. (orig.)

  14. 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.

  15. LD Definition.

    Science.gov (United States)

    Learning Disability Quarterly, 1987

    1987-01-01

    The position paper (1981) of the National Joint Committee on Learning Disabilities presents a revised definition of learning disabilities and identifies issues and concerns (such as the limitation to children and the exclusion clause) associated with the definition included in P.L. 94-142, the Education for All Handicapped Children Act. (DB)

  16. An investigation into the minimum accelerometry wear time for reliable estimates of habitual physical activity and definition of a standard measurement day in pre-school children.

    Science.gov (United States)

    Hislop, Jane; Law, James; Rush, Robert; Grainger, Andrew; Bulley, Cathy; Reilly, John J; Mercer, Tom

    2014-11-01

    The purpose of this study was to determine the number of hours and days of accelerometry data necessary to provide a reliable estimate of habitual physical activity in pre-school children. The impact of a weekend day on reliability estimates was also determined and standard measurement days were defined for weekend and weekdays.Accelerometry data were collected from 112 children (60 males, 52 females, mean (SD) 3.7 (0.7)yr) over 7 d. The Spearman-Brown Prophecy formula (S-B prophecy formula) was used to predict the number of days and hours of data required to achieve an intraclass correlation coefficient (ICC) of 0.7. The impact of including a weekend day was evaluated by comparing the reliability coefficient (r) for any 4 d of data with data for 4 d including one weekend day.Our observations indicate that 3 d of accelerometry monitoring, regardless of whether it includes a weekend day, for at least 7 h  d(-1) offers sufficient reliability to characterise total physical activity and sedentary behaviour of pre-school children. These findings offer an approach that addresses the underlying tension in epidemiologic surveillance studies between the need to maintain acceptable measurement rigour and retention of a representatively meaningful sample size.

  17. Oncoplastic round block technique has comparable operative parameters as standard wide local excision: a matched case-control study.

    Science.gov (United States)

    Lim, Geok-Hoon; Allen, John Carson; Ng, Ruey Pyng

    2017-08-01

    Although oncoplastic breast surgery is used to resect larger tumors with lower re-excision rates compared to standard wide local excision (sWLE), criticisms of oncoplastic surgery include a longer-albeit, well concealed-scar, longer operating time and hospital stay, and increased risk of complications. Round block technique has been reported to be very suitable for patients with relatively smaller breasts and minimal ptosis. We aim to determine if round block technique will result in operative parameters comparable with sWLE. Breast cancer patients who underwent a round block procedure from 1st May 2014 to 31st January 2016 were included in the study. These patients were then matched for the type of axillary procedure, on a one to one basis, with breast cancer patients who had undergone sWLE from 1st August 2011 to 31st January 2016. The operative parameters between the 2 groups were compared. 22 patients were included in the study. Patient demographics and histologic parameters were similar in the 2 groups. No complications were reported in either group. The mean operating time was 122 and 114 minutes in the round block and sWLE groups, respectively (P=0.64). Length of stay was similar in the 2 groups (P=0.11). Round block patients had better cosmesis and lower re-excision rates. A higher rate of recurrence was observed in the sWLE group. The round block technique has comparable operative parameters to sWLE with no evidence of increased complications. Lower re-excision rate and better cosmesis were observed in the round block patients suggesting that the round block technique is not only comparable in general, but may have advantages to sWLE in selected cases.

  18. Definition of a Standard Protocol to Determine the Growth Potential of Listeria Monotgenes and Yersinia Enterocolitica in Pork Sausage Produced in Abruzzo Region, Italy.

    Science.gov (United States)

    Sperandii, Anna Franca; Neri, Diana; Romantini, Romina; Santarelli, Gino Angelo; Prencipe, Vincenza

    2015-11-02

    Pork meat products consumed raw or after a short period of fermentation can be considered at risk for food safety. Sausages (fresh sausage made from pork meat) are produced in several Italian regions, with variation in ingredients. In some Italian Regions, including Abruzzo, these products are frequently consumed raw or undercooked, after a variable period of fermentation. The European Community food regulation promotes the use of challenge tests to determine safety levels. This study is aimed to ensure safety of Abruzzo's sausages, compared with growth potential (δ) of Listeria monocytogenes and Yersinia enterocolitica , and also aims to define an experimental standard protocol document to carry out challenge tests. Guidelines classify ready-to-eat foods in categories that are able to support (δ>0.5 log 10 ufc/g) and not support (δ≤0.5 log 10 ufc/g) the growth of Listeria monocytogenes. The products were manufactured according to traditional recipes and were contaminated in laboratory. Results from the experiment yielded information useful to assess the ability of these products to support the growth of pathogenic microorganisms. The batches of sausages were stored at 8, 12, 18 and 20°C to get statistical evaluation. The results showed that, despite the conditioning of the storage temperature and the level of water activity, both organisms remain in the product in concentrations similar to those leading or being able to increase its charge. In particular, the period of greatest consumption of this product (7/8 days of preparation) corresponds to the period of greatest growth of pathogenic microorganisms studied, except for those stored at a temperature of 8°C, which are safer for the consumer.

  19. 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...

  20. 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

  1. The Quality of Teaching Staff: Higher Education Institutions' Compliance with the European Standards and Guidelines for Quality Assurance--The Case of Portugal

    Science.gov (United States)

    Cardoso, Sónia; Tavares, Orlanda; Sin, Cristina

    2015-01-01

    In recent years, initiatives for the improvement of teaching quality have been pursued both at European and national levels. Such is the case of the European Standards and Guidelines for Quality Assurance (ESG) and of legislation passed by several European countries, including Portugal, in response to European policy developments driven by the…

  2. Feasibility of using training cases from International Spinal Cord Injury Core Data Set for testing of International Standards for Neurological Classification of Spinal Cord Injury items

    DEFF Research Database (Denmark)

    Liu, N; Hu, Z W; Zhou, M W

    2014-01-01

    STUDY DESIGN: Descriptive comparison analysis. OBJECTIVE: To evaluate whether five training cases of International Spinal Cord Injury Core Data Set (ISCICDS) are appropriate for testing the facts within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI...... include information about zone of partial preservation, sensory score or motor score. CONCLUSION: Majority of the facts related to SL, ML and AIS are included in the five training cases of ISCICDS. Thus, using these training cases, it is feasible to test the above facts within the ISNCSCI. It is suggested...

  3. Functional Case Test Design to Optimize the Software Development in Italian Tax Processes (Part I: Methodology Definition

    Directory of Open Access Journals (Sweden)

    Rolli Fernando

    2017-01-01

    Full Text Available In Europe's general context of economic integration, the National States have preserved a few competences. Among them, the most important competence is taxation management, which has now become an important lever to stabilize the State's budget and to meet the economic parameters set by the European Agreements. From this perspective, it is crucial to identify a software development mode to reduce the time spent for the implementation/adjustment of the tax payment software application and, at the same time, to minimize the overall risk level. In software development, approximately 40% of time is spent in a series of testing activities: this stage of the development process is mostly placed at the end of the implementation activities. Consequently, since many testing activities have to be waived in order to meet the deadlines for software delivery, applications that are not entirely in compliance with the user's needs and/or entailing non-compliance are more likely to be introduced. This paper focuses on improving the testing process in tax procedures. The proposed method aims to improve the process, by introducing an integrated procedure based on Axiomatic Design. The approach developed will facilitate a reduction both in the testing preparation time and in performing the test cases. In this scenario, it will be possible to optimize the data compilation process, to verify the compliance within the technical specifications as provided by the Italian Revenue Agency, to identify possible critical scenarios with a proactive approach, and to avoid classes of non-conformities.

  4. 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

  5. Goal Definition

    DEFF Research Database (Denmark)

    Bjørn, Anders; Laurent, Alexis; Owsianiak, Mikołaj

    2018-01-01

    The goal definition is the first phase of an LCA and determines the purpose of a study in detail. This chapter teaches how to perform the six aspects of a goal definition: (1) Intended applications of the results, (2) Limitations due to methodological choices, (3) Decision context and reasons...... for carrying out the study, (4) Target audience , (5) Comparative studies to be disclosed to the public and (6) Commissioner of the study and other influential actors. The instructions address both the conduct and reporting of a goal definition and are largely based on the ILCD guidance document (EC...

  6. The Common Core State Standards and the Role of Instructional Materials: A Case Study on EdReports.org

    Science.gov (United States)

    Watt, Michael G.

    2016-01-01

    The purpose of this study was to review research studies investigating the role of instructional materials in relation to the Common Core State Standards and to evaluate whether a new organisation, EdReports.org, founded to evaluate the alignment of instructional materials to the Common Core State Standards, has achieved its objectives. Content…

  7. Standards Collection Development and Management in an Academic Library: A Case Study at the University of Western Ontario Libraries

    Science.gov (United States)

    Dunn, Linda K.; Xie, Shiyi

    2017-01-01

    How can academic libraries ensure their standards collections meet the teaching and research needs of science and engineering faculties? Nowadays, most academic libraries face financial constraints that greatly impact collection development. This article documents an academic library's experience with standards collections and the investigation…

  8. Role of research in the safety case of future reactor concepts definite needs, confirmatory areas, added value

    International Nuclear Information System (INIS)

    Timo, Okkonen; Juhani, Hyvarinen

    2002-01-01

    In this paper, we aim to describe the role(s) of research when assessing - and finally demonstrating - the safety of future reactor concepts. The term 'research' could be defined in quite a limited fashion, while in this paper, we will use it synonymously to all Research and Design (R and D) work. First, we will provide a top-down planning perspective by identifying the general set of safety factors related to new reactor projects; i.e., factors that have to be accounted for already in the safety case. The research needs can be based on such a set of safety factors and related challenges, and it is crucial that the research requirements remain reasonable. For this, suitable design choices have to be made, such that they limit the criticality of individual plant functions, related systems/ structures/components (SSC), and human actions. In this context, we will discuss the general ways of limiting excessive research needs. The critical plant functions and SSC, in their turn, will require a strong safety demonstration. Once major design decisions have been made according to the aforementioned lines, actual systems are designed, using available equipment or developing new. Research support is needed to establish the technological adequacy and confidence level of each decision at each design level; this is relatively easy where conventional technologies are used, but more challenging if novel technologies come into question. Maturity of technology also correlates strongly with the attainable certainty and qualification of analysis tools. Here, we will describe the general phases of R and D from exploratory work to safety demonstration, and also independent confirmation. We will also touch upon the roles of different actors - the vendor, the licensee and the regulator - as well as their strategies in attacking the above-mentioned safety factors through research. (authors)

  9. Preparation, definition and stabilisation of an inorganic sol by an organic macromolecule: case of an aluminium hydroxide colloid

    International Nuclear Information System (INIS)

    Hurbin-Faucon, A.

    1966-01-01

    An attempt has been made in this work to define an aluminium colloid which is resistant as a high ionic force and to analyse, in the case of this system, the possibilities. and the limits of certain techniques used in the physical chemistry of colloids. The aluminium colloid is obtained by peptization of an aluminium hydroxide precipitate. The physical characterisation of the micelle is effected using the light scattering method which makes it possible to define the colloid from the point of view of size and shape. An interesting characteristic, arising from the low refractive index of the colloid studied, has led us to use not only the general MIE methods but also the methods normally used in macro-molecular chemistry; these latter involve fewer hypotheses and thus make it possible to carry out a more complete analysis of the sol. Since the aluminium hydroxide colloid is sensitive to a high ionic force, we have begun to study the possibility of making it more stable by means of a macromolecule: gelatin. After characterizing this macromolecule by means of potentiometric and light scattering measurements, we have shown the existence of a chemical interaction which occurs when aluminium hydroxide is brought into contact with gelatin; this interaction leads to the production of an inorganic-organic entity which is stable when the ionic force increases. We have established some of the characteristics of the complex thus formed, in particular the pH range of the solution necessary for its formation, its stability. in the presence of electrolytes and some hypotheses concerning its size and shape, Finally we have tried to define the influence of. the molecular weight and the respective dimensions of each constituent on the formation of the complex and thus on the stabilization. (author) [fr

  10. Meeting the Standards for Foreign Language Leaming through an Internet-Based Newspaper Project: Case Studies of Advanced-Level Japanese Learners

    Directory of Open Access Journals (Sweden)

    Miyuki Fukai

    2005-01-01

    Full Text Available Published in 1996, the Standards far Foreign Language Learning (Standards, define knowledge and abilities that foreign language learners should acquire in the U.S. The Internet is believed to facilitate standards-based instruction because of its capabilities as a communication medium, information provider, and publication tool. This paper presents one part of a study that investigated this claim through examining an Internet-based newspaper project in an advanced-level college Japanese course in light of the Japanese Standards. Six students were selected to serve as case studies, with their experiences in relation to this project analyzed in depth. The results show that the students found using the Internet to read authentic materials with the help of an online dictionary to be a positive experience. This then resulted in their actively using Japanese for personal enjoyment outside the classroom. These results suggest that the project was particularly successful in two goal areas: Communication and Communities.

  11. Scope Definition

    DEFF Research Database (Denmark)

    Bjørn, Anders; Owsianiak, Mikołaj; Laurent, Alexis

    2018-01-01

    The scope definition is the second phase of an LCA. It determines what product systems are to be assessed and how this assessment should take place. This chapter teaches how to perform a scope definition. First, important terminology and key concepts of LCA are introduced. Then, the nine items...... making up a scope definition are elaborately explained: (1) Deliverables. (2) Object of assessment, (3) LCI modelling framework and handling of multifunctional processes, (4) System boundaries and completeness requirements, (5) Representativeness of LCI data, (6) Preparing the basis for the impact...... assessment, (7) Special requirements for system comparisons, (8) Critical review needs and (9) Planning reporting of results. The instructions relate both to the performance and reporting of a scope definition and are largely based on ILCD....

  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. 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...

  14. Field Performance versus Standard Test Condition Efficiency of Tandem Solar Cells and the Specific Case of Perovskites/Silicon Devices

    KAUST Repository

    Dupre, Olivier; Niesen, Bjö rn; De Wolf, Stefaan; Ballif, Christophe

    2018-01-01

    efficiencies and calculate their energy yields using field data from Denver. We find that annual losses due to differences between operating conditions and standard test conditions are similar for single-junction and four-terminal tandem devices. The additional

  15. International Harmonisation Of Accounting Standards: The Case For A Mandatory Requirement For The Direct Method Of Reporting Operating Cash Flows

    OpenAIRE

    Christine Yap

    2011-01-01

    Even though standard setters have now embraced cash flow statements there remains ambivalence as to the best format (i.e. direct or indirect method) for disclosing cash flow from operations. In 1987 the FASB asserted that information about the gross amounts of cash receipts and cash payments is more relevant than information about the net amounts of cash receipts and payments. Yet apart from Australia and New Zealand, most standard setting bodies, including the International Accounting Standa...

  16. Craniospinal Germinomas in Patient with Down Syndrome Successfully Treated with Standard-Dose Chemotherapy and Craniospinal Irradiation: Case Report and Literature Review.

    Science.gov (United States)

    Miyake, Yohei; Adachi, Jun-Ichi; Suzuki, Tomonari; Mishima, Kazuhiko; Sasaki, Atsushi; Nishikawa, Ryo

    2017-12-01

    Patients with Down syndrome (DS) are more likely to develop chemotherapy-related complications. The standard treatment for these patients with cancer has not yet been established, and the risks of standard chemotherapy are unclear. In this paper, a rare case of multiple craniospinal germinomas in a patient with DS, which was successfully treated with standard-dose chemotherapy combined with craniospinal irradiation, is reported. The authors report a case of multiple craniospinal germinomas in a DS patient who presented with bilateral oculomotor and facial nerve palsy and hearing loss. The patient underwent 3 courses of combination chemotherapy using a standard dose of carboplatin and etoposide and 23.4 Gy of concurrent craniospinal irradiation. Posttreatment magnetic resonance imaging showed reduction of the tumors. Both fluorodeoxyglucose- and methionine-positron emission tomography demonstrated no uptake in the residual tumors. Follow-up magnetic resonance imaging and positron emission tomography did not reveal tumor recurrence for 18 months. As far as we know, this is the first case of multiple craniospinal germinomas in a patient with DS who achieved a successful treatment result without fatal adverse events. The literature review indicated that disseminated germinomas may need intensive treatment to reduce recurrence risk. However, intensive chemotherapy using a combination of 3 or more anticancer drugs can increase the rate of treatment-related death during the early stage. Our case indicated that multiple craniospinal germinoma of DS patients could be treated with a standard dose of carboplatin and etoposide regimen with concurrent craniospinal irradiation along with appropriate supportive therapy and careful observation. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Blaming the Victim and Exonerating the Perpetrator in Cases of Rape and Robbery: Is There a Double Standard?

    Science.gov (United States)

    Bieneck, Steffen; Krahe, Barbara

    2011-01-01

    Research in legal decision making has demonstrated the tendency to blame the victim and exonerate the perpetrator of sexual assault. This study examined the hypothesis of a special leniency bias in rape cases by comparing them to cases of robbery. N = 288 participants received descriptions of rape and robbery of a female victim by a male…

  18. Nuclear standards

    International Nuclear Information System (INIS)

    Fichtner, N.; Becker, K.; Bashir, M.

    1981-01-01

    This compilation of all nuclear standards available to the authors by mid 1980 represents the third, carefully revised edition of a catalogue which was first published in 1975 as EUR 5362. In this third edition several changes have been made. The title has been condensed. The information has again been carefully up-dated, covering all changes regarding status, withdrawal of old standards, new projects, amendments, revisions, splitting of standards into several parts, combination of several standards into one, etc., as available to the authors by mid 1980. The speed with which information travels varies and requires in many cases rather tedious and cumbersome inquiries. Also, the classification scheme has been revised with the goal of better adjustment to changing situations and priorities. Whenever it turned out to be difficult to attribute a standard to a single subject category, multiple listings in all relevant categories have been made. As in previous editions, within the subcategories the standards are arranged by organization (in Categorie 2.1 by country) alphabetically and in ascending numerical order. It covers all relevant areas of power reactors, the fuel cycle, radiation protection, etc., from the basic laws and governmental regulations, regulatory guides, etc., all the way to voluntary industrial standards and codes of pratice. (orig./HP)

  19. Influence of new customs procedures and logistic security standards on companies competiveness – a Croatian company case study

    Directory of Open Access Journals (Sweden)

    Aleksandar Erceg

    2014-12-01

    Full Text Available In today’s global market, companies are constantly confronted with the competition on the local, national and international level. Companies therefore use a variety of strategies and tools to become and/or remain competitive. Potential areas for cost reduction in companies are supply chain management and logistic and customs procedures. Implementation of various logistic standards in supply chain management can provide significant cost savings for the company’s daily operations and thus reduce overall costs and improve the competitiveness. Using different customs procedures and logistic standards to reduce their costs and become more competitive in the market is necessary for Croatian companies. The method of using these tools is not a one-time process and requires constant efforts. Companies therefore have to be ready to improve daily to be and remain competitive. Using a variety of modern customs procedures can save their money and time, not only through these procedures, but also through better use of their employee’s time, their own vehicles and other equipment. The paper analyzes various customs procedures and logistic standards that can help companies save time and money and improve their competitiveness. In the example of Croatian company, which uses various available procedures and standards the benefits of their use are shown. Apart from bringing savings in operations, all these procedures and standards allow the company to be better, cheaper and more attractive to buyers.

  20. Alignment of single-case design (SCD) research with individuals who are deaf or hard of hearing with the what Works Clearinghouse standards for SCD research.

    Science.gov (United States)

    Wendel, Erica; Cawthon, Stephanie W; Ge, Jin Jin; Beretvas, S Natasha

    2015-04-01

    The authors assessed the quality of single-case design (SCD) studies that assess the impact of interventions on outcomes for individuals who are deaf or hard-of-hearing (DHH). More specifically, the What Works Clearinghouse (WWC) standards for SCD research were used to assess design quality and the strength of evidence of peer-reviewed studies available in the peer-reviewed, published literature. The analysis yielded four studies that met the WWC standards for design quality, of which two demonstrated moderate to strong evidence for efficacy of the studied intervention. Results of this review are discussed in light of the benefits and the challenges to applying the WWC design standards to research with DHH individuals and other diverse, low-incidence populations. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Benefits and limitations of using the weather radar for the definition of rainfall thresholds for debris flows. Case study from Catalonia (Spain).

    Science.gov (United States)

    Abancó, C.; Hürlimann, M.; Sempere, D.; Berenguer, M.

    2012-04-01

    Torrential processes such as debris flows or hyperconcentrated flows are fast movements formed by a mix of water and different amounts of unsorted solid material. They occur in steep torrents and suppose a high risk for the human settlements. Rainfall is the most common triggering factor for debris flows. The rainfall threshold defines the rainfall conditions that, when reached or exceeded, are likely to provoke one or more events. Many different types of empirical rainfall thresholds for landslide triggering have been defined. Direct measurements of rainfall data are normally not available from a point next to or in the surroundings of the initiation area of the landslide. For this reason, most of the thresholds published for debris flows have been established by data measured at the nearest rain gauges (often located several km far from the landslide). Only in very few cases, the rainfall data to analyse the triggering conditions of the debris flows have been obtained by weather (Doppler) radar. Radar devices present certain limitations in mountainous regions due to undesired reboots, but their main advantage is that radar data can be obtained for any point of the territory. The objective of this work was to test the use of the weather radar data for the definition of rainfall thresholds for debris-flow triggering. Thus, rainfall data obtained from 3 to 5 rain gauges and from radar were compared for a dataset of events occurred in Catalonia (Spain). The goal was to determine in which cases the description of the rainfall episode (in particular the maximum intensity) had been more accurate. The analysed dataset consists of: 1) three events occurred in the Rebaixader debris-flow monitoring station (Axial Pyrenees) including two hyperconcentrated flows and one debris flow; 2) one debris-flow event occurred in the Port Ainé ski resort (Axial Pyrenees); 3) one debris-flow event in Montserrat (Mediterranean Coastal range). The comparison of the hyetographs from the

  2. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: Initial report

    International Nuclear Information System (INIS)

    Jabbari, Siavash; Kim, Hyungjin M.; Feng, Mary; Lin, Alexander; Tsien, Christina; Elshaikh, Mohamed; Terrel, Jeffrey E.; Murdoch-Kinch, Carol; Eisbruch, Avraham

    2005-01-01

    Purpose: To compare quality of life (QOL) and xerostomia between head-and-neck cancer patients who received standard radiotherapy (RT) and patients matched by factors known to affect QOL who received intensity-modulated RT (IMRT). Methods and Materials: This was a prospective, longitudinal study of patients with head-and-neck cancer requiring bilateral neck irradiation who received IMRT at the University of Michigan and patients who received standard RT at affiliated clinics. Each patient received a validated head-and-neck cancer-related QOL questionnaire (HNQOL) consisting of four multi-item domains-Eating, Communication, Pain, and Emotion-and a validated patient-reported xerostomia questionnaire (XQ). In both questionnaires, the answers were scored 0-100, with higher scores denoting worse QOL or xerostomia. The questionnaires were given before therapy and at 1, 3, 6, 12, 18, and 24 months after the completion of therapy. Each standard RT patient was matched with several IMRT patients according to tumor site, stage, RT status (postoperative or definitive), and age. A linear mixed-effects model was fit to compare outcomes between the two treatment groups and to model trends over time. To account for matching, the differences in scores between the matched sets of patients were fit as a random intercept. Also, matching was taken into account in the model by using the standard error of the within-paired-groups differences. Results: Between 1997 and 2002, 10 patients who had received standard RT and answered the XQ and HNQOL through at least 1 year were included in the study. Each of these patients was matched with a subgroup of 2-5 patients (median, 3) who had received IMRT, had similar patient and tumor characteristics, and answered the same questionnaires. A total of 30 patients were included in the IMRT group. During the initial months after therapy, the XQ and HNQOL summary scores worsened significantly in both groups compared with the pretherapy scores. Starting

  3. Evaluation model for enterprise standardization programs: the case of Petrobras Transporte's marine terminals unit

    Energy Technology Data Exchange (ETDEWEB)

    Maldonado, Luciano; De Ludovico Almeida, Maria Fatima; Penchino Pereira, Paulo Penchina; Santos, Ubirajara; Henrique Ferreira, Manoel; Muller, Gabriela [Petrobras Transporte - Transpetro (Brazil)

    2010-07-01

    With the economic opening and the globalization process, standardization, metrology and quality activities have become known among companies as knowledge areas with direct impact on their search for operational excellence and competitiveness. Petrobras Transporte's Marine Terminal Units has been working over the last years to be recognized as a reference in the activities it pursues. This is based on the Petrobras Transporte's strategic plan 2020, which foresees amongst others, the specialization of technical workforce, operational safety excellence, capital discipline, customer satisfaction, the search for new technologies and markets and the rendering of new services. To achieve these goals, the Marine Terminals Standardization Program must be adhered to. Since that program was launched in 2004, the need for an evaluation model to evaluate its implementation progress, measure the degree of standards compliance and its potential economic, social and environmental impacts have become evident. This paper describes the innovative evaluation model applied to Petrobras Transporte's marine terminals standardization program.

  4. Utilizing Innovative Video Chat Technology to Meet National Standards: A Case Study on a STARTALK Hindi Language Program

    Science.gov (United States)

    Parveen, Shaheen; Pater, Cayley

    2012-01-01

    Responding to the need for foreign language fluency in ever-globalizing business and cultural spheres, the federal government and foreign language institutions in an eleven-member task force collaboratively published a set of nationally recognized, foundational standards for foreign language teaching. Rather than rely on teacher-centered…

  5. 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.

  6. 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.

  7. 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

  8. Aid conditionalities, international Good Manufacturing Practice standards and local production rights: a case study of local production in Nepal.

    Science.gov (United States)

    Brhlikova, Petra; Harper, Ian; Subedi, Madhusudan; Bhattarai, Samita; Rawal, Nabin; Pollock, Allyson M

    2015-06-14

    Local pharmaceutical production has been endorsed by the WHO as a means of addressing health priorities of developing countries. However, local producers of essential medicines must comply with international pharmaceutical standards in order to be eligible to compete in donor tenders. These standards determine production rights for on-patent and off-patent medicines, and guide international procurement of medicines. We reviewed the literature on the impact of Good Manufacturing Practice (GMP) on local production; a gap analysis from the literature review indicated a need for further research. Over sixty interviews were conducted with people involved in the Nepali pharmaceutical production and distribution chain from 2006 to 2009 on the GMP areas of relevance: regulatory capacity, staffing, funding and training, resourcing of GMP, inspectors' interpretation of the rules and compliance. Although Nepal producers have increased their overall share of the domestic market, only the public manufacturer, Royal Drugs, focuses on medicines for public health programmes; private producers engage mainly in brand competition for private markets, not essential medicines. Nepali regulators and producers state that implementation of GMP standards is hindered by low regulatory capacity, insufficient training of staff in the industry, financial constraints and lack of investment for upgrading capital. The transition period to mandatory compliance with WHO GMP rules is lengthy. Less than half of private producers had WHO GMP in 2013. Producers are not directly affected by international harmonisation of standards as they do not export medicines and the Nepali regulator does not enforce the WHO standards strictly. Without an international GMP certificate they cannot tender for donor dependent health programmes. In Nepal, local private manufacturers focus mainly on brand competition for private consumption not essential medicines, the government preferentially procures essential

  9. Gravitational Field as a Pressure Force from Logarithmic Lagrangians and Non-Standard Hamiltonians: The Case of Stellar Halo of Milky Way

    Science.gov (United States)

    El-Nabulsi, Rami Ahmad

    2018-03-01

    Recently, the notion of non-standard Lagrangians was discussed widely in literature in an attempt to explore the inverse variational problem of nonlinear differential equations. Different forms of non-standard Lagrangians were introduced in literature and have revealed nice mathematical and physical properties. One interesting form related to the inverse variational problem is the logarithmic Lagrangian, which has a number of motivating features related to the Liénard-type and Emden nonlinear differential equations. Such types of Lagrangians lead to nonlinear dynamics based on non-standard Hamiltonians. In this communication, we show that some new dynamical properties are obtained in stellar dynamics if standard Lagrangians are replaced by Logarithmic Lagrangians and their corresponding non-standard Hamiltonians. One interesting consequence concerns the emergence of an extra pressure term, which is related to the gravitational field suggesting that gravitation may act as a pressure in a strong gravitational field. The case of the stellar halo of the Milky Way is considered.

  10. Immune Reconstitution Inflammatory Syndrome and Cytomegalovirus Pneumonia Case Report: Highlights and Missing Links in Classification Criteria and Standardized Treatment

    Directory of Open Access Journals (Sweden)

    Stefania Petarra-Del Río

    2017-01-01

    Full Text Available Background. Cytomegalovirus (CMV pulmonary involvement is rarely associated with IRIS; therefore, limited information is available. Case Presentation. Here, we describe the case of a 43-year-old HIV-infected male who developed an unusual case of IRIS after cytomegalovirus (CMV pneumonia. Clinically there was a progressive and paradoxical worsening of respiratory distress, despite being treated for CMV after initiation with antiretroviral therapy. Chest X-ray revealed disseminated infiltrates in both lungs; chest CT-scan showed generalized lung involvement and mediastinal adenopathy. Pulmonary biopsy confirmed CMV pneumonia with the observation of typical viral inclusions on pneumocytes. Conclusions. CMV pneumonia can be associated with the development of IRIS requiring treatment with immunosuppressant’s and immunomodulatory drugs.

  11. Data-protection standards and confidentiality of HIV/AIDS status in the workplace - a South African case study.

    Science.gov (United States)

    Muskat-Gorska, Zuzanna

    2008-11-01

    The article contextualises an emerging new regime for information privacy in South Africa (i.e. the draft Protection of Personal Information Bill). Subsequently, it discusses the possibility of successful implementation of international data-protection standards in an environment where there is an urgent need to balance HIV/AIDS confidentiality rights with public health requirements. Also, the article presents a preliminary assessment of the possible impact of professionalisation (and outsourcing) of workplace HIV/AIDS management on workplace data-protection practices, and it identifies some spaces for social dialogue on HIV/AIDS-data treatment in South Africa. The study methods comprise an analysis of legal documents (concerning international data-protection standards and the development of law governing data protection and HIV/AIDS confidentiality in South Africa) and interviews conducted with workplace health managers and trade union representatives, in Johannesburg, in 2007.

  12. Analysis and meta-analysis of single-case designs with a standardized mean difference statistic: a primer and applications.

    Science.gov (United States)

    Shadish, William R; Hedges, Larry V; Pustejovsky, James E

    2014-04-01

    This article presents a d-statistic for single-case designs that is in the same metric as the d-statistic used in between-subjects designs such as randomized experiments and offers some reasons why such a statistic would be useful in SCD research. The d has a formal statistical development, is accompanied by appropriate power analyses, and can be estimated using user-friendly SPSS macros. We discuss both advantages and disadvantages of d compared to other approaches such as previous d-statistics, overlap statistics, and multilevel modeling. It requires at least three cases for computation and assumes normally distributed outcomes and stationarity, assumptions that are discussed in some detail. We also show how to test these assumptions. The core of the article then demonstrates in depth how to compute d for one study, including estimation of the autocorrelation and the ratio of between case variance to total variance (between case plus within case variance), how to compute power using a macro, and how to use the d to conduct a meta-analysis of studies using single-case designs in the free program R, including syntax in an appendix. This syntax includes how to read data, compute fixed and random effect average effect sizes, prepare a forest plot and a cumulative meta-analysis, estimate various influence statistics to identify studies contributing to heterogeneity and effect size, and do various kinds of publication bias analyses. This d may prove useful for both the analysis and meta-analysis of data from SCDs. Copyright © 2013 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  13. Influence of new customs procedures and logistic security standards on companies competiveness – a Croatian company case study

    OpenAIRE

    Erceg, Aleksandar

    2014-01-01

    In today’s global market, companies are constantly confronted with the competition on the local, national and international level. Companies therefore use a variety of strategies and tools to become and/or remain competitive. Potential areas for cost reduction in companies are supply chain management and logistic and customs procedures. Implementation of various logistic standards in supply chain management can provide significant cost savings for the company’s daily operations an...

  14. Proposed Standards for Variable Harmonization Documentation and Referencing: A Case Study Using QuickCharmStats 1.1

    Science.gov (United States)

    Winters, Kristi; Netscher, Sebastian

    2016-01-01

    Comparative statistical analyses often require data harmonization, yet the social sciences do not have clear operationalization frameworks that guide and homogenize variable coding decisions across disciplines. When faced with a need to harmonize variables researchers often look for guidance from various international studies that employ output harmonization, such as the Comparative Survey of Election Studies, which offer recoding structures for the same variable (e.g. marital status). More problematically there are no agreed documentation standards or journal requirements for reporting variable harmonization to facilitate a transparent replication process. We propose a conceptual and data-driven digital solution that creates harmonization documentation standards for publication and scholarly citation: QuickCharmStats 1.1. It is free and open-source software that allows for the organizing, documenting and publishing of data harmonization projects. QuickCharmStats starts at the conceptual level and its workflow ends with a variable recording syntax. It is therefore flexible enough to reflect a variety of theoretical justifications for variable harmonization. Using the socio-demographic variable ‘marital status’, we demonstrate how the CharmStats workflow collates metadata while being guided by the scientific standards of transparency and replication. It encourages researchers to publish their harmonization work by providing researchers who complete the peer review process a permanent identifier. Those who contribute original data harmonization work to their discipline can now be credited through citations. Finally, we propose peer-review standards for harmonization documentation, describe a route to online publishing, and provide a referencing format to cite harmonization projects. Although CharmStats products are designed for social scientists our adherence to the scientific method ensures our products can be used by researchers across the sciences. PMID

  15. Contribution to Energy Management of the Main Standards for Environmental Management Systems: The Case of ISO 14001 and EMAS

    Directory of Open Access Journals (Sweden)

    Iker Laskurain

    2017-11-01

    Full Text Available The adoption of Energy Management Systems (EnMSs based on international standards has gained momentum since the ISO 50001 standard was launched in 2011. Before that, the potential to improve the energy management with Environmental Management Systems (EMSs based on ISO 14001 and EMAS was identified in the literature. However, no in-depth analysis reported in the literature has explored this claim. The need for research is now even more evident with the development of new versions of the standards for environmental management―ISO 14001:2015 and EMAS III. Since many companies that already have a certified EMSs might be uncertain whether to adopt an ISO 50001 based EnMSs, the present work aims to shed light on the contribution of ISO 14001:2015 and EMAS III to energy management. Furthermore, the work summarizes the results of an empirical exploratory study carried out in eight Spanish organizations, four with an EMS implemented and certified based on ISO 14001:2015 and four more with an EMS registered to EMAS III. The findings show that both ISO14001 and EMAS certified organizations carry out energy management practices, even though they have no formal EnMSs implemented. Implications for managers and policy makers are discussed, together with avenues for further research.

  16. Standardization process aligned to integrated management system: the case of TRANSPETRO's Oil Pipelines and Terminals Unit

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Maria Fatima Ludovico de [Pontificia Universidade Catolica do Rio de Janeiro (PUC-Rio/ITUC), Rio de Janeiro, RJ (Brazil). Instituto Tecnologico; Labrunie, Charles; Araujo, Dario Doria de [TRANSPETRO - PETROBRAS Transporte S.A., Rio de Janeiro, RJ (Brazil). Diretoria de Terminais e Oleodutos

    2009-07-01

    This paper presents the implementation by PETROBRAS Transporte S.A. - TRANSPETRO of its Oil Pipelines and Terminals Standardization Program (PRONOT) within the scope of the 'Integrated Management System' (IMS). This program, launched in 2006 in the regions where the company operates, aims at standardizing all of its oil pipeline and terminal operations. Its implementation was planned in two phases: the first, already successfully concluded, refers to pipeline operations, industrial maintenance and right-of-way activities management; and the second, initiated in 2009, encompasses cross-sectional activities including health, safety and environment (HSE); training and development of oil pipeline workforce; communication with stake holders; oil pipeline integrity; and engineering project requirements. The documental structures of TRANSPETRO IMS and PRONOT are described and represented graphically to emphasize the intentional alignment of the standardization process carried out by the Oil Pipelines and Terminals Unit to the corporate IMS, based upon national and international literature review and through practical research focusing on the best international practices. (author)

  17. Predictive Ability from ePortfolios of Student Achievement Associated with Professional Teaching Standards: An Exploratory Case Study

    Science.gov (United States)

    Payne, Phillip; Burrack, Frederick

    2017-01-01

    This exploratory case study, focused on a music teacher preparation program, examined the coursework ePortfolios of pre-service music teachers to determine if any parts of the ePortfolio process predicted teaching effectiveness in the classroom during the student teaching semester. Sixty-five undergraduate pre-service music teachers made up the…

  18. 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.

  19. 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.

  20. 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

  1. New JLS-Factor Model versus the Standard JLS Model: A Case Study on Chinese Stock Bubbles

    Directory of Open Access Journals (Sweden)

    Zongyi Hu

    2017-01-01

    Full Text Available In this paper, we extend the Johansen-Ledoit-Sornette (JLS model by introducing fundamental economic factors in China (including the interest rate and deposit reserve rate and the historical volatilities of targeted and US equity indices into the original model, which is a flexible tool to detect bubbles and predict regime changes in financial markets. We then derive a general method to incorporate these selected factors in addition to the log-periodic power law signature of herding and compare the prediction accuracy of the critical time between the original and the new JLS models (termed the JLS-factor model by applying these two models to fit two well-known Chinese stock indices in three bubble periods. The results show that the JLS-factor model with Chinese characteristics successfully depicts the evolutions of bubbles and “antibubbles” and constructs efficient end-of-bubble signals for all bubbles in Chinese stock markets. In addition, the results of standard statistical tests demonstrate the excellent explanatory power of these additive factors and confirm that the new JLS model provides useful improvements over the standard JLS model.

  2. The impact of case definition on attention-deficit/hyperactivity disorder prevalence estimates in community-based samples of school-aged children.

    Science.gov (United States)

    McKeown, Robert E; Holbrook, Joseph R; Danielson, Melissa L; Cuffe, Steven P; Wolraich, Mark L; Visser, Susanna N

    2015-01-01

    To determine the impact of varying attention-deficit/hyperactivity disorder (ADHD) diagnostic criteria, including new DSM-5 criteria, on prevalence estimates. Parent and teacher reports identified high- and low-screen children with ADHD from elementary schools in 2 states that produced a diverse overall sample. The parent interview stage included the Diagnostic Interview Schedule for Children-IV (DISC-IV), and up to 4 additional follow-up interviews. Weighted prevalence estimates, accounting for complex sampling, quantified the impact of varying ADHD criteria using baseline and the final follow-up interview data. At baseline 1,060 caregivers were interviewed; 656 had at least 1 follow-up interview. Teachers and parents reported 6 or more ADHD symptoms for 20.5% (95% CI = 18.1%-23.2%) and 29.8% (CI = 24.5%-35.6%) of children respectively, with criteria for impairment and onset by age 7 years (DSM-IV) reducing these proportions to 16.3% (CI = 14.7%-18.0%) and 17.5% (CI = 13.3%-22.8%); requiring at least 4 teacher-reported symptoms reduced the parent-reported prevalence to 8.9% (CI = 7.4%-10.6%). Revising age of onset to 12 years per DSM-5 increased the 8.9% estimate to 11.3% (CI = 9.5%-13.3%), with a similar increase seen at follow-up: 8.2% with age 7 onset (CI = 5.9%-11.2%) versus 13.0% (CI = 7.6%-21.4%) with onset by age 12. Reducing the number of symptoms required for those aged 17 and older increased the overall estimate to 13.1% (CI = 7.7%-21.5%). These findings quantify the impact on prevalence estimates of varying case definition criteria for ADHD. Further research of impairment ratings and data from multiple informants is required to better inform clinicians conducting diagnostic assessments. DSM-5 changes in age of onset and number of symptoms required for older adolescents appear to increase prevalence estimates, although the full impact is uncertain due to the age of our sample. Published by Elsevier Inc.

  3. Development of standardized bioassay protocols for the toxicity assessment of waste, manufactured products, and effluents in Latin America: Venezuela, a Case Study

    International Nuclear Information System (INIS)

    Rodriquez-Grau, J.

    1993-01-01

    The present status of the toxicity assessment of industrial products in Latin America is well below North America/EC standards. As an example, most of Latin America regulatory laws regarding effluent discharge are still based upon concentration limits of certain major pollutants, and BOD/COD measurements; no reference is made to the necessity of aquatic bioassay toxicity data. Aware of this imperative need, the Venezuelan Petroleum Industry (PDVSA), through its R ampersand D Corporative branch (INTEVEP) gave priority to the development of standardized acute/sublethal toxicity test protocols as sound means of evaluating their products and wastes. Throughout this presentation, the Venezuelan case will be studied, showing strategies undertaken to accelerate protocol development. Results will show the assessment of 14 different protocols encompassing a variety of species of aquatic/terrestrial organisms, and a series of toxicity test endpoints including mortality, reproductive, biological and immunological measurements, most of which are currently in use or being developed. These protocols have already yielded useful results in numerous cases where toxicity assessment was required, including evaluations of effluent, oil dispersants, drilling fluids, toxic wastes, fossil fuels and newly developed products. The Venezuelan case demonstrates that the integration of Industry, Academia and Government, which is an essential part of SETAC's philosophy, is absolutely necessary for the successful advancement of environmental scientific/regulatory issues

  4. Nearly Zero Energy Standard for Non-Residential Buildings with high Energy Demands—An Empirical Case Study Using the State-Related Properties of BAVARIA

    Directory of Open Access Journals (Sweden)

    Michael Keltsch

    2017-03-01

    Full Text Available The Energy Performance of Buildings Directive (EPBD 2010 calls for the Nearly Zero Energy Building (nZEB Standard for new buildings from 2021 onwards: Buildings using “almost no energy” are powered by renewable sources or by the energy produced by the building itself. For residential buildings, this ambitious new standard has already been reached. But for other building types, this goal is still far away. The potential of these buildings to meet a nZEB Standard was investigated by analyzing ten case studies, representing non-residential buildings with different uses. The analysis shows that the primary characteristics common to critical building types are a dense building context with a very high degree of technical installation (such as hospital, research, and laboratory buildings. The large primary energy demand of these types of buildings cannot be compensated by building- and property-related energy generation, including off-site renewables. If the future nZEB Standard were to be defined with lower requirements because of this, the state-related properties of Bavaria suggest that the real potential energy savings available in at least 85% of all new buildings would be insufficiently exploited. Therefore, it would be more useful to individualize the legal energy verification process for new buildings, to distinguish critical building types such as laboratories and hospitals from the other building types.

  5. Analysis the Appropriate using Standard Costing Applying in Land Cost Component of Real Estate Development Activities: A Case Study of PT Subur Agung

    Directory of Open Access Journals (Sweden)

    Elfrida Yanti

    2011-05-01

    Full Text Available Standard cost is generally used by manufacturing business, which direct material, labor, and factory overhead are cleared allocated. On real estate business in this case PT Subur Agung use standard cost based on three costs, raw land, land improvement and interest expense categories instead of direct material, direct labor and overhead. Developer use these cost to predict the project cost and estimate the pre-selling price, in accordance with the cost estimation classification matrix, the variance range is in the expected accuracy rate by testing the variance percentage between standard cost and actual cost. The additional similar projects in PT Subur Agung also follow the same scope. All these evidences have proved the appropriate using standard costing in land cost component of real estate development activities but how it applies this article will analyze in this particular project with using descriptive and exploratory method. The analysis started by knowing the conceptual situation of PT Subur Agung and the data was presented in tables and calculation with detail explanation. 

  6. On the effects of emission standards as a non-tariff barrier to trade in the case of a foreign Bertrand duopoly: A note

    International Nuclear Information System (INIS)

    Toshimitsu, Tsuyoshi

    2008-01-01

    Employing a model of an environmentally differentiated product market, we analyze how an emission regulation as non-tariff barriers to trade affects imports, the environment, and welfare in the case of a foreign Bertrand duopoly. Related to this issue, we reconsider the result of Moraga-Gonzalez and Padron-Fumero [Moraga-Gonzalez, J.L., Padron-Fumero, N., 2002. Environmental policy in a green market. Environmental and Resource Economics 22, 419-447] that a strict emission standard on a dirtier product degrades the environment and reduces the net social surplus associated with the valuation of environmental damage, if the marginal social valuation of environmental damage is larger. On the other hand, we show that a strict emission standard on a cleaner product always improves the environment and the net social surplus associated with the valuation of environmental damage. (author)

  7. Field Performance versus Standard Test Condition Efficiency of Tandem Solar Cells and the Specific Case of Perovskites/Silicon Devices

    KAUST Repository

    Dupre, Olivier

    2018-01-05

    Multijunction cells may offer a cost-effective route to boost the efficiency of industrial photovoltaics. For any technology to be deployed in the field, its performance under actual operating conditions is extremely important. In this perspective, we evaluate the impact of spectrum, light intensity, and module temperature variations on the efficiency of tandem devices with crystalline silicon bottom cells with a particular focus on perovskite top cells. We consider devices with different efficiencies and calculate their energy yields using field data from Denver. We find that annual losses due to differences between operating conditions and standard test conditions are similar for single-junction and four-terminal tandem devices. The additional loss for the two-terminal tandem configuration caused by current mismatch reduces its performance ratio by only 1.7% when an optimal top cell bandgap is used. Additionally, the unusual bandgap temperature dependence of perovskites is shown to have a positive, compensating effect on current mismatch.

  8. Design of standard operating procedure production proceses (case study on the home industry Bedugul Baturiti Tabanan Bali)

    Science.gov (United States)

    Kasiani; Suhantono, Djoko; Mirah Kencanawati, AAA

    2018-01-01

    Candikuning is part of the district of Baturiti, tourism village, better known by the name of Bedugul. No less interesting is the variety of chips produced by two partner groups as a souvenir after the tour, such as Chips: Spinach; beans; Tempeh. The purpose of this research were to design a Standard Operating Procedure (SOP): Production Processes on the Home Industry Bedugul Baturiti Tabanan Bali. The data technic collected use: observation; Documentation; and then interview to collect information. The data analysis technic done by using the Miles & Huberman. Result this research that the draft SOP: Production Processes Chips (Menu). The conclusion in this research SOP Production Processes use with flowchart and description on the Home Industry Bedugul Baturiti Tabanan Bali.

  9. 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)

  10. Use of MODIS Terra Imagery to Estimate Surface Water Quality Standards, Using Lake Thonotosassa, Florida, as a Case Study

    Science.gov (United States)

    Moreno, Max J.; Al-Hamdan, Mohammad Z.; Estes, Maurice G., Jr.; Rickman, Douglas L.

    2010-01-01

    Lake Thonotosassa is a highly eutrophied lake located in an area with rapidly growing population in the Tampa Bay watershed, Florida. The Florida Administrative Code has designated its use for "recreation, propagation and maintenance of a healthy, well-balanced population of fish and wildlife." Although this lake has been the subject of efforts to improve water quality since 1970, overall water quality has remained below the acceptable state standards, and has a high concentration of nutrients. This condition is of great concern to public health since it has favored episodic blooms of Cyanobacteria. Some Cyanobacterial species release toxins that can reach humans through drinking water, fish consumption, and direct contact with contaminated water. The lake has been historically popular for fishing and water sports, and its overflow water drains into the Hillsborough River, the main supply of municipal water for the City of Tampa, this explains why it has being constantly monitored in situ for water quality by the Environmental Protection Commission of Hillsborough County (EPC). Advances in remote sensing technology, however, open the possibility of facilitating similar types of monitoring in this and similar lakes, further contributing to the implementation of surveillance systems that would benefit not just public health, but also tourism and ecosystems. Although traditional application of this technology to water quality has been focused on much larger coastal water bodies like bays and estuaries, this study evaluates the feasibility of its application on a 46.6 km2 freshwater lake. Using surface reflectance products from Moderate-Resolution Imaging Spectroradiometer (MODIS) Terra, this study evaluates associations between remotely sensed data and in situ data from the EPC. The parameters analyzed are the surface water quality standards used by the State of Florida and general indicators of trophic status.

  11. 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)

  12. Addition of PM2.5 into the National Ambient Air Quality Standards of China and the Contribution to Air Pollution Control: The Case Study of Wuhan, China

    Science.gov (United States)

    You, Mingqing

    2014-01-01

    PM2.5 has gradually become a major environmental problem of China with its rapid economic development, urbanization, and increasing of motor vehicles. Findings and awareness of serious PM2.5 pollution make the PM2.5 a new criterion pollutant of the Chinese National Ambient Air Quality Standard (NAAQS) revised in 2012. The 2012 NAAQS sets the PM2.5 concentrate limitation with the 24-hour average value and the annual mean value. Wuhan is quite typical among central and southern China in climate, economy, development level, and energy consumption. The data are cited from the official website of Wuhan Environmental Protection Bureau and cover the period from 1 January to 30 June 2013. The data definitely confirm the existence of serious PM2.5 pollution in Wuhan and indicate that the addition of PM2.5 as a criterion pollutant significantly brings down the attainment rate of air quality. The example of Wuhan reveals that local governments should take measures to reduce the emission of PM2.5 if it affects the attainment rate and the performance evaluation value of air quality. The main contribution of 2012 NAAQS is that it brings down the attainment rate of the air quality and forces local governmental officials to take the measures accordingly. PMID:24982994

  13. Application of best practice for setting minimum energy efficiency standards in technically disadvantaged countries: Case study of Air Conditioners in Brunei Darussalam

    International Nuclear Information System (INIS)

    Shi, Xunpeng

    2015-01-01

    Highlights: • Setting MEPS requires significant data, financial resources and technical capacity. • Application of best practice in technical disadvantaged countries (TDCs) was demonstrated. • Best practice was successfully applied to Brunei for its AC MEPS. • For Brunei, COP at 2.9 is recommended and 15% efficiency improvement is achievable. • The methodology is applicable to other appliances in any TDCs. - Abstract: Application of the best practice of setting minimum energy performance standards (MEPS) in technically disadvantaged countries (TDCs) faces many barriers. The best practice of determining MEPS has a comprehensive analytical framework including engineering-economic analysis, life-cycle cost-benefit analysis, as well stakeholders’ and market impact assessments. However, TDCs usually are lack of reference product classes, market data, and other necessary inputs data. This study demonstrated how to overcome those barriers to apply the best practice to TDCs using the actual experience in setting initial MEPS for Air Conditioners (ACs) in Brunei from scratch with limited secondary data as an example. The series of application works include definition of the product classes and the baseline group; collection of market data; formulation of cost-efficiency relationship from the market data; examination of the economic, environmental, and financial impacts of various MEPS options; revealing of the consumers’ willingness to pay; and analysis of the impacts and responses from the industry and consumers. The coordination with the compliance of the Montreal Protocol was also considered. The methodology should also be applicable to setting MEPF for other appliances in any TDCs.

  14. Addition of PM 2.5 into the national ambient air quality standards of China and the contribution to air pollution control: the case study of Wuhan, China.

    Science.gov (United States)

    You, Mingqing

    2014-01-01

    PM2.5 has gradually become a major environmental problem of China with its rapid economic development, urbanization, and increasing of motor vehicles. Findings and awareness of serious PM2.5 pollution make the PM2.5 a new criterion pollutant of the Chinese National Ambient Air Quality Standard (NAAQS) revised in 2012. The 2012 NAAQS sets the PM2.5 concentrate limitation with the 24-hour average value and the annual mean value. Wuhan is quite typical among central and southern China in climate, economy, development level, and energy consumption. The data are cited from the official website of Wuhan Environmental Protection Bureau and cover the period from 1 January to 30 June 2013. The data definitely confirm the existence of serious PM2.5 pollution in Wuhan and indicate that the addition of PM2.5 as a criterion pollutant significantly brings down the attainment rate of air quality. The example of Wuhan reveals that local governments should take measures to reduce the emission of PM2.5 if it affects the attainment rate and the performance evaluation value of air quality. The main contribution of 2012 NAAQS is that it brings down the attainment rate of the air quality and forces local governmental officials to take the measures accordingly.

  15. Addition of PM2.5 into the National Ambient Air Quality Standards of China and the Contribution to Air Pollution Control: The Case Study of Wuhan, China

    Directory of Open Access Journals (Sweden)

    Mingqing You

    2014-01-01

    Full Text Available PM2.5 has gradually become a major environmental problem of China with its rapid economic development, urbanization, and increasing of motor vehicles. Findings and awareness of serious PM2.5 pollution make the PM2.5 a new criterion pollutant of the Chinese National Ambient Air Quality Standard (NAAQS revised in 2012. The 2012 NAAQS sets the PM2.5 concentrate limitation with the 24-hour average value and the annual mean value. Wuhan is quite typical among central and southern China in climate, economy, development level, and energy consumption. The data are cited from the official website of Wuhan Environmental Protection Bureau and cover the period from 1 January to 30 June 2013. The data definitely confirm the existence of serious PM2.5 pollution in Wuhan and indicate that the addition of PM2.5 as a criterion pollutant significantly brings down the attainment rate of air quality. The example of Wuhan reveals that local governments should take measures to reduce the emission of PM2.5 if it affects the attainment rate and the performance evaluation value of air quality. The main contribution of 2012 NAAQS is that it brings down the attainment rate of the air quality and forces local governmental officials to take the measures accordingly.

  16. 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.

  17. Reconceptualising the Standard of Care in Sport: The Case of Youth Rugby in England and South Africa

    Directory of Open Access Journals (Sweden)

    Steve Greenfield

    2015-12-01

    Full Text Available Sport is an important area of civil society in both South Africa and England, and this article is broadly concerned with the relationship between sport and personal injury. More specifically, the article compares how rugby is regulated by the tort of negligence in England and delict in South Africa respectively. Regarding liability, for sport there are very specific factors that need to be taken into account. The article is concerned with, firstly, the broader context of sport as an important social and cultural activity, and secondly the specific sporting context that includes the rules of the game as well as the playing culture, with a focus on rugby at junior level. Through a critical and comparative analysis of how the standards of care in sport have been developed in both jurisdictions, the aim of this article is to consider how sport specific elements can be incorporated into the traditional legal principles. This comparative analysis contextualises the various discussions in the light of the differences between the English tort of negligence and the South African law of delict. Our argument is that the context and specificity of rugby should be more explicitly taken into account when evaluating potential liability. To establish a standard of care for sport is complex, with many factors to be taken into account and balanced against one another. The law of negligence/delict therefore needs to be adaptable and flexible to resolve new situations where injuries have occurred. Even in established situations where liability has been previously determined, novel events do occur and knowledge develops that requires a reconsideration of the principles that govern liability. In junior rugby, the risk of very serious injuries is relatively small and the law needs to tread a cautious path through liability, ensuring it is a vehicle that promotes sport rather than creating barriers to its enjoyment and practice. A greater understanding of sport

  18. Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

    Science.gov (United States)

    Meyer-Rath, Gesine; van Rensburg, Craig; Larson, Bruce; Jamieson, Lise; Rosen, Sydney

    2017-01-01

    The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country's committed HIV budget. We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016-2018. We calculated the incremental cost-effectiveness ratio (ICER) as cost per life-year saved (LYS) of 16 HIV prevention and treatment interventions over 20 years (2016-2035). We iteratively evaluated the most cost effective option (defined by an intervention and its coverage) over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD. The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS. The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547-872 per life year saved, a small fraction of the country's GDP per capita of

  19. Case Study: Nutritional and Lifestyle Support to Reduce Infection Incidence in an International-Standard Premier League Soccer Player.

    Science.gov (United States)

    Ranchordas, Mayur K; Bannock, Laurent; Robinson, Scott L

    2016-04-01

    Professional soccer players are exposed to large amounts of physiological and psychological stress, which can increase infection risk and threaten availability for training and competition. Accordingly, it is important for practitioners to implement strategies that support player well-being and prevent illness. This case study demonstrates how a scientifically supported and practically applicable nutrition and lifestyle strategy can reduce infection incidence in an illness-prone professional soccer player. In the 3 months before the intervention, the player had 3 upper-respiratory tract infections (URTIs) and subsequently missed 3 competitive matches and 2 weeks' training. He routinely commenced morning training sessions in the fasted state and was estimated to be in a large daily energy deficit. Throughout the 12-week intervention, the amount, composition, and timing of energy intake was altered, quercetin and vitamin D were supplemented, and the player was provided with a daily sleep and hygiene protocol. There was a positive increase in serum vitamin D 25(OH) concentration from baseline to Week 12 (53 n·mol-1 to 120 n·mol-1) and salivary immunoglobulin-A (98 mg·dl-1 to 135 mg·dl-1), as well as a decline in the number of URTI symptoms (1.8 ± 2.0 vs. 0.25 ± 0.5 for Weeks 0-4 and Weeks 8-12, respectively). More important, he maintained availability for all training and matches over the 12-week period. We offer this case study as a real-world applied example for other players and practitioners seeking to deploy nutrition and lifestyle strategies to reduce risk of illness and maximize player availability.

  20. Factors Influencing Academic Performance Of Standard Eight Girls In National Examinations In Public Primary Schools A Case Of Matungu Division.

    Directory of Open Access Journals (Sweden)

    Oparanya Wamukoya Windrick

    2015-06-01

    Full Text Available ABSTARCT This study is designed to establish the factors influencing academic of standard eight girls in public primary schools in National exams in Matungu division. The researcher aimed at finding out why there is increased low performance of girls in public schools despite the fact that they are assessed through periodic performance tests do continuous assessment tests CATS midterm carry out tuition and the provision of free primary education which is aimed at improving academic performance. This study adapted a descriptive survey design as a major method of research where data was collected by the researcher members of a population under study. The target population comprised of Head teachers teachers pupils parents and parent schools representatives. Purposive sampling and simple random technique were used. Data was collected by use of questionnaires and interview guides. Data was analyzed by use of descriptive statistics constituting frequencies and percentages.The study established that girls were exposed to harsh school environmental conditions they walked long distances to school schools lacked facilities like toilets libraries and were exposed to male pest teachers. There were also teacher factors like training teacher shortage and motivation that affected girls performance.The study came up with recommendations for improvement of girls academic performance. More public schools should be build to reduce on distance and also overpopulation. The ministry of Education should monitor and evaluate the academic performance of girls in rural areas. The government should put up strict rules on pest teachers. The ministry should hire more teachers.

  1. Web technology to support work processes in energy policy research - A case study with energy efficiency standards

    International Nuclear Information System (INIS)

    Benenson, Peter; McMahon, James E.; Brown, Stephen R.

    2002-01-01

    This paper focuses on a process to design and build a web-based system to assist staff in day-to-day management and contemporaneous documentation of their work. Other groups that want to use web technology to support their work could apply the approach presented here, but the design itself pertains to a particular set of issues in a unique context. Each user must apply the approach to identify their objectives and design a site to meet them. The main question that the Energy Efficiency Standards Group addressed was: ''How can we facilitate documentation of interim results and final products while conducting a complex, interdependent set of analyses by multiple authors under time pressures for delivering a final product?'' The approach to address this question includes categorization of the components of the work, discussions with staff, development of infrastructure support for documentation, implementation of the documentation process and integration with the workflow, and follow- up with staff. The search for a solution raised a number of issues such as the need for a thorough understanding of the work, consensus building by inclusion of key staff, and deliverable scheduling to allow for contemporaneous documentation. Documentation results vary among the product analyses, from extensive internal and external use to much slower adoption. Complaints include the length of the input forms and pressure from clients to deliver results. But with repeated demand for interim output, the need for thorough contemporaneous documentation still remains. Accordingly, as problems arise there is continued commitment among the staff to address them

  2. Building America Case Study: Standard- Versus High-Velocity Air Distribution in High-Performance Townhomes, Denver, Colorado

    Energy Technology Data Exchange (ETDEWEB)

    2017-06-09

    IBACOS investigated the performance of a small-diameter high velocity heat pump system compared to a conventional system in a new construction triplex townhouse. A ductless heat pump system also was installed for comparison, but the homebuyer backed out because of aesthetic concerns about that system. In total, two buildings, having identical solar orientation and comprised of six townhomes, were monitored for comfort and energy performance. Results show that the small-diameter system provides more uniform temperatures from floor to floor in the three-story townhome. No clear energy consumption benefit was observed from either system. The builder is continuing to explore the small-diameter system as its new standard system to provide better comfort and indoor air quality. The homebuilder also explored the possibility of shifting its townhome product to meet the U.S. Department of Energy Challenge Home National Program Requirements. Ultimately, the builder decided that adoption of these practices would be too disruptive midstream in the construction cycle. However, the townhomes met the ENERGY STAR Version 3.0 program requirements.

  3. Involving stakeholders in policy research should not imply that they control the problem definition: lessons from a case study on new analgesics

    NARCIS (Netherlands)

    Moret-Hartman, M.; van der Wilt, G.J.; Grin, J.

    2009-01-01

    The Dutch Health Care Insurance Board (HCIB) commissions research to guide their policy recommendations. However, the studies conducted do not always yield relevant information. This may result from differences in problem definitions held by the HCIB and target populations. To compensate these

  4. Can adaptive threshold-based metabolic tumor volume (MTV) and lean body mass corrected standard uptake value (SUL) predict prognosis in head and neck cancer patients treated with definitive radiotherapy/chemoradiotherapy?

    Science.gov (United States)

    Akagunduz, Ozlem Ozkaya; Savas, Recep; Yalman, Deniz; Kocacelebi, Kenan; Esassolak, Mustafa

    2015-11-01

    To evaluate the predictive value of adaptive threshold-based metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax) and maximum lean body mass corrected SUV (SULmax) measured on pretreatment positron emission tomography and computed tomography (PET/CT) imaging in head and neck cancer patients treated with definitive radiotherapy/chemoradiotherapy. Pretreatment PET/CT of the 62 patients with locally advanced head and neck cancer who were treated consecutively between May 2010 and February 2013 were reviewed retrospectively. The maximum FDG uptake of the primary tumor was defined according to SUVmax and SULmax. Multiple threshold levels between 60% and 10% of the SUVmax and SULmax were tested with intervals of 5% to 10% in order to define the most suitable threshold value for the metabolic activity of each patient's tumor (adaptive threshold). MTV was calculated according to this value. We evaluated the relationship of mean values of MTV, SUVmax and SULmax with treatment response, local recurrence, distant metastasis and disease-related death. Receiver-operating characteristic (ROC) curve analysis was done to obtain optimal predictive cut-off values for MTV and SULmax which were found to have a predictive value. Local recurrence-free (LRFS), disease-free (DFS) and overall survival (OS) were examined according to these cut-offs. Forty six patients had complete response, 15 had partial response, and 1 had stable disease 6 weeks after the completion of treatment. Median follow-up of the entire cohort was 18 months. Of 46 complete responders 10 had local recurrence, and of 16 partial or no responders 10 had local progression. Eighteen patients died. Adaptive threshold-based MTV had significant predictive value for treatment response (p=0.011), local recurrence/progression (p=0.050), and disease-related death (p=0.024). SULmax had a predictive value for local recurrence/progression (p=0.030). ROC curves analysis revealed a cut-off value of 14.00 mL for

  5. Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

    Science.gov (United States)

    Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

    2016-01-01

    Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

  6. Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

    Science.gov (United States)

    Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

    2017-04-01

    2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health

  7. Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

    Directory of Open Access Journals (Sweden)

    Gesine Meyer-Rath

    Full Text Available The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment <