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Sample records for acr appropriateness criteria

  1. ACR Appropriateness Criteria Myelopathy.

    PubMed

    Roth, Christopher J; Angevine, Peter D; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fries, Ian Blair; Holly, Langston T; Kendi, Ayse Tuba Karaqulle; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; O'Toole, John E; Sharma, Aseem; Shetty, Vilaas S; West, O Clark; Cornelius, Rebecca S; Bykowski, Julie

    2016-01-01

    Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26653797

  2. ACR Appropriateness Criteria Crohn Disease.

    PubMed

    Kim, David H; Carucci, Laura R; Baker, Mark E; Cash, Brooks D; Dillman, Jonathan R; Feig, Barry W; Fowler, Kathryn J; Gage, Kenneth L; Noto, Richard B; Smith, Martin P; Yaghmai, Vahid; Yee, Judy; Lalani, Tasneem

    2015-10-01

    Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26435118

  3. ACR Appropriateness Criteria Head Trauma.

    PubMed

    Shetty, Vilaas S; Reis, Martin N; Aulino, Joseph M; Berger, Kevin L; Broder, Joshua; Choudhri, Asim F; Kendi, A Tuba; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; Prall, J Adair; Raksin, Patricia B; Roth, Christopher J; Sharma, Aseem; West, O Clark; Wintermark, Max; Cornelius, Rebecca S; Bykowski, Julie

    2016-06-01

    Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27262056

  4. ACR appropriateness criteria on metastatic bone disease.

    PubMed

    Roberts, Catherine C; Daffner, Richard H; Weissman, Barbara N; Bancroft, Laura; Bennett, D Lee; Blebea, Judy S; Bruno, Michael A; Fries, Ian Blair; Germano, Isabelle M; Holly, Langston; Jacobson, Jon A; Luchs, Jonathan S; Morrison, William B; Olson, Jeffrey J; Payne, William K; Resnik, Charles S; Schweitzer, Mark E; Seeger, Leanne L; Taljanovic, Mihra; Wise, James N; Lutz, Stephen T

    2010-06-01

    Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology. PMID:20522392

  5. ACR Appropriateness Criteria Breast Cancer Screening.

    PubMed

    Mainiero, Martha B; Lourenco, Ana; Mahoney, Mary C; Newell, Mary S; Bailey, Lisa; Barke, Lora D; D'Orsi, Carl; Harvey, Jennifer A; Hayes, Mary K; Huynh, Phan Tuong; Jokich, Peter M; Lee, Su-Ju; Lehman, Constance D; Mankoff, David A; Nepute, Joshua A; Patel, Samir B; Reynolds, Handel E; Sutherland, M Linda; Haffty, Bruce G

    2013-01-01

    Mammography is the recommended method for breast cancer screening of women in the general population. However, mammography alone does not perform as well as mammography plus supplemental screening in high-risk women. Therefore, supplemental screening with MRI or ultrasound is recommended in selected high-risk populations. Screening breast MRI is recommended in women at high risk for breast cancer on the basis of family history or genetic predisposition. Ultrasound is an option for those high-risk women who cannot undergo MRI. Recent literature also supports the use of breast MRI in some women of intermediate risk, and ultrasound may be an option for intermediate-risk women with dense breasts. There is insufficient evidence to support the use of other imaging modalities, such as thermography, breast-specific gamma imaging, positron emission mammography, and optical imaging, for breast cancer screening. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23290667

  6. ACR Appropriateness Criteria Renal Cell Carcinoma Staging.

    PubMed

    Vikram, Raghunandan; Beland, Michael D; Blaufox, M Donald; Moreno, Courtney Coursey; Gore, John L; Harvin, Howard J; Heilbrun, Marta E; Liauw, Stanley L; Nguyen, Paul L; Nikolaidis, Paul; Preminger, Glenn M; Purysko, Andrei S; Raman, Steven S; Taffel, Myles T; Wang, Zhen J; Weinfeld, Robert M; Remer, Erick M; Lockhart, Mark E

    2016-05-01

    Renal cell carcinoma accounts for 2%-3% of all visceral malignancies. Preoperative imaging can provide important staging and anatomic information to guide treatment decisions. Size of the primary tumor and degree of local invasion, such as involvement of perinephric fat or renal sinus fat, and tumor thrombus in renal veins and inferior vena cava are important detriments to local staging of primary tumor. Both kidneys are assessed for presence of other synchronous lesions. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27016804

  7. ACR Appropriateness Criteria Osteonecrosis of the Hip.

    PubMed

    Murphey, Mark D; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Chang, Eric Y; Dempsey, Molly E; Fox, Michael G; Fries, Ian Blair; Greenspan, Bennett S; Hochman, Mary G; Jacobson, Jon A; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Rubin, David A; Small, Kirstin M; Weissman, Barbara N

    2016-02-01

    Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26846390

  8. ACR appropriateness Criteria® infertility.

    PubMed

    Wall, Darci J; Javitt, Marcia C; Glanc, Phyllis; Bhosale, Priyadarshani R; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Nyberg, David A; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2015-03-01

    Appropriate imaging for women undergoing infertility workup depends upon the clinician's suspicion for potential causes of infertility. Transvaginal US is the preferred modality to assess the ovaries for features of polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility. For women who have a history or clinical suspicion of endometriosis, which affects at least one third of women with infertility, both MRI and pelvic US can provide valuable information. If tubal occlusion is suspected, whether due to endometriosis, previous pelvic inflammatory disease, or other cause, hysterosalpingogram (HSG) is the preferred method of evaluation. To assess for anatomic causes of recurrent pregnancy loss (RPL) such as Müllerian anomalies, synechiae, and leiomyomas, saline infusion sonohysterography, MRI and 3-D US are most appropriate. Up to 10% of women suffering recurrent pregnancy loss have a congenital Müllerian anomaly. When assessment of the pituitary gland is indicated, MRI is the imaging exam of choice.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:25706363

  9. ACR Appropriateness Criteria Review ACR Appropriateness Criteria® Occupational Lung Diseases.

    PubMed

    Bacchus, Leon; Shah, Rakesh D; Chung, Jonathan H; Crabtree, Traves P; Heitkamp, Darel E; Iannettoni, Mark D; Johnson, Geoffrey B; Jokerst, Clinton; McComb, Barbara L; Saleh, Anthony G; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

    2016-01-01

    Occupational lung disease is a category of disease entities characterized by a reaction of the lung parenchyma to inhaled aerosolized particles found in the environment. This document summarizes the imaging appropriateness data for silicosis, coal worker pneumoconiosis, and asbestosis. The main points of the document are that computed tomography is more sensitive than radiography, computed tomography without contrast generally suffices for evaluation, and fluorodeoxyglucose-positron emission tomography may have utility in patients with mesothelioma. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26656194

  10. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation.

    PubMed

    Hanley, Michael; Ahmed, Osmanuddin; Chandra, Ankur; Gage, Kenneth L; Gerhard-Herman, Marie D; Ginsburg, Michael; Gornik, Heather L; Johnson, Pamela T; Oliva, Isabel B; Ptak, Thomas; Steigner, Michael L; Strax, Richard; Rybicki, Frank J; Dill, Karin E

    2016-07-01

    Pulmonary arteriovenous malformations are often included in the differential diagnosis of common clinical presentations, including hypoxemia, hemoptysis, brain abscesses, and paradoxical stroke, as well as affecting 30% to 50% of patients with hereditary hemorrhagic telangiectasia (HHT). Various imaging studies are used in the diagnostic and screening settings, which have been reviewed by the ACR Appropriateness Criteria Vascular Imaging Panel. Pulmonary arteriovenous malformation screening in patients with HHT is commonly performed with transthoracic echocardiographic bubble study, followed by CT for positive cases. Although transthoracic echocardiographic bubble studies and radionuclide perfusion detect right-to-left shunts, they do not provide all of the information needed for treatment planning and may remain positive after embolization. Pulmonary angiography is appropriate for preintervention planning but not as an initial test. MR angiography has a potential role in younger patients with HHT who may require lifelong surveillance, despite lower spatial resolution compared with CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27209598

  11. ACR Appropriateness Criteria Acute Trauma to the Foot.

    PubMed

    Bancroft, Laura W; Kransdorf, Mark J; Adler, Ronald; Appel, Marc; Beaman, Francesca D; Bernard, Stephanie A; Bruno, Michael A; Dempsey, Molly E; Fries, Ian B; Khoury, Viviane; Khurana, Bharti; Mosher, Timothy J; Roberts, Catherine C; Tuite, Michael J; Ward, Robert J; Zoga, Adam C; Weissman, Barbara N

    2015-06-01

    This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can directly evaluate the capsuloligamentous complex, specifically the plantar plate. Radiography can detect radiopaque penetrating foreign bodies, and ultrasound can be helpful in detecting those that are nonradiopaque. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging and treatment. PMID:25935824

  12. ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy.

    PubMed

    Kouri, Brian E; Abrams, Ross A; Al-Refaie, Waddah B; Azad, Nilofer; Farrell, James; Gaba, Ron C; Gervais, Debra A; Gipson, Matthew G; Kolbeck, Kenneth J; Marshalleck, Francis E; Pinchot, Jason W; Small, William; Ray, Charles E; Hohenwalter, Eric J

    2016-03-01

    Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26944037

  13. ACR Appropriateness Criteria Low Back Pain.

    PubMed

    Patel, Nandini D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Fries, Ian Blair; Harvey, H Benjamin; Holly, Langston; Hunt, Christopher H; Jagadeesan, Bharathi D; Kennedy, Tabassum A; O'Toole, John E; Perlmutter, Joel S; Policeni, Bruno; Rosenow, Joshua M; Schroeder, Jason W; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S

    2016-09-01

    Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. PMID:27496288

  14. ACR appropriateness Criteria® second and third trimester bleeding.

    PubMed

    Podrasky, Ann E; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2013-12-01

    Vaginal bleeding occurring in the second or third trimesters of pregnancy can variably affect perinatal outcome, depending on whether it is minor (i.e. a single, mild episode) or major (heavy bleeding or multiple episodes.) Ultrasound is used to evaluate these patients. Sonographic findings may range from marginal subchorionic hematoma to placental abruption. Abnormal placentations such as placenta previa, placenta accreta and vasa previa require accurate diagnosis for clinical management. In cases of placenta accreta, magnetic resonance imaging is useful as an adjunct to ultrasound and is often appropriate for evaluation of the extent of placental invasiveness and potential involvement of adjacent structures. MRI is useful for preplanning for cases of complex delivery, which may necessitate a multi-disciplinary approach for optimal care.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24263752

  15. ACR Appropriateness Criteria® Intensive Care Unit Patients.

    PubMed

    Suh, Robert D; Genshaft, Scott J; Kirsch, Jacobo; Kanne, Jeffrey P; Chung, Jonathan H; Donnelly, Edwin F; Ginsburg, Mark E; Heitkamp, Darel E; Henry, Travis S; Kazerooni, Ella A; Ketai, Loren H; McComb, Barbara L; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H

    2015-11-01

    Portable chest radiography is a fundamental and frequently utilized examination in the critically ill patient population. The chest radiograph often represents a timely investigation of new or rapidly evolving clinical findings and an evaluation of proper positioning of support tubes and catheters. Thoughtful consideration of the use of this simple yet valuable resource is crucial as medical cost containment becomes even more mandatory. This review addresses the role of chest radiography in the intensive care unit on the basis of the existing literature and as formed by a consensus of an expert panel on thoracic imaging through the American College of Radiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26439890

  16. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors.

    PubMed

    Roberts, Catherine C; Kransdorf, Mark J; Beaman, Francesca D; Adler, Ronald S; Amini, Behrang; Appel, Marc; Bernard, Stephanie A; Fries, Ian Blair; Germano, Isabelle M; Greenspan, Bennett S; Holly, Langston T; Kubicky, Charlotte D; Shek-Man Lo, Simon; Mosher, Timothy J; Sloan, Andrew E; Tuite, Michael J; Walker, Eric A; Ward, Robert J; Wessell, Daniel E; Weissman, Barbara N

    2016-04-01

    Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26922595

  17. ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease.

    PubMed

    Earls, James P; Woodard, Pamela K; Abbara, Suhny; Akers, Scott R; Araoz, Philip A; Cummings, Kristopher; Cury, Ricardo C; Dorbala, Sharmila; Hoffmann, Udo; Hsu, Joe Y; Jacobs, Jill E; Min, James K

    2014-01-01

    Atherosclerotic cardiovascular disease is the leading cause of death for both men and women in the United States. Coronary artery disease has a long asymptomatic latent period and early targeted preventive measures can reduce mortality and morbidity. It is important to accurately classify individuals at elevated risk in order to identify those who might benefit from early intervention. Imaging advances have made it possible to detect subclinical coronary atherosclerosis. Coronary artery calcium score correlates closely with overall atherosclerotic burden and provides useful prognostic information for patient management. Our purpose is to discuss use of diagnostic imaging in asymptomatic patients at elevated risk for future cardiovascular events. The goal for these patients is to further refine targeted preventative efforts based on risk. The following imaging modalities are available for evaluating asymptomatic patients at elevated risk: radiography, fluoroscopy, multidetector CT, ultrasound, MRI, cardiac perfusion scintigraphy, echocardiography, and PET. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24316232

  18. ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease.

    PubMed

    Woodard, Pamela K; White, Richard D; Abbara, Suhny; Araoz, Philip A; Cury, Ricardo C; Dorbala, Sharmila; Earls, James P; Hoffmann, Udo; Hsu, Joe Y; Jacobs, Jill E; Javidan-Nejad, Cylen; Krishnamurthy, Rajesh; Mammen, Leena; Martin, Edward T; Ryan, Thomas; Shah, Amar B; Steiner, Robert M; Vogel-Claussen, Jens; White, Charles S

    2013-05-01

    Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are etiologies of chronic noncardiac chest pain. Noncardiac chest pain is most commonly related to gastroesophageal reflux disease or other esophageal diseases. Alternatively, it may be related to costochondritis, arthritic or degenerative diseases, old trauma, primary or metastatic tumors, or pleural disease. Rarely, noncardiac chest pain may be referred pain from organ systems below the diaphragm, such as the gallbladder. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23542027

  19. ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease.

    PubMed

    Hoffmann, Udo; Akers, Scott R; Brown, Richard K J; Cummings, Kristopher W; Cury, Ricardo C; Greenberg, S Bruce; Ho, Vincent B; Hsu, Joe Y; Min, James K; Panchal, Kalpesh K; Stillman, Arthur E; Woodard, Pamela K; Jacobs, Jill E

    2015-12-01

    Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies. PMID:26653833

  20. ACR Appropriateness Criteria Fever Without Source or Unknown Origin-Child.

    PubMed

    Westra, Sjirk J; Karmazyn, Boaz K; Alazraki, Adina L; Dempsey, Molly E; Dillman, Jonathan R; Garber, Matthew; Moore, Sheila G; Raske, Molly E; Rice, Henry E; Rigsby, Cynthia K; Safdar, Nabile; Simoneaux, Stephen F; Strouse, Peter J; Trout, Andrew T; Wootton-Gorges, Sandra L; Coley, Brian D

    2016-08-01

    The cause of fever in a child can often be determined from history, physical examination, and laboratory tests; infections account for the majority of cases. Yet in 20%, no apparent cause can be found, designated as fever without source (FWS). The yield of chest radiography in children with FWS is low, and it is usually not appropriate. However, in children with respiratory signs, high fever (>39°C), or marked leukocytosis (≥20,000/mm(3)), chest radiography is usually appropriate, as it has a higher yield in detecting clinically occult pneumonia. In newborns with FWS, there is higher risk for serious bacterial infection, and the routine use of chest radiography is controversial. In children with neutropenia, fever is a major concern. In some clinical circumstances, such as after hematopoietic stem cell transplantation, chest CT scan may be appropriate even if the results of chest radiography are negative or nonspecific, as it has higher sensitivity and can demonstrate specific findings (such as lung nodule and "halo sign") that can guide management. In a child with prolonged fever of unknown origin despite extensive medical workup (fever of unknown origin), diagnosis is usually dependent on clinical and laboratory studies, and imaging tests have low yield. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or

  1. ACR Appropriateness Criteria® Hodgkin Lymphoma-Unfavorable Clinical Stage I and II.

    PubMed

    Roberts, Kenneth B; Younes, Anas; Hodgson, David C; Advani, Ranjana; Dabaja, Bouthaina S; Dhakal, Sughosh; Flowers, Christopher R; Ha, Chul S; Hoppe, Bradford S; Mendenhall, Nancy P; Metzger, Monika L; Plastaras, John P; Shapiro, Ronald; Smith, Sonali M; Terezakis, Stephanie A; Winkfield, Karen M; Constine, Louis S

    2016-08-01

    These guidelines review the historical evolution of treatment for early-stage Hodgkin lymphoma (HL) with current standards that rely on prognostic factors to risk stratify and direct current treatment schemes that includes differentiation of favorable and unfavorable presentations. The major clinical trials for unfavorable early-stage HL are reviewed. Patients in this heterogenous subgroup of classic HL are best managed with sequential chemotherapy and radiotherapy. The role of imaging response assessment as a means to modify therapy is a strategy under investigation. Tailoring the radiation treatment volume and radiation dose prescription along with selective use of modern conformal techniques is expected to help reduce long-term toxicities. Many patients are well served receiving involved-site radiotherapy to 30 Gy after appropriate systemic therapy intensity; but, there are nuances for which some variations in the chemotherapy and radiotherapy specifics are appropriately individualized. Following a discussion of the current evidence-based treatment algorithms, several different example cases are reviewed to help physicians make appropriate treatment decisions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:27299425

  2. ACR Appropriateness Criteria Retreatment of Recurrent Head and Neck Cancer After Prior Definitive Radiation

    SciTech Connect

    McDonald, Mark W.; Lawson, Joshua; Garg, Madhur Kumar; Quon, Harry; Ridge, John A.; Saba, Nabil; Salama, Joseph K.; Smith, Richard V.; Yeung, Anamaria Reyna; Yom, Sue S.; Beitler, Jonathan J.

    2011-08-01

    Recurrent and second primary head-and-neck squamous cell carcinomas arising within or in close proximity to previously irradiated fields are a common clinical challenge. Whereas surgical salvage therapy is recommended for resectable disease, randomized data support the role of postoperative reirradiation in high-risk patients. Definitive reirradiation is an established approach for patients with recurrent disease who are medically or technically inoperable or decline radical surgery. The American College of Radiology Expert Panel on Head and Neck Cancer reviewed the relevant literature addressing re-treatment after prior definitive radiation and developed appropriateness criteria for representative clinical scenarios. Examples of unresectable recurrent disease and microscopic residual disease after salvage surgery were addressed. The panel evaluated the appropriateness of reirradiation, the integration of concurrent chemotherapy, radiation technique, treatment volume, dose, and fractionation. The panel emphasized the importance of patient selection and recommended evaluation and treatment at tertiary-care centers with a head-and-neck oncology team equipped with the resources and experience to manage the complexities and toxicities of re-treatment.

  3. ACR Appropriateness Criteria® Diffuse Large B-Cell Lymphoma.

    PubMed

    Dabaja, Bouthaina S; Advani, Ranjana; Hodgson, David C; Dhakal, Sughosh; Flowers, Christopher R; Ha, Chul S; Hoppe, Bradford S; Mendenhall, Nancy P; Metzger, Monika L; Plastaras, John P; Roberts, Kenneth B; Shapiro, Ronald; Smith, Sonali M; Terezakis, Stephanie A; Winkfield, Karen M; Younes, Anas; Constine, Louis S

    2015-12-01

    The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). Treatment approaches with different chemotherapy regimens used is discussed in detail. The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies; the last 2 showed a potential benefit of radiation both for early and advanced stage. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26583344

  4. ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases

    PubMed Central

    Gore, Elizabeth M.; Bradley, Jeffrey D.; Buatti, John M.; Germano, Isabelle; Ghafoori, A. Paiman; Henderson, Mark A.; Murad, Gregory J.A.; Patchell, Roy A.; Patel, Samir H.; Robbins, Jared R.; Robins, H. Ian; Vassil, Andrew D.; Wippold, Franz J.; Yunes, Michael J.; Videtic, Gregory M.M.

    2014-01-01

    Abstract Pretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4–8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24971478

  5. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

    PubMed

    Andreotti, Rochelle F; Lee, Susanna I; Dejesus Allison, Sandra O; Bennett, Genevieve L; Brown, Douglas L; Dubinsky, Theodore; Glanc, Phyllis; Javitt, Marcia C; Mitchell, Donald G; Podrasky, Ann E; Shipp, Thomas D; Siegel, Cary Lynn; Wong-You-Cheong, Jade J; Zelop, Carolyn M

    2011-09-01

    Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:21873877

  6. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

    PubMed

    Bhosale, Priyadarshani R; Javitt, Marcia C; Atri, Mostafa; Harris, Robert D; Kang, Stella K; Meyer, Benjamin J; Pandharipande, Pari V; Reinhold, Caroline; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Zelop, Carolyn M; Glanc, Phyllis

    2016-06-01

    Acute pelvic pain in premenopausal women frequently poses a diagnostic dilemma. These patients may exhibit nonspecific signs and symptoms such as nausea, vomiting and leukocytosis. The cause of pelvic pain includes a myriad of diagnostic possibilities such as obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The choice of the imaging modality is usually determined by a suspected clinical differential diagnosis. Thus the patient should undergo careful evaluation and the suspected differential diagnosis should be narrowed before an optimal imaging modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice, to assess for pelvic pain, when an obstetric or gynecologic etiology is suspected and computed tomography is often more useful when gastrointestinal or genitourinary pathology is thought to be more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies owing to its lack of ionizing radiation.The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26588104

  7. ACR Appropriateness Criteria® Local Excision in Early Stage Rectal Cancer.

    PubMed

    Russo, Suzanne; Blackstock, A William; Herman, Joseph M; Abdel-Wahab, May; Azad, Nilofer; Das, Prajnan; Goodman, Karyn A; Hong, Theodore S; Jabbour, Salma K; Jones, William E; Konski, Andre A; Koong, Albert C; Kumar, Rachit; Rodriguez-Bigas, Miguel; Small, William; Thomas, Charles R; Suh, W Warren

    2015-10-01

    Low anterior resection or abdominoperineal resection are considered standard treatments for early rectal cancer but may be associated with morbidity in selected patients who are candidates for early distal lesions amenable to local excision (LE). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel recognizes the importance of accurate staging to identify patients who may be candidates for a LE approach. Patients who may be candidates for LE alone include those with small, low-lying T1 tumors, without adverse pathologic features. Several surgical approaches can be utilized for LE however none include lymph node evaluation. Adjuvant radiation±chemotherapy may be warranted depending on the risk of nodal metastases. Patients with high-risk T1 tumors, T2 tumors not amenable to radical surgery may also benefit from adjuvant treatment; however, patients with positive margins or T3 lesions should be offered abdominoperineal resection or low anterior resection. Neoadjuvant radiation±chemotherapy followed by LE in higher risk patients results in excellent local control, but it is not clear if this approach reduces recurrence rates over surgery alone. PMID:26371522

  8. ACR Appropriateness Criteria on Induction and Adjuvant Therapy for Stage N2 Non-Small-Cell Lung Cancer: Expert Panel on Radiation Oncology-Lung

    SciTech Connect

    Gopal, Ramesh S.; Dubey, Sarita; Rosenzweig, Kenneth E.; Chang, Joe Yujiao; Decker, Roy; Gewanter, Richard M.; Kong Fengming; Lally, Brian E.; Langer, Corey J.; Lee, Hoon Ku; Movsas, Benjamin M.D.

    2010-11-15

    'The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.'

  9. ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 appropriate use criteria for peripheral vascular ultrasound and physiological testing part I: Arterial ultrasound and physiological testing

    PubMed Central

    Mohler, Emile R.; Gornik, Heather L.; Gerhard-Herman, Marie; Misra, Sanjay; Olin, Jeffrey W.; Zierler, R. Eugene

    2015-01-01

    The American College of Cardiology Foundation (ACCF), in partnership with key specialty and subspecialty societies, conducted a review of common clinical scenarios where noninvasive vascular testing (ultrasound and physiological testing) is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 159 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). A total of 255 indications (with the inclusion of surveillance timeframes) were rated. One hundred and seventeen indications were rated as appropriate, 84 were rated as uncertain, and 54 were rated as inappropriate. The AUC for peripheral vascular disease have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22694919

  10. ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 Appropriate Use Criteria for Peripheral Vascular Ultrasound and Physiological Testing Part I: Arterial Ultrasound and Physiological Testing

    PubMed Central

    Mohler, Emile R.; Gornik, Heather L.; Gerhard-Herman, Marie; Misra, Sanjay; Olin, Jeffrey W.; Zierler, R. Eugene; Wolk, Michael J.; Mohler, Emile R.; Dixon, Bradley S.; Driver, Vickie R.; Fail, Peter S.; Fazel, Reza; Findeiss, Laura; Fuchs, Richard; Gillespie, John; Hughes, Joseph P.; Jaigobin, Cheryl; Leers, Steven A.; Moore, Colleen; Pellerito, John S.; Robbin, Michelle L.; Shugart, Rita E.; Weaver, Fred A.; White, Christopher J.; Yevzlin, Alexander S.; Wolk, Michael J.; Bailey, Steven R.; Douglas, Pamela S.; Hendel, Robert C.; Kramer, Christopher M.; Min, James K.; Patel, Manesh R.; Shaw, Leslee; Stainback, Raymond F.; Allen, Joseph M.

    2015-01-01

    The American College of Cardiology Foundation (ACCF), in partnership with key specialty and subspecialty societies, conducted a review of common clinical scenarios where noninvasive vascular testing (ultrasound and physiological testing) is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC). The 159 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). A total of 255 indications (with the inclusion of surveillance timeframes) were rated. One hundred and seventeen indications were rated as appropriate, 84 were rated as uncertain, and 54 were rated as inappropriate. The AUC for peripheral vascular disease have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22694840

  11. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine.

    PubMed

    Hendel, Robert C; Berman, Daniel S; Di Carli, Marcelo F; Heidenreich, Paul A; Henkin, Robert E; Pellikka, Patricia A; Pohost, Gerald M; Williams, Kim A

    2009-06-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac radionuclide imaging (RNI) is frequently considered. This document is a revision of the original Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) Appropriateness Criteria, published 4 years earlier, written to reflect changes in test utilization and new clinical data, and to clarify RNI use where omissions or lack of clarity existed in the original criteria. This is in keeping with the commitment to revise and refine appropriate use criteria (AUC) on a frequent basis. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Sixty-seven clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of cardiac RNI for diagnosis and risk assessment in intermediate- and high-risk patients with coronary artery disease (CAD) was viewed favorably, while testing in low-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Additionally, use for perioperative testing was found to be inappropriate except for high selected groups of patients. It is anticipated that these results will have a significant impact on physician decision making, test performance, and reimbursement policy, and will help guide future research. PMID:19451357

  12. Appropriate Use Criteria for Amyloid PET

    PubMed Central

    Johnson, Keith A.; Minoshima, Satoshi; Bohnen, Nicolaas I.; Donohoe, Kevin J.; Foster, Norman L.; Herscovitch, Peter; Karlawish, Jason H.; Rowe, Christopher C.; Carrillo, Maria C.; Hartley, Dean M.; Hedrick, Saima; Mitchell, Kristi; Pappas, Virginia; Thies, William H.

    2013-01-01

    Positron Emission Tomography (PET) of brain amyloid-beta is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. In order to provide guidance to dementia care practitioners, patients and caregivers, the Alzheimer Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be appropriately used. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. While empirical evidence of impact on clinical outcomes is not yet available, a set of specific Appropriate Use Criteria (AUC) were agreed upon that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes. PMID:23360977

  13. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-11-23

    The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:20975004

  14. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D; Kramer, Christopher M; Berman, Daniel; Brown, Alan; Chaudhry, Farooq A; Cury, Ricardo C; Desai, Milind Y; Einstein, Andrew J; Gomes, Antoinette S; Harrington, Robert; Hoffmann, Udo; Khare, Rahul; Lesser, John; McGann, Christopher; Rosenberg, Alan; Schwartz, Robert; Shelton, Marc; Smetana, Gerald W; Smith, Sidney C

    2010-11-23

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21087721

  15. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-01-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21232696

  16. Developing a Formal Representation for Medication Appropriateness Criteria

    PubMed Central

    Salmasian, Hojjat; Tran, Tran H; Friedman, Carol

    2014-01-01

    Inappropriate medications use (IMU) is a serious issue of global concern that leads to a waste of resources and potentially harms the patients. IMU can usually be identified by extracting information about the patient’s conditions and treatments, and comparing them with “medication appropriateness criteria”. To enable automation of these criteria, we developed a formal representation for them, which we called Objective Medication Appropriateness Criteria (OMAC). OMAC represents four aspects of the criteria: trigger, rules, action and metadata. Our evaluation showed that OMAC can completely represent explicitly defined medication appropriateness criteria using links to external knowledge sources. OMAC is the first formal representation for medication appropriateness criteria, and will enable development of structured rules for appropriate use of medications that can be implemented using standards for clinical decision support. PMID:25954464

  17. Development and validation of a simple lupus severity index using ACR criteria for classification of SLE

    PubMed Central

    Bello, Ghalib A; Brown, Michael A; Kelly, Jennifer A; Thanou, Aikaterini; James, Judith A; Montgomery, Courtney G

    2016-01-01

    Objective To develop a simple systemic lupus erythematosus (SLE) severity index that requires knowledge of only American College of Rheumatology (ACR) criteria and subcriteria. Methods This study used demographic, mortality and medical records data of 1915 patients with lupus from the Lupus Family Registry and Repository. The data were randomly split (2:1 ratio) into independent training and validation sets. A logistic regression with ridge penalty was used to model the probability of being prescribed major immunosuppressive drugs—a surrogate indicator of lupus severity. ACR criteria and subcriteria were used as predictor variables in this model, and the resulting regression coefficient estimates obtained from the training data were used as item weightings to construct the severity index. Results The resulting index was tested on the independent validation dataset and was found to have high predictive accuracy for immunosuppressive use and early mortality. The index was also found to be strongly correlated with a previously existing severity score for lupus. In addition, demographic factors known to influence lupus severity (eg, age of onset, gender and ethnicity) all showed robust associations with our severity index that were consistent with observed clinical trends. Conclusions This new index can be easily computed using ACR criteria, which may be among the most readily available data elements from patient medical records. This tool may be useful in lupus research, especially large dataset analyses to stratify patients by disease severity, an important prognostic indicator in SLE. PMID:27026812

  18. The Features of the Synovium in Early Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria

    PubMed Central

    van de Sande, Marleen G. H.; de Hair, Maria J. H.; Schuller, Yvonne; van de Sande, Gijs P. M.; Wijbrandts, Carla A.; Dinant, Huib J.; Gerlag, Danielle M.; Tak, Paul P.

    2012-01-01

    Objectives It has been shown in early arthritis cohorts that the 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) enable an earlier diagnosis, perhaps at the cost of a somewhat more heterogeneous patient population. We describe the features of synovial inflammation in RA patients classified according to these new criteria. Methods At baseline, synovial tissue biopsy samples were obtained from disease-modifying antirheumatic drug (DMARD)-naïve early RA patients (clinical signs and symptoms <1 year). Synovial tissue was analyzed for cell infiltration, vascularity, and expression of adhesion molecules. Stained sections were evaluated by digital image analysis. Patients were classified according to the two different sets of classification criteria, autoantibody status, and outcome. Findings Synovial tissue of 69 RA patients according to 2010 ACR/EULAR criteria was analyzed: 56 patients who fulfilled the criteria for RA at baseline and 13 who were initially diagnosed as undifferentiated arthritis but fulfilled criteria for RA upon follow up. The synovium at baseline was infiltrated by plasma cells, macrophages, and T cells as well as other cells, and findings were comparable to those when patients were selected based on the 1987 ACR criteria for RA. There was no clear cut difference in the characteristics of the synovium between RA patients initially diagnosed as undifferentiated arthritis and those who already fulfilled classification criteria at baseline. Conclusion The features of synovial inflammation are similar when the 2010 ACR/EULAR classification criteria are used compared to the 1987 ACR criteria. PMID:22574210

  19. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

    PubMed Central

    Basger, Benjamin Joseph; Chen, Timothy Frank; Moles, Rebekah Jane

    2012-01-01

    Objective To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. Design RAND/UCLA appropriateness method. Participants A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. Main outcome measure Agreement on all criteria. Results Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. Conclusions A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals. PMID:22983875

  20. Development of appropriateness explicit criteria for cataract extraction by phacoemulsification

    PubMed Central

    Ma Quintana, José; Escobar, Antonio; Aróstegui, Inmaculada

    2006-01-01

    Background Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines. PMID:16512906

  1. Performance of the new 2011 ACR/EULAR remission criteria with tocilizumab using the phase IIIb study TAMARA as an example and their comparison with traditional remission criteria

    PubMed Central

    Iking-Konert, Christof; Aringer, Martin; Wollenhaupt, Jürgen; Mosch, Thomas; Tuerk, Stefan; Feist, Eugen; Burmester, Gerd R

    2011-01-01

    Background Remission is the established goal in rheumatoid arthritis (RA) treatment. Although originally defined by a disease activity score in 28 joints (DAS28) <2.6, more stringent criteria may imply the absence of disease activity. The 2011 ACR/EULAR remission criteria provide the newest and most stringent definition of remission. Objectives To evaluate post hoc the remission by ACR/EULAR criteria and compare the criteria with the conventional DAS28 in TAMARA, an open-label phase IIIb tocilizumab (TCZ) trial including patients with active RA receiving inadequate disease-modifying antirheumatic drugs (DMARDs) or tumour necrosis factor α (TNFα) inhibitor treatment. Results 286 patients were enrolled, 99.7% of patients were receiving a conventional DMARD and 41.6% had TNFα inhibitor pretreatment. Baseline mean DAS28 of 6.0 ± 1.0 fell to 2.6 ± 1.5 at week 24. DAS28 <2.6 was achieved by 47.6% at week 24. Remission rates with the new ACR/EULAR Boolean-based criteria for clinical studies were 15.0% after 12 weeks and 20.3% after 24 weeks. Of note, 13.5% of patients with previous TNFα blocker inadequate response still achieved remission according to the new ACR/EULAR criteria after 24 weeks. Clinical Disease Activity Index and Simplified Disease Activity Index remission rates were 24.1% and 25.2%, respectively. Conclusions Under the definition of the new stringent 2011 ACR/EULAR remission criteria, patients with active RA despite DMARD treatment and even after inadequate response to TNFα inhibitors, receiving TCZ showed significant rates of remission. Similar remission rates were achieved, when clinical practice criteria, not inclusive of acute phase reactants, were used. PMID:21875873

  2. Applying appropriate-use criteria to cardiac revascularisation in India

    PubMed Central

    Sood, Neeraj; Ugargol, Allen P; Barnes, Kayleigh; Mahajan, Anish

    2016-01-01

    Objectives The high prevalence of coronary heart disease and dramatic growth of cardiac interventions in India motivate an evaluation of the appropriateness of coronary revascularisation procedures in India. Although, appropriate-use criteria (AUC) have been used to analyse the appropriateness of cardiovascular care in the USA, they are yet to be applied to care in India. In our study, we apply AUC to cardiac care in Karnataka, India, compare our results to international applications of AUC, and suggest ways to improve the appropriateness of care in India. Setting Data were collected from the Vajpayee Arogyashree Scheme, a government-sponsored health insurance scheme in Karnataka, India. These data were collected as part of the preauthorisation process for cardiac procedures. Participants The final data included a random sample of 600 patients from 28 hospitals in Karnataka, who obtained coronary artery bypass grafting or percutaneous coronary intervention between 1 October 2014 and 31 December 2014. Primary and secondary outcome measures We obtained our primary baseline results using a random imputation simulation to fill in missing data. Our secondary outcome measure was a best case–worst case scenario where missing data were filled to give the lowest or highest number of appropriate cases. Results Of the cases, 86.7% (CI 0.837% to 0.892%) were deemed appropriate, 3.65% (CI 0.023% to 0.055%) were inappropriate and 9.63% (CI 0.074% to 0.123%) were uncertain. Conclusions The vast majority of cardiac revascularisation procedures performed on beneficiaries of a government-sponsored insurance programme in India were found to be appropriate. These results meet or exceed levels of appropriate use of cardiac care in the USA. PMID:27029773

  3. ACR Appropriateness Criteria on acute pelvic pain in the reproductive age group.

    PubMed

    Andreotti, Rochelle F; Lee, Susanna I; Choy, Garry; DeJesus Allison, Sandra O; Bennett, Genevieve L; Brown, Douglas L; Glanc, Phyllis; Horrow, Mindy M; Javitt, Marcia C; Lev-Toaff, Anna S; Podrasky, Ann E; Scoutt, Leslie M; Zelop, Carolyn

    2009-04-01

    Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation. PMID:19327655

  4. Teacher Criteria for Evaluating and Selecting Developmentally Appropriate Computer Software

    ERIC Educational Resources Information Center

    Ntuli, Esther; Kyei-Blankson, Lydia

    2011-01-01

    Although many teacher training programs and school districts offer courses and workshops on technology integration in instruction, research shows that teachers still face major challenges especially as it relates to selecting and using developmentally appropriate technology to meet the needs of diverse learners. The current study examines the…

  5. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Criteria for establishing appropriated fund wage areas. 532.211 Section 532.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Prevailing Rate Determinations § 532.211 Criteria for establishing appropriated fund wage areas. (a)...

  6. Selective involvement of ERK and JNK mitogen-activated protein kinases in early rheumatoid arthritis (1987 ACR criteria compared to 2010 ACR/EULAR criteria): a prospective study aimed at identification of diagnostic and prognostic biomarkers as well as therapeutic targets

    PubMed Central

    de Launay, Daphne; van de Sande, Marleen GH; de Hair, Maria JH; Grabiec, Aleksander M; van de Sande, Gijs PM; Lehmann, K Aad; Wijbrandts, Carla A; van Baarsen, Lisa GM; Gerlag, Danielle M; Tak, Paul P; Reedquist, Kris A

    2012-01-01

    Objectives To investigate the expression and activation of mitogen-activated protein kinases in patients with early arthritis who are disease-modifying antirheumatic drug (DMARD) naïve. Methods A total of 50 patients with early arthritis who were DMARD naïve (disease duration <1 year) were prospectively followed and diagnosed at baseline and after 2 years for undifferentiated arthritis (UA), rheumatoid arthritis (RA) (1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria), or spondyloarthritis (SpA). Synovial biopsies obtained at baseline were examined for expression and phosphorylation of p38, extracellular signal regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) by immunohistochemistry and digital analysis. Synovial tissue mRNA expression was measured by quantitative PCR (qPCR). Results ERK and JNK activation was enhanced at inclusion in patients meeting RA criteria compared to other diagnoses. JNK activation was enhanced in patients diagnosed as having UA at baseline who eventually fulfilled 1987 ACR RA criteria compared to those who remained UA, and in patients with RA fulfilling 2010 ACR/EULAR criteria at baseline. ERK and JNK activation was enhanced in patients with RA developing progressive joint destruction. JNK activation in UA predicted 1987 ACR RA classification criteria fulfilment (R2=0.59, p=0.02) after follow-up, and disease progression in early arthritis (R2=0.16, p<0.05). Enhanced JNK activation in patients with persistent disease was associated with altered synovial expression of extracellular matrix components and CD44. Conclusions JNK activation is elevated in RA before 1987 ACR RA classification criteria are met and predicts development of erosive disease in early arthritis, suggesting JNK may represent an attractive target in treating RA early in the disease process. PMID:21953337

  7. Towards Tailored Patient's Management Approach: Integrating the Modified 2010 ACR Criteria for Fibromyalgia in Multidimensional Patient Reported Outcome Measures Questionnaire

    PubMed Central

    El Miedany, Yasser; El Gaafary, Maha; Youssef, Sally; Ahmed, Ihab

    2016-01-01

    Objectives. To assess the validity, reliability, and responsiveness to change of a patient self-reported questionnaire combining the Widespread Pain Index and the Symptom Severity Score as well as construct outcome measures and comorbidities assessment in fibromyalgia patients. Methods. The PROMs-FM was conceptualized based on frameworks used by the WHO Quality of Life tool and the PROMIS. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction were achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. The questionnaire included the modified ACR criteria main items (Symptom Severity Score and Widespread Pain Index), in addition to assessment of functional disability, quality of life (QoL), review of the systems, and comorbidities. Every patient completed HAQ and EQ-5D questionnaires. Results. A total of 146 fibromyalgia patients completed the questionnaire. The PROMs-FM questionnaire was reliable as demonstrated by a high standardized alpha (0.886–0.982). Content construct assessment of the functional disability and QoL revealed significant correlation (p < 0.01) with both HAQ and EQ-5D. Changes in functional disability and QoL showed significant (p < 0.01) variation with diseases activity status in response to therapy. There was higher prevalence of autonomic symptoms, CVS risk, sexual dysfunction, and falling. Conclusions. The developed PROMs-FM questionnaire is a reliable and valid instrument for assessment of fibromyalgia patients. A phased treatment regimen depending on the severity of FMS as well as preferences and comorbidities of the patient is the best approach to tailored patient management. PMID:27190648

  8. Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab.

    PubMed

    Gimelli, Alessia; Rovai, Ilaria; Liga, Riccardo; Pasanisi, Emilio Maria; Marzullo, Paolo

    2016-06-01

    The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia. A cohort of 251 consecutive patients, admitted to our Institute from January to March 2015, who underwent stress/rest MPI on a dedicated cardiac camera equipped with cadmium-zinc-telluride detectors, was selected. The level of clinical appropriateness of each MPI test was categorized in each patient according to the AUC criteria. According to the accepted criteria, the majority of the MPI stress-tests could be classified as clinically appropriate (218 of 251, 87 % of the tests), while only 16 (6 %) and 17 (7 %) resulted of uncertain appropriateness or clearly inappropriate, respectively. Of the 251 appropriate tests, 22 (10 %), 65 (30 %), and 131 (60 %) showed the presence of a mild (SDS < 4), moderate (4 ≥ SDS < 7), and severe (SDS ≥ 7) ischemic burden, respectively, while none of the inappropriate test showed moderate-to-severe ischaemia (P < 0.001 for comparisons). The rate of inappropriate MPI tests is considerably low in a high-volume laboratory. Appropriate and inappropriate studies identify patients at high and low probability of significant ischemia, respectively, providing insights on the effects of the level of appropriateness on stress-test results. PMID:26961179

  9. A method for discovering and inferring appropriate eligibility criteria in clinical trial protocols without labeled data

    PubMed Central

    2013-01-01

    Background We consider the user task of designing clinical trial protocols and propose a method that discovers and outputs the most appropriate eligibility criteria from a potentially huge set of candidates. Each document d in our collection D is a clinical trial protocol which itself contains a set of eligibility criteria. Given a small set of sample documentsD′,|D′|≪|D|, a user has initially identified as relevant e.g., via a user query interface, our scoring method automatically suggests eligibility criteria from D, D ⊃ D', by ranking them according to how appropriate they are to the clinical trial protocol currently being designed. The appropriateness is measured by the degree to which they are consistent with the user-supplied sample documents D'. Method We propose a novel three-step method called LDALR which views documents as a mixture of latent topics. First, we infer the latent topics in the sample documents using Latent Dirichlet Allocation (LDA). Next, we use logistic regression models to compute the probability that a given candidate criterion belongs to a particular topic. Lastly, we score each criterion by computing its expected value, the probability-weighted sum of the topic proportions inferred from the set of sample documents. Intuitively, the greater the probability that a candidate criterion belongs to the topics that are dominant in the samples, the higher its expected value or score. Results Our experiments have shown that LDALR is 8 and 9 times better (resp., for inclusion and exclusion criteria) than randomly choosing from a set of candidates obtained from relevant documents. In user simulation experiments using LDALR, we were able to automatically construct eligibility criteria that are on the average 75% and 70% (resp., for inclusion and exclusion criteria) similar to the correct eligibility criteria. Conclusions We have proposed LDALR, a practical method for discovering and inferring appropriate eligibility criteria in clinical

  10. Do water quality criteria based on nonnative species provide appropriate protection for native species?

    PubMed

    Jin, Xiaowei; Wang, Zijian; Wang, Yeyao; Lv, Yibing; Rao, Kaifeng; Jin, Wei; Giesy, John P; Leung, Kenneth M Y

    2015-08-01

    The potential use of toxicity data for nonnative species to derive water quality criteria is controversial because it is sometimes questioned whether criteria based on species from one geographical region provide appropriate protection for species in a different region. However, this is an important concept for the development of Chinese water quality criteria or standards. Data were assembled on 38 chemicals for which values were available for both native and nonnative species. Sensitivities of these organisms were compared based on the 5% hazardous concentration values and the species sensitivity distribution from a literature review. Results of the present study's analysis showed that there is approximately 74% certainty that use of nonnative species to generate water quality criteria would be sufficiently protective of aquatic ecosystems in China. Without applying any assessment factor to the water quality criteria generated from nonnative species, the uncertainty would be 26% when the native Chinese species might be under protection. Applying an assessment factor of 10 would offer adequate protection to native Chinese species for approximately 90% of tested chemicals and thus reduce the uncertainty from 26% to 10%. PMID:25761401

  11. Effect of coenzyme Q10 evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R: four case reports and literature review.

    PubMed

    Alcocer-Gómez, Elísabet; Cano-García, Francisco Javier; Cordero, Mario D

    2013-01-01

    Recently, Coenzyme Q10 (CoQ10) deficiency has been implicated in the pathophysiology of fibromyalgia (FM). It is our objective to present the findings of the FM evaluation before and after oral CoQ10 treatment using the American College of Rheumatology (ACR) Diagnostic Criteria of 1990 and 2010, and Symptom Checklist-Revised (Scl-90-R). Four patients with FM were examined using the trigger points, the Fibromyalgia Impact Questionnaire, visual analog scale (pain, fatigue, and sleep), Widespread Pain Index, symptom severity scale, and Scl-90-R. Previously, CoQ10 contents from patients were analyzed by high-performance liquid chromatography. All patients showed CoQ10 deficiency. All patients meet the ACR 1990 and 2010 criteria. After treatment, all patients showed an important improvement in clinical symptoms in all evaluation methods. According to our results, and evaluated by three methods, patients with FM are candidates for treatment with CoQ10. However, more controlled clinical trials and investigations are needed to clarify the precise mechanism(s) by which CoQ10 may contribute in pathological and therapeutic processes of FM and to provide data on its effectiveness in FM. PMID:24103521

  12. Health Disparities Research Among Small Tribal Populations: Describing Appropriate Criteria for Aggregating Tribal Health Data.

    PubMed

    Van Dyke, Emily R; Blacksher, Erika; Echo-Hawk, Abigail L; Bassett, Deborah; Harris, Raymond M; Buchwald, Dedra S

    2016-07-01

    In response to community concerns, we used the Tribal Participatory Research framework in collaboration with 5 American-Indian communities in Washington, Idaho, and Montana to identify the appropriate criteria for aggregating health data on small tribes. Across tribal sites, 10 key informant interviews and 10 focus groups (n = 39) were conducted between July 2012 and April 2013. Using thematic analysis of focus group content, we identified 5 guiding criteria for aggregating tribal health data: geographic proximity, community type, environmental exposures, access to resources and services, and economic development. Preliminary findings were presented to focus group participants for validation at each site, and a culminating workshop with representatives from all 5 tribes verified our final results. Using this approach requires critical assessment of research questions and study designs by investigators and tribal leaders to determine when aggregation or stratification is appropriate and how to group data to yield robust results relevant to local concerns. At project inception, tribal leaders should be consulted regarding the validity of proposed groupings. After regular project updates, they should be consulted again to confirm that findings are appropriately contextualized for dissemination. PMID:27268030

  13. The disconnect between the guidelines, the appropriate use criteria, and reimbursement coverage decisions: the ultimate dilemma.

    PubMed

    Fogel, Richard I; Epstein, Andrew E; Mark Estes, N A; Lindsay, Bruce D; DiMarco, John P; Kremers, Mark S; Kapa, Suraj; Brindis, Ralph G; Russo, Andrea M

    Recently, the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society published appropriate use criteria (AUC) for implantable cardioverter-defibrillators and cardiac resynchronization therapy. These criteria were developed to critically review clinical situations that may warrant implantation of an implantable cardioverter-defibrillator or cardiac resynchronization therapy device, and were based on a synthesis of practice guidelines and practical experience from a diverse group of clinicians. When the AUC was drafted, the writing committee recognized that some of the scenarios that were deemed "appropriate" or "may be appropriate" were discordant with the clinical requirements of many payers, including the Medicare National Coverage Determination (NCD). To charge Medicare for a procedure that is not covered by the NCD may be construed as fraud. Discordance between the guidelines, the AUC, and the NCD places clinicians in the difficult dilemma of trying to do the "right thing" for their patients, while recognizing that the "right thing" may not be covered by the payer or insurer. This commentary addresses these issues. Options for reconciling this disconnect are discussed, and recommendations to help clinicians provide the best care for their patients are offered. PMID:23916934

  14. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method.

    PubMed

    Meddings, Jennifer; Saint, Sanjay; Fowler, Karen E; Gaies, Elissa; Hickner, Andrew; Krein, Sarah L; Bernstein, Steven J

    2015-05-01

    Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA Appropriateness Method was applied. After reviewing the literature, a 15-member multidisciplinary panel of physicians, nurses, and specialists in infection prevention rated scenarios for catheter use as appropriate, inappropriate, or of uncertain appropriateness by using a standardized, multiround rating process. The appropriateness of Foley catheters, intermittent straight catheters (ISCs), and external condom catheters for hospitalized adults on medical services was assessed in 299 scenarios, including urinary retention, incontinence, wounds, urine volume measurement, urine sample collection, and comfort. The scenarios included patient-specific issues, such as difficulty turning and catheter placement challenges. The panel rated 105 Foley scenarios (43 appropriate, 48 inappropriate, 14 uncertain), 97 ISC scenarios (15 appropriate, 66 inappropriate, 16 uncertain), and 97 external catheter scenarios (30 appropriate, 51 inappropriate, 16 uncertain). The refined criteria clarify that Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means; specify that patients in the intensive care unit (ICU) need specific medical indications for catheters because ICU location alone is not an appropriate indication; and recognize that Foley and external catheters may be pragmatically appropriate to manage urinary incontinence in select patients. These new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use. PMID:25938928

  15. The 1995 forum on appropriate criteria and methods for seismic design of nuclear piping

    SciTech Connect

    Slagis, G.C.

    1996-12-01

    A record of the 1995 Forum on Appropriate Criteria and Methods for Seismic Design of Nuclear Piping is provided. The focus of the forum was the earthquake experience data base and whether the data base demonstrates that seismic inertia loads will not cause failure in ductile piping systems. This was a follow-up to the 1994 Forum when the use of earthquake experience data, including the recent Northridge earthquake, to justify a design-by-rule method was explored. Two possible topics for the next forum were identified--inspection after an earthquake and design for safe-shutdown earthquake only.

  16. Cost Savings Associated With Implementation of Peer-Reviewed Appropriate Use Criteria for Percutaneous Coronary Interventions.

    PubMed

    Puri, Pranav; Carroll, Jennifer; Patterson, Bobette

    2016-04-15

    Appropriate use criteria (AUC) for coronary revascularization have been developed to provide a practical standard to assess the quality of patient selection for percutaneous coronary interventions (PCI). However, the economic impact of AUC implementation has yet to be quantified. A peer-reviewed AUC process was implemented at UnityPoint Trinity in February 2012. Volumes of PCI cases were measured in 12-month intervals for 2 years after AUC implementation and compared with volumes from the corresponding 12-month intervals in the 2 years preceding implementation of AUC. Hospital reimbursement was averaged based on each year's payer mix and reimbursement contracts. In the 2 years preceding AUC implementation, PCI volumes were similar (1,414 in 2010 and 1,411 in 2011). After AUC implementation, volumes of PCI decreased by 17% in both 2012 and 2013. From 2012 to 2013, the relative ratio of elective to acute interventions decreased from 1.36 to 1.02. In the same time frame, the proportion of appropriate PCI significantly increased from 76% to 84% (p <0.001). Total hospital reimbursement for PCI decreased by 36% after AUC implementation. In conclusion, implementation of a peer-reviewed AUC process at the UnityPoint Trinity led to significant cost savings through a large decrease in volume of PCI with concurrent improvement in PCI appropriateness. PMID:26899491

  17. Aggressive rheumatoid arthritis registry in Italy. Characteristics of the early rheumatoid arthritis subtype among patients classified according to the ACR criteria.

    PubMed

    2003-01-01

    The Italian Society of Rheumatology in the year 2000 decided to sponsor the creation of a data base (Registry) of consecutive patients who fulfilled the diagnosis of rheumatoid arthritis (RA) according to the American College of Rheumatology (ACR) criteria. The registry is designed to collect data on the "aggressive" type of RA all over the country in order to determine the percentage of patients who satisfy the established criteria among incident cases of RA and to define the therapeutic approach according to the characteristics of the enrolled patients. Predefined criteria set up by eight recognized opinion leaders on the disease were used by all the centers to create the database. The GIARA registry (Gruppo Italiano Artrite Reumatoide Aggressiva) has now enrolled 706 patients who will be followed up for 24 months. They have been divided into two major subsets--patients with early (< 4 months' disease duration) and late (> 4 months) RA--with the aim of establishing whether differences in clinical, serological, radiographic and therapeutic (DMARDs: disease modifying antirheumatic drugs) parameters may distinguish the two subsets. The major conclusion of this preliminary analysis is that an overall tendency to undertreatment is discernable. PMID:14969064

  18. Indications for TEE before cardioversion for atrial fibrillation: implications for appropriateness criteria.

    PubMed

    Grewal, Gaganpreet K; Klosterman, Tristan B; Shrestha, Kevin; Yarmohammadi, Hirad; Zurick, Andrew O; Varr, Brandon C; Tang, W H Wilson; Lindsay, Bruce D; Klein, Allan L

    2012-06-01

    The purpose of this study was to evaluate appropriateness of transesophageal echocardiography (TEE) before direct current cardioversion (DCC), investigate indications for TEE, and analyze if indications are predictive of outcome. According to American College of Cardiology Foundation/American Society of Echocardiography 2011 Appropriateness Criteria, TEE is appropriate in the evaluation of patients with atrial fibrillation (AF) to facilitate clinical decision making with regards to anticoagulation and/or DCC. However, it is unclear in which instances physicians utilize TEE. We reviewed 671 TEE studies in 604 AF patients (age 66 ± 13 years, 67% male) in which TEE was performed before DCC for left atrial thrombus (LAT)/sludge. Studies were divided by the main indication for TEE into the following 8 categories: 1) congestive heart failure (CHF)/hemodynamic compromise; 2) symptomatic; 3) new onset AF; 4) hospitalized and symptomatic; 5) high stroke risk; 6) subtherapeutic anticoagulation; 7) miscellaneous; and 8) inappropriate for TEE. The main indications for TEE before DCC were symptomatic (26.4%) and CHF/hemodynamic compromise (26.1%). We deemed 2.7% of the studies as inappropriate. LAT/sludge was found in 8.2% of studies. Incidence of LAT/sludge differed significantly between indications (p = 0.0021) and the highest incidences occurred in the high stroke risk (17.6%) and hospitalized and symptomatic (14.1%) categories. No LAT/sludge was found in the miscellaneous or inappropriate groups. Stroke occurred in 2.5% (n = 15) of all patients and in all groups except for miscellaneous and inappropriate (p = 0.3). TEE is appropriately used prior to DCC for patients with the main indications of symptomatic and CHF/hemodynamic compromise. In a minority of studies, TEE utilization was inappropriate. Incidence of LAT/sludge differed between indications. PMID:22698535

  19. EACVI appropriateness criteria for the use of cardiovascular imaging in heart failure derived from European National Imaging Societies voting.

    PubMed

    Garbi, Madalina; Edvardsen, Thor; Bax, Jeroen; Petersen, Steffen E; McDonagh, Theresa; Filippatos, Gerasimos; Lancellotti, Patrizio

    2016-07-01

    This paper presents the first European appropriateness criteria for the use of cardiovascular imaging in heart failure, derived from voting of the European National Imaging Societies representatives. The paper describes the development process and discusses the results. PMID:27129538

  20. Application of appropriate use criteria for percutaneous coronary intervention in Japan.

    PubMed

    Inohara, Taku; Kohsaka, Shun; Ueda, Ikuko; Yagi, Takashi; Numasawa, Yohei; Suzuki, Masahiro; Maekawa, Yuichiro; Fukuda, Keiichi

    2016-08-26

    The aim of this review was to summarize the concept of appropriate use criteria (AUC) regarding percutaneous coronary intervention (PCI) and document AUC use and impact on clinical practice in Japan, in comparison with its application in the United States. AUC were originally developed to subjectively evaluate the indications and performance of various diagnostic and therapeutic modalities, including revascularization techniques. Over the years, application of AUC has significantly impacted patient selection for PCI in the United States, particularly in non-acute settings. After the broad implementation of AUC in 2009, the rate of inappropriate PCI decreased by half by 2014. The effect was further accentuated by incorporation of financial incentives (e.g., restriction of reimbursement for inappropriate procedures). On the other hand, when the United States-derived AUC were applied to Japanese patients undergoing elective PCI from 2008 to 2013, about one-third were classified as inappropriate, largely due to the perception gap between American and Japanese experts. For example, PCI for low-risk non-left atrial ascending artery lesion was more likely to be classified as appropriate by Japanese standards, and anatomical imaging with coronary computed tomography angiography was used relatively frequently in Japan, but no scenario within the current AUC includes this modality. To extrapolate the current AUC to Japan or any other region outside of the United States, these local discrepancies must be taken into consideration, and scenarios should be revised to reflect contemporary practice. Understanding the concept of AUC as well as its perception gap between different counties will result in the broader implementation of AUC, and lead to the quality improvement of patients' care in the field of coronary intervention. PMID:27621773

  1. Application of appropriate use criteria for percutaneous coronary intervention in Japan

    PubMed Central

    Inohara, Taku; Kohsaka, Shun; Ueda, Ikuko; Yagi, Takashi; Numasawa, Yohei; Suzuki, Masahiro; Maekawa, Yuichiro; Fukuda, Keiichi

    2016-01-01

    The aim of this review was to summarize the concept of appropriate use criteria (AUC) regarding percutaneous coronary intervention (PCI) and document AUC use and impact on clinical practice in Japan, in comparison with its application in the United States. AUC were originally developed to subjectively evaluate the indications and performance of various diagnostic and therapeutic modalities, including revascularization techniques. Over the years, application of AUC has significantly impacted patient selection for PCI in the United States, particularly in non-acute settings. After the broad implementation of AUC in 2009, the rate of inappropriate PCI decreased by half by 2014. The effect was further accentuated by incorporation of financial incentives (e.g., restriction of reimbursement for inappropriate procedures). On the other hand, when the United States-derived AUC were applied to Japanese patients undergoing elective PCI from 2008 to 2013, about one-third were classified as inappropriate, largely due to the perception gap between American and Japanese experts. For example, PCI for low-risk non-left atrial ascending artery lesion was more likely to be classified as appropriate by Japanese standards, and anatomical imaging with coronary computed tomography angiography was used relatively frequently in Japan, but no scenario within the current AUC includes this modality. To extrapolate the current AUC to Japan or any other region outside of the United States, these local discrepancies must be taken into consideration, and scenarios should be revised to reflect contemporary practice. Understanding the concept of AUC as well as its perception gap between different counties will result in the broader implementation of AUC, and lead to the quality improvement of patients’ care in the field of coronary intervention. PMID:27621773

  2. Toward appropriate criteria in medication adherence assessment in older persons: Position Paper.

    PubMed

    Giardini, Anna; Martin, Maria Teresa; Cahir, Caitriona; Lehane, Elaine; Menditto, Enrica; Strano, Maria; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra

    2016-06-01

    Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed. PMID:26630945

  3. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What criteria will Reclamation apply to determine whether it is appropriate to recommend that a feasibility study be conducted? 404.44 Section 404.44 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER...

  4. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  5. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  6. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  7. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... establishing appropriated fund wage areas. (a) Each wage area shall consist of one or more survey areas along with nonsurvey areas, if any. (1) Survey area: A survey area is composed of the counties, parishes, cities, or townships in which survey data are collected. Except in very unusual circumstances, a...

  8. Assessment of Children's Digital Courseware in Light of Developmentally Appropriate Courseware Criteria

    ERIC Educational Resources Information Center

    Ihmeideh, Fathi Mahmoud

    2015-01-01

    Developmentally appropriate courseware can play a crucial role in enhancing children's learning and development. Research studies have demonstrated that early childhood educators face major challenges in selecting and updating developmental courseware that supports young children's development. The primary purpose of this study was to assess…

  9. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the State in its work and training programs for TANF recipients. (5) The service or work site to which... safety standards. (6) Assignments must not be made which are discriminatory in terms of age, sex, race, creed, color, or national origin. (7) Appropriate work may be temporary, permanent, full-time,...

  10. Evaluation of Posttreatment Follow-Up of Patients With Prostate Cancer Relative to the American College of Radiology’s Appropriateness Criteria

    PubMed Central

    McDonald, Jennifer S.; Carter, Rickey E.; Karnes, R. Jeffrey; Port, John D.; Kawashima, Akira; Carlson, Stephanie K.; Bender, Claire E.

    2016-01-01

    OBJECTIVE The American College of Radiology (ACR) Appropriateness Criteria panel has recommended that patients with prostate cancer who have received treatment undergo imaging only after suspected cancer recurrence. We examined whether local physicians followed this recommendation and what types of imaging examinations were ordered in a cohort of patients with local prostate cancer. MATERIALS AND METHODS The Rochester Epidemiology Project, a research consortium that collects, links, and stores medical record information of Olmsted County, Minnesota, residents, was used to capture the complete medical history of treated patients with prostate cancer from 2000 through 2011. Clinical information and imaging examinations performed were retrieved by chart review. Suspected recurrence was defined as treatment-specific prostate-specific antigen level elevations, bone pain, or abnormal digital rectal examination findings. RESULTS Of the 670 treated patients with prostate cancer who were included in the final analysis, 129 (19%) underwent posttreatment imaging. After excluding imaging related to retreatment or another cancer, 13 patients (i.e., 2% of the entire cohort and 10% of imaged patients) underwent imaging in the absence of suspected recurrence. A total of 90 patients (70% of imaged patients) underwent imaging after suspected recurrence. Of these 90 patients, 62 (69%) underwent a bone scan as their first imaging modality either alone or in combination with other imaging modalities. Of the providers who ordered a bone scan first, 27% were urologists, 23% were radiation oncologists, and 24% were primary care physicians. CONCLUSION Most patients in this study did not undergo imaging in the absence of suspected recurrence. Various types of imaging examinations were ordered for patients with suspected recurrence. PMID:26496548

  11. Appropriate Use Criteria in Echocardiography: An Observational Institutional Study with the Perspective of a Quality Improvement Project

    PubMed Central

    Rameh, Vanessa; Kossaify, Antoine

    2016-01-01

    BACKGROUND Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources. OBJECTIVES The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP). METHODS The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category. RESULTS Of the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category. DISCUSSION Interpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly. CONCLUSION AUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome. PMID:26917982

  12. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study

    PubMed Central

    Souza, JP; Cecatti, JG; Parpinelli, MA; Serruya, SJ; Amaral, E

    2007-01-01

    Background The study of severe maternal morbidity survivors (near miss) may be an alternative or a complement to the study of maternal death events as a health care indicator. However, there is still controversy regarding the criteria for identification of near-miss maternal morbidity. This study aimed to characterize the near miss maternal morbidity according to different sets of criteria. Methods A descriptive study in a tertiary center including 2,929 women who delivered there between July 2003 and June 2004. Possible cases of near miss were daily screened by checking different sets of criteria proposed elsewhere. The main outcome measures were: rate of near miss and its primary determinant factors, criteria for its identification, total hospital stay, ICU stay, and number and kind of special procedures performed. Results There were two maternal deaths and 124 cases of near miss were identified, with 102 of them admitted to the ICU (80.9%). Among the 126 special procedures performed, the most frequent were central venous access, echocardiography and invasive mechanical ventilation. The mean hospital stay was 10.3 (± 13.24) days. Hospital stay and the number of special procedures performed were significantly higher when the organ dysfunction based criteria were applied. Conclusion The adoption of a two level screening strategy may lead to the development of a consistent severe maternal morbidity surveillance system but further research is needed before worldwide near miss criteria can be assumed. PMID:17848189

  13. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  14. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  15. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  16. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... sufficient to supply the proposed service area, including all practicable water sources such as lower quality... health and safety; (3) Will meet water demand, including projected future needs; (4)...

  17. 75 FR 58448 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on October 21, 2010, at 11545... Subcommittee will review current Design Acceptance Criteria associated with Digital Instrumentation and...

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

    PubMed Central

    Santos, Juliana P; Cecatti, José G; Serruya, Suzanne J; Almeida, Paulo V; Duran, Pablo; de Mucio, Bremen; Pileggi-Castro,, Cynthia

    2015-01-01

    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. PMID:26735223

  19. Praise Acres Project

    ERIC Educational Resources Information Center

    Hayes, Carolyn

    2004-01-01

    In this article, the author presents the "Praise Acres Project," which was initiated from a letter written by a local resident. The resident wrote about an idea to develop a wetlands and outdoor lab facility on his property for students. Thus, a plan was conceived that would not only benefit the owner, but also enhance high school science…

  20. ACR process for ethylene

    SciTech Connect

    Baldwin, R.L.; Kamm, G.R.

    1983-01-01

    Describes how the advanced cracking reactor process, which is ready for a logical commercial application, offers total liquids feedstock flexibility from light naphthenes through vacuum gas oils in the same production unit. Several processes are presently being developed which are aimed at maintaining olefin selectivity when cracking the heaviest feeds. Addresses the problems posed by such heavy feedstocks. The following trends favor the ACR process in the 1980s: natural gas price decontrol; limited natural gas reserves; few new domestic LPG-based ethylene plants will be built; an economic recovery will create the need for more ethylene capacity; modest increases in ''real'' crude oil prices; plentiful supplies of vacuum gas oil at prices making it an attractive ethylene feedstock; and increasing supplies of light naphtha at prices making it an attractive ethylene feedstock as well. Predicts that these factors will swing the preferred feedstocks for ethylene manufacture back to crude oil distillates before the end of the decade. Argues that in this environment, the ACR process can deliver the lowest cost ethylene in the industry. ACR has full-range feedstock flexibility, high selectivity to ethylene, and less sensitivity to feedstock costs and co-product credits.

  1. Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association.

    PubMed

    Johnson, Keith A; Minoshima, Satoshi; Bohnen, Nicolaas I; Donohoe, Kevin J; Foster, Norman L; Herscovitch, Peter; Karlawish, Jason H; Rowe, Christopher C; Carrillo, Maria C; Hartley, Dean M; Hedrick, Saima; Pappas, Virginia; Thies, William H

    2013-03-01

    Positron emission tomography (PET) of brain amyloid β is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. To provide guidance to dementia care practitioners, patients, and caregivers, the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be used appropriately. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific appropriate use criteria (AUC) were agreed on that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes. PMID:23359661

  2. Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial).

    PubMed

    Bradley, Steven M; Chan, Paul S; Hartigan, Pamela M; Nallamothu, Brahmajee K; Weintraub, William S; Sedlis, Steven P; Dada, Marcin; Maron, David J; Kostuk, William J; Berman, Daniel S; Teo, Koon K; Mancini, G B John; Boden, William E; Spertus, John A

    2015-07-15

    Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio 0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among patients classified as appropriate by the AUC, Seattle Angina Questionnaire scores at 1 month were better in the PCI-treated group compared with the medical therapy group (80 ± 23 vs 75 ± 24 for angina frequency, 73 ± 24 vs 68 ± 24 for physical limitations, and 68 ± 23 vs 60 ± 24 for quality of life; all p <0.01), with differences generally persisting through 12 months. In contrast, health status scores were similar throughout the first year of follow-up in PCI + OMT patients compared with OMT alone in patients classified as uncertain or inappropriate. In conclusion, these findings support the validity of the AUC in

  3. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

    Objective To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. Design Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. Main measurements Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. Results Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ≥65; meeting ≥2 deterioration criteria; an index of frailty with ≥2 criteria; early warning score >4; presence of ≥1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. Conclusions An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL. PMID:25613983

  4. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M

    2012-04-01

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  5. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2012-02-28

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  6. Licensing the ACR in the USA - A Status Report

    SciTech Connect

    Snell, Victor; Langman, Vince; Ion, Robert; Reid, Calvin

    2004-07-01

    The ACR-700 (ACR) is an evolutionary reactor design, which incorporates the inherent safety features of the Candu products, as well as the successful operating experience of the current Candu 6 reactors. The improvements to the ACR from Candu 6 result in significant reductions in capital and operating costs as well as enhanced safety. AECL Technologies (AECLT, a wholly owned US subsidiary of Atomic Energy of Canada Limited) is the proponent for the ongoing pre-application review of the ACR with the US Nuclear Regulatory Commission (NRC) in the United States. This pre-application review will be completed shortly and will support an application to the USNRC for Standard Design Certification (SDC). AECL Technologies' overall objective for the pre-application review of the ACR is to obtain an understanding of the scope, cost, and the schedule to obtain a Standard Design Certification for the ACR. The pre-application review will address licensing issues associated with the Candu reactor technologies in ACR that depart from the light water reactor, pressure-vessel based regulatory framework in the USA. Therefore, during the course of the ACR pre-application review, major USNRC issues with the ACR design will be identified early and the scope of the work required to address these concerns, along with associated completion schedules, will be formulated and ultimately agreed upon with the USNRC. AECLT has been informed by the NRC staff that the results of their pre-application review will be documented in a Safety Assessment Report (SAR), which will state whether there are any major impediments to licensing the ACR in the United States. In particular, the SAR should provide confirmation of the licensing criteria applicable to the ACR, provide an assessment of the completeness of AECL's Research and Development (R and D) programs that exist or are planned in support of the ACR, provide an assessment of the suitability for purpose of the computer codes used in the safety

  7. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.

    PubMed

    Douglas, Pamela S; Garcia, Mario J; Haines, David E; Lai, Wyman W; Manning, Warren J; Patel, Ayan R; Picard, Michael H; Polk, Donna M; Ragosta, Michael; Parker Ward, R; Weiner, Rory B

    2011-03-01

    The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns,and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios)were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC).The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general,the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making,healthcare delivery, and reimbursement policy. Furthermore,recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID

  8. AcrS/EnvR Represses Expression of the acrAB Multidrug Efflux Genes in Escherichia coli▿

    PubMed Central

    Hirakawa, Hidetada; Takumi-Kobayashi, Asuka; Theisen, Ulrike; Hirata, Takahiro; Nishino, Kunihiko; Yamaguchi, Akihito

    2008-01-01

    The acrS regulatory gene is located upstream of the acrEF multidrug efflux system genes. However, the roles of AcrS in regulation of drug efflux pumps have not been clearly understood. Here we show that AcrS represses other multidrug efflux genes, acrAB, which encode a major efflux system in Escherichia coli. PMID:18567659

  9. 75 FR 1831 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-13

    ... October 14, 2009 (74 FR 58268-58269). Detailed ACRS meeting agendas and meeting transcripts are available... prior to the meeting, if possible, so that appropriate arrangements can be made. Thirty-five hard copies... compact disk containing each presentation at least 30 minutes before the meeting. Electronic...

  10. 78 FR 79020 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  11. 78 FR 70597 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  12. 78 FR 70598 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  13. 75 FR 57536 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR The ACRS... Safeguards. BILLING CODE 7590-01-P...

  14. ACR CT Accreditation Program and the Lung Cancer Screening Program Designation.

    PubMed

    Kazerooni, Ella A; Armstrong, Mark R; Amorosa, Judith K; Hernandez, Dina; Liebscher, Lawrence A; Nath, Hrudaya; McNitt-Gray, Michael F; Stern, Eric J; Wilcox, Pamela A

    2016-02-01

    The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care. PMID:26846533

  15. Appropriate drinking water treatment processes for organic micropollutants removal based on experimental and model studies - a multi-criteria analysis study.

    PubMed

    Sudhakaran, Sairam; Lattemann, Sabine; Amy, Gary L

    2013-01-01

    The presence of organic micropollutants (OMPs), pharmaceuticals and personal care products (PPCPs) in potable water is of great environmental and public health concern. OMPs are included in the priority list of contaminants in United States EPA and European framework directives. Advanced treatment processes such as reverse osmosis, nanofiltration, ozonation and adsorption are the usual industry-recommended processes for OMPs removal, however, natural systems, e.g., riverbank filtration and constructed wetlands, are also potentially efficient options for OMPs removal. In this study, a decision support system (DSS) based on multi-criteria analysis (MCA) was created to compare processes for OMPs removal under various criteria. Multi-criteria analysis (MCA), a transparent and reliable procedure, was adopted. Models were built for both experimental and predicted percent-removals for a range of OMPs reflecting different physicochemical properties. The experimental percent-removals for several processes (riverbank filtration (RBF), ozonation, advanced oxidation, adsorption, reverse osmosis, and nanofiltration) were considered. The predicted percent-removals were taken from validated quantitative structure activity relationship (QSAR) models. Analytical methods to detect OMPs in water are very laborious, thus a modeling approach such as QSAR is an attractive option. A survey among two groups of participants including academics (PhD students and post-doctoral research associates) and industry (managers and operators) representatives was conducted to assign weights for the following criteria: treatability, costs, technical considerations, sustainability and time. The process rankings varied depending on the contaminant species and personal preferences (weights). The results indicated that RBF and oxidation were preferable over adsorption and membranes processes. The results also suggest that the use of a hybrid treatment process, e.g., combining a natural system with an

  16. 76 FR 32240 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-03

    ... ACRS meetings ] were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  17. 76 FR 52715 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  18. 77 FR 60480 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-03

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation...

  19. 78 FR 17944 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  20. 75 FR 27841 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  1. 76 FR 36160 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-21

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  2. 76 FR 27101 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  3. 75 FR 27840 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  4. 78 FR 20959 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a...

  5. 78 FR 37595 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-21

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  6. 76 FR 34276 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  7. 78 FR 24441 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S....

  8. 77 FR 45699 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on August 14, 2012, Room...

  9. 78 FR 51752 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 18, 2013, Room...

  10. 77 FR 28903 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22, 2012, Room...

  11. 77 FR 59676 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 3, 2012, Room...

  12. 78 FR 2694 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... the Federal Register on Monday, December 17, 2012, (77 FR 74697-74698). Information regarding this... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima; Cancellation of the January 18, 2013, ACRS Subcommittee Meeting The ACRS Subcommittee meeting on...

  13. 77 FR 74697 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on January 18, 2013, Room...

  14. 77 FR 28637 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-15

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22- 23, 2012, Room...

  15. 77 FR 45700 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on August 15, 2012, Room...

  16. TU-A-18C-01: ACR Accreditation Updates in CT, Ultrasound, Mammography and MRI

    SciTech Connect

    Price, R; Berns, E; Hangiandreou, N; McNitt-Gray, M

    2014-06-15

    A goal of an imaging accreditation program is to ensure adequate image quality, verify appropriate staff qualifications, and to assure patient and personnel safety. Currently, more than 35,000 facilities in 10 modalities have been accredited by the American College of Radiology (ACR), making the ACR program one of the most prolific accreditation options in the U.S. In addition, the ACR is one of the accepted accreditations required by some state laws, CMS/MIPPA insurance and others. Familiarity with the ACR accreditation process is therefore essential to clinical diagnostic medical physicists. Maintaining sufficient knowledge of the ACR program must include keeping up-to-date as the various modality requirements are refined to better serve the goals of the program and to accommodate newer technologies and practices. This session consists of presentations from authorities in four ACR accreditation modality programs, including magnetic resonance imaging, mammography, ultrasound, and computed tomography. Each speaker will discuss the general components of the modality program and address any recent changes to the requirements. Learning Objectives: To understand the requirements of the ACR MR accreditation program. The discussion will include accreditation of whole-body general purpose magnets, dedicated extremity systems well as breast MRI accreditation. Anticipated updates to the ACR MRI Quality Control Manual will also be reviewed. To understand the current ACR MAP Accreditation requirement and present the concepts and structure of the forthcoming ACR Digital Mammography QC Manual and Program. To understand the new requirements of the ACR ultrasound accreditation program, and roles the physicist can play in annual equipment surveys and setting up and supervising the routine QC program. To understand the requirements of the ACR CT accreditation program, including updates to the QC manual as well as updates through the FAQ process.

  17. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Ronan, Grace; Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M; Brindis, Ralph G; Kramer, Christopher M; Shaw, Leslee J; Cerqueira, Manuel D; Chen, Jersey; Dean, Larry S; Fazel, Reza; Hundley, W Gregory; Itchhaporia, Dipti; Kligfield, Paul; Lockwood, Richard; Marine, Joseph Edward; McCully, Robert Benjamin; Messer, Joseph V; O'Gara, Patrick T; Shemin, Richard J; Wann, L Samuel; Wong, John B; Patel, Manesh R; Kramer, Christopher M; Bailey, Steven R; Brown, Alan S; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Lindsay, Bruce D; Min, James K; Shaw, Leslee J; Stainback, Raymond F; Wann, L Samuel; Wolk, Michael J; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1-9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG

  18. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1 to 9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram

  19. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

    PubMed Central

    Choi, Byoung Wook; Chan, Carmen; Jinzaki, Masahiro; Tsai, I-Chen; Yong, Hwan Seok; Yu, Wei

    2010-01-01

    There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence. The Asian Society of Cardiovascular Imaging, as the only society dedicated to cardiovascular imaging in Asia, formed a cardiac CT and cardiac MR guideline working group in order to help Asian practitioners to establish cardiac CT and cardiac MR services. In this ASCI cardiac MR appropriateness criteria report, 23 Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in Asia. Indications were rated on a scale of 1–9 to be categorized into ‘appropriate’ (7–9), ‘uncertain’ (4–6), or ‘inappropriate’ (1–3). According to median scores of the 23 members, the final ratings for indications were 24 appropriate, 18 uncertain and 8 inappropriate with 22 ‘highly-agreed’ (19 appropriate and 3 inappropriate) indications. This report is expected to have a significant impact on the cardiac MR practices in many Asian countries by promoting the appropriate use of cardiac MR. Electronic supplementary material The online version of this article (doi:10.1007/s10554-010-9687-z) contains supplementary material, which is available to authorized users. PMID:20734234

  20. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and PRA will hold a meeting... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039)....

  1. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... participation in ACRS meetings were published in the Federal Register on November 8, 2013 (78 FR 67205-67206..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  2. 75 FR 66803 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039)....

  3. 76 FR 11524 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... Boiling Water Reactors (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactors... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-...

  4. 75 FR 30077 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ... Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR The... Reactor Safeguards. BILLING CODE 7590-01-P...

  5. 75 FR 82093 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License Renewal; Notice of Meeting The ACRS Subcommittee on Plant License Renewal will hold a meeting on January 12, 2011, Room T-2B1, 11545 Rockville...

  6. 75 FR 25303 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting on May 19, 2010, Room T-2B1, 11545 Rockville...

  7. 78 FR 20958 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting on April 23, 2013, Room T-2B1, 11545...

  8. 77 FR 5063 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-01

    ... October 17, 2011, (76 FR 64127- 64128). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Thermal-Hydraulics Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal-Hydraulics Phenomena will hold...

  9. 75 FR 82092 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  10. 77 FR 56240 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-12

    ..., (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  11. 77 FR 31044 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-24

    ..., (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  12. 76 FR 34779 - Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on June...

  13. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on...

  14. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on December...

  15. 75 FR 16874 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-02

    ... Register on October 14, 2009, (74 FR 52829-52830). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  16. 75 FR 82093 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  17. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  18. 77 FR 38099 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-26

    ... October 17, 2011, (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  19. 75 FR 58447 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials...

  20. 78 FR 66967 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommitte on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-07

    ..., 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are available on the NRC... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommitte on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  1. 75 FR 4881 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-29

    ... Register on October 14, 2009, (74 FR 52829-52830). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  2. 76 FR 55716 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on...

  3. 76 FR 61119 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and...

  4. 76 FR 5218 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... Register on October 21, 2010 (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water...

  5. 77 FR 76089 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  6. 76 FR 27102 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified...

  7. 77 FR 59678 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... October 17, 2011, (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

  8. 75 FR 52999 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On ESBWR The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on September 23-24, 2010, Room T-2B1, 11545 Rockville...

  9. 76 FR 44377 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... events at the Fukushima Dai-Ichi reactor site in Japan. The Subcommittee will hear presentations by and... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on...

  10. 78 FR 65008 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... published in the Federal Register on October 18, 2012 (77 FR 64146- 64147). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S....

  11. 75 FR 57536 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... were published in the Federal Register on October 14, 2009 (74 FR 58268- 58269). Detailed meeting... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Regulatory Policies and Practices The ACRS Subcommittee on Regulatory Policies and Practices will hold a meeting...

  12. 78 FR 27442 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 23, Room T-2B1,...

  13. 78 FR 17945 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on April 10, 2013, Room...

  14. 77 FR 31676 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ... October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on June 20, 2012, Room...

  15. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Register on October 18, 2012 (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 4, 2012, Room...

  16. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 4, 2013, Room...

  17. 78 FR 65008 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on November 5, 2013, Room...

  18. 77 FR 64147 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-18

    ... published in the Federal Register on October 17, 2011 (76 FR 64126- 64127). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 31, 2012, Room...

  19. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 5, 2012, Room...

  20. 77 FR 52371 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-29

    ... Register on October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 5, 2012, Room...

  1. 78 FR 51752 - Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory..., September 16, 2013--8:30 a.m. Until 5 p.m. The Subcommittee will review the State-of-the-Art Reactor... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147)....

  2. 77 FR 33004 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... White Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  3. 78 FR 12800 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant License... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... White Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  4. 75 FR 58448 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268- 58269... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  5. Appropriateness of diagnostics tests.

    PubMed

    Cappelletti, P

    2016-05-01

    The evolution of the concept of 'appropriateness', in the three past decades, from 'no harm' and 'no waste' to 'medical decision-making' and 'determining outcomes' highlights two main points: its foundation is evidence-based medicine, and it is a quality of every phase of the total testing process, not only for the selection of tests. Nevertheless, appropriateness in Laboratory Hematology, as well as in Laboratory Medicine, is an elusive concept: 'Appropriateness' interplays with 'patient's safety', 'healthcare costs', 'clinical decision-making', and 'effectiveness', and the criteria for appropriateness, mainly adherence to clinical guidelines, are often not evidence-based and not always consensus-based. Moreover, practising appropriateness is a complex issue because of the ambiguity of the criteria and targets, the never-ending work of implementing guidelines and their audit, and the uniqueness of the clinical situation of the individual patient. Authors agree on some practical rules: establishing a multidisciplinary and multiprofessional team, choosing carefully clinical targets, finding or building evidences, sharing guidelines with clinicians, choosing adequate tools for changing, working hard on implementation, identifying the 'right' laboratory methods and processes, checking progress indefinitely, providing information, interpretations, and consultations, and promoting feedback and audits. The success depends on the 'right' combination of educational, operative, and reinforcing interventions. Competences in organization, in implementation science, and in interpersonal relationship management are essential as well as knowledge and experience in Hematology, not only in Laboratory Hematology. PMID:27161094

  6. ARM Cloud Retrieval Ensemble Data Set (ACRED)

    SciTech Connect

    Zhao, C; Xie, S; Klein, SA; McCoy, R; Comstock, JM; Delanoë, J; Deng, M; Dunn, M; Hogan, RJ; Jensen, MP; Mace, GG; McFarlane, SA; O’Connor, EJ; Protat, A; Shupe, MD; Turner, D; Wang, Z

    2011-09-12

    This document describes a new Atmospheric Radiation Measurement (ARM) data set, the ARM Cloud Retrieval Ensemble Data Set (ACRED), which is created by assembling nine existing ground-based cloud retrievals of ARM measurements from different cloud retrieval algorithms. The current version of ACRED includes an hourly average of nine ground-based retrievals with vertical resolution of 45 m for 512 layers. The techniques used for the nine cloud retrievals are briefly described in this document. This document also outlines the ACRED data availability, variables, and the nine retrieval products. Technical details about the generation of ACRED, such as the methods used for time average and vertical re-grid, are also provided.

  7. The Automated Conflict Resolution System (ACRS)

    NASA Technical Reports Server (NTRS)

    Kaplan, Ted; Musliner, Andrew; Wampler, David

    1993-01-01

    The Automated Conflict Resolution System (ACRS) is a mission-current scheduling aid that predicts periods of mutual interference when two or more orbiting spacecraft are scheduled to communicate with the same Tracking and Data Relay Satellite (TDRS) at the same time. The mutual interference predicted has the potential to degrade or prevent communications. Thus the ACRS system is a useful tool for aiding in the scheduling of Space Network (SN) communications.

  8. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels... materials and metallurgy. The Subcommittee will hear presentations by and hold discussions with the...

  9. 76 FR 22934 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on May 11, 2011, Room T-2B3, 11545 Rockville Pike... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038- 65039)....

  10. 76 FR 71609 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on December 14, 2011, Room T-2B3, 11545 Rockville Pike... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64127-...

  11. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on September 20, 2011, Room T-2B1, 11545 Rockville Pike, Rockville... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-...

  12. 78 FR 2695 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... Operations and Fire Protection; Notice of Meeting The ACRS Subcommittee on Plant Operations and Fire... onsite emergency response capabilities such as Emergency Operating Procedures (EOPs), Severe...

  13. 75 FR 61781 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... representatives of the NRC staff, the Nuclear Energy Institute (NEI), and other interested persons regarding this... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available...

  14. 75 FR 71154 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... would result in a major inconvenience. Dated: November 15, 2010. Antonio Dias, Chief, Reactor Safety... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... were published in the Federal Register on October 21, 2010, (75 FR 65038- 65039). Detailed...

  15. 76 FR 27103 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear presentations... were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on...

  16. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear presentations..., (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on...

  17. 78 FR 27442 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant License... October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835)...

  18. 78 FR 27443 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability... were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting... Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  19. 77 FR 36582 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory... October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (240-888-9835) to...

  20. 77 FR 18873 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Regulatory... Subcommittee will review the Draft NUREG Report on the State- of-the-Art Reactor Consequence Analyses (SOARCA... were published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed...

  1. 76 FR 63329 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (240-888-9835) to...

  2. 78 FR 59074 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835)...

  3. 78 FR 31988 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant... Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are... Rockville Pike, Rockville, MD. After registering with security, please contact Mr. Theron Brown...

  4. 75 FR 58447 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant License... Branch A, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  5. 75 FR 52556 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-26

    ..., (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on the NRC Web... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory..., 2010. Cayetano Santos, Chief, Reactor Safety Branch A, Advisory Committee on Reactor...

  6. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation and Controls (I&C) Systems will hold a meeting...

  7. 75 FR 51501 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and Procedures The ACRS Subcommittee on Planning and Procedures will hold a meeting on September 8, 2010,...

  8. The Expanding Significance of One Acre.

    ERIC Educational Resources Information Center

    Gilbert, Daniel R., Jr.

    2003-01-01

    A management class assignment requires students to study the history and complexity of one acre of land. The intent is to develop connections between the natural environment and human acts of management, focusing on the concept of privilege. (Contains 15 references.) (SK)

  9. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Payment acres. 760.632 Section 760.632 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE... considered the same as a planting of an initial crop in tropical regions as defined in part 1437, subpart...

  10. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Payment acres. 760.632 Section 760.632 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE... considered the same as a planting of an initial crop in tropical regions as defined in part 1437, subpart...

  11. Small Break LOCA Analysis of ACR-700 NPP

    SciTech Connect

    Limin Zheng; Sen Shen; Wright, David

    2006-07-01

    A small break loss of coolant accident (SB-LOCA) analysis to assess a preliminary conceptual design of the ACR-700 PHWR nuclear power plant (NPP) developed by AECL has been performed with CATHENA MOD 3.5d, a PHWR system thermal-hydraulic analysis code. The limiting break size has been found by performing a sensitivity study for three different break locations [i.e. reactor inlet header (RIH), HTS pump suction (PS) pipe and reactor outlet head (ROH)] under the limiting case (i.e. SB-LOCA with subsequent loss of class IV power with all safety systems available). The analysis results indicate that the SB-LOCA acceptance criteria are satisfied. (authors)

  12. 77 FR 68160 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... develop a revision to the Station Blackout Rule. The Subcommittee will hear presentations by and hold... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147)....

  13. 77 FR 64563 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-22

    ... efforts to develop a revision to the Station Blackout Rule. The Subcommittee will hear presentations by... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR...

  14. 77 FR 59677 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127... p.m. The Subcommittee will review and discuss SECY-12-0110, ``Consideration of Economic...

  15. 77 FR 47680 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittees on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... published in the Federal Register on Wednesday, August 1, 2012 (77 FR 45698-45699). Further information... and PRA and Fukushima; Revision to Notice of Meetings The (ACRS) Subcommittee on Fukushima...

  16. 78 FR 29159 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-17

    ... published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  17. 76 FR 55718 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web..., Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a...

  18. 76 FR 72451 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... October 17, 2011, (76 FR 64127- 64128). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  19. 78 FR 56756 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-13

    ... were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  20. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ..., (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  1. 77 FR 74698 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  2. 78 FR 34677 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the Acrs Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-10

    ... Register on October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  3. 78 FR 31987 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  4. 75 FR 58449 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are..., Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a...

  5. 78 FR 3474 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-16

    ... October 18, 2012, (77 FR 64146-64147). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor...

  6. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on..., Metallurgy And Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy and...

  7. 75 FR 65036 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-21

    ... protection program transition to National Fire Protection Association (NFPA) Standard 805. The Subcommittee... participation in ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR...

  8. 76 FR 16458 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on April... Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts...

  9. 77 FR 64148 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-18

    ... Reactors,'' Revision 2 and RG 1.79.1, ``Initial Test Program of Emergency Core Cooling Systems for Boiling... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64127-64128)....

  10. 76 FR 18585 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor... October 21, 2010, (75 FR 65038- 65039). Detailed meeting agendas and meeting transcripts are available...

  11. 75 FR 16203 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Power...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-31

    ....'' This supplement extends the GEH/GNF computational methods to include GNF-2 fuel design. The... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR...

  12. 77 FR 24745 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-25

    ... October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are available on... Hydraulic Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal Hydraulic Phenomena will hold...

  13. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... October 14, 2009, (74 FR 58268- 58269). Detailed meeting agendas and meeting transcripts are available on... Hydraulics Phenomena The ACRS Subcommittee on Thermal Hydraulics Phenomena will hold a meeting on September...

  14. 76 FR 44378 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... for Nuclear Power Plants''; NUREG/CR-4461, Revision 2, ``Tornado Climatology of the Contiguous...

  15. Radiology practice models: the 2008 ACR Forum.

    PubMed

    Gunderman, Richard B; Weinreb, Jeffrey C; Van Moore, Arl; Hillman, Bruce J; Neiman, Harvey L; Thrall, James H

    2008-09-01

    The 2008 ACR Forum brought together a diverse group of participants from clinical radiology, radiology leadership and practice management, managed care, economics, law, and entrepreneurship in Washington, DC, in January 2008 to discuss current models of radiology practice and anticipate new ones. It addressed what forces shape the practice of radiology, how these forces are changing, and how radiology practices can most effectively respond to them in the future. PMID:18755435

  16. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Notification of base acres. 1412.44 Section 1412.44... through 2012 § 1412.44 Notification of base acres. The operator and owners of record of a farm will be notified in writing of the number of base acres eligible for enrollment in a contract, unless such...

  17. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Election of base acres. 1412.21 Section 1412.21... CROP REVENUE ELECTION PROGRAM FOR THE 2008 AND SUBSEQUENT CROP YEARS Establishment of Base Acres for a Farm for Covered Commodities § 1412.21 Election of base acres. (a) Subject to adjustments in...

  18. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039.... Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor...

  19. 76 FR 5220 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on February 9, 2011, at...

  20. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... ACRS meetings were published in the Federal Register on October 21, 2010 (75 FR 65038-65039). Detailed... Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on April 5, 2011, at...

  1. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... identification of digital system failure modes and use of hazard analysis methods for digital safety systems. The... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital...

  2. 75 FR 16203 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on EPR; Notice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-31

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on EPR; Notice of Meeting The ACRS Subcommittee on the U.S. Evolutionary Power Reactor (EPR) will hold a meeting on April 20-21, 2010, at 11545 Rockville Pike, T2-...

  3. 76 FR 7882 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation & Control (DI&C) Systems will hold a meeting on February 23, 2011, Room T-2B3, 11545...

  4. 75 FR 67783 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-03

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and Procedures The ACRS Subcommittee on Planning and Procedures will hold a meeting on December 1, 2010, in Room... conduct of the meeting, persons planning to attend should check with these references if such...

  5. 76 FR 23630 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ..., Reactor Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR...

  6. 75 FR 82094 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on January...

  7. 76 FR 16458 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a meeting on April 5, 2011, Room T-2B3, 11545...

  8. 76 FR 27102 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... follows: Friday, May 27, 2011--8:30 a.m. Until 5 p.m. The Subcommittee will review Chapter 5,...

  9. 78 FR 12800 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room....

  10. 78 FR 31987 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146-64147... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room. Dated: May...

  11. 77 FR 67688 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C... Instrumentation and Control of the Babcock & Wilcox (B&W) mPower reactor. The Subcommittee will hear presentations... participation in ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR...

  12. 77 FR 10784 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... were published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed...

  13. 77 FR 36581 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor... October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and meeting transcripts are available...

  14. 77 FR 36583 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and... participation in ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126- 64127... security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room. Dated: June...

  15. 77 FR 33003 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C... for reviewing the mPower reactor. The Subcommittee will hear presentations by and hold discussions... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127)....

  16. 75 FR 74103 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038- 65039... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000; Notice... exception of portions that may be closed to protect unclassified safeguards information, pursuant to 5...

  17. 75 FR 55366 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning And...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning And... Branch A, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  18. 75 FR 81318 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of The ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of The ACRS Subcommittee on AP1000; Notice... Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  19. 76 FR 11525 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA), Room T-2B1, 11545 Rockville Pike, Rockville, Maryland. The entire meeting... published in the Federal Register on October 21, 2010, (75 FR 65038- 65039). Detailed meeting agendas...

  20. 76 FR 18586 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on April 20, 2011, Room T-2B1, 11545 Rockville Pike... published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas...

  1. 75 FR 66803 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... ACRS meetings were ] published in the Federal Register on October 14, 2009, (74 FR 58268- 58269... with the NRC staff, AREVA, UniStar, and other interested persons. The Subcommittee will gather... rescheduling would result in a major inconvenience. Dated: October 21, 2010. Antonio F. Dias, Chief,...

  2. 75 FR 55365 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ..., (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on the NRC Web... Operations and Fire Protection The ACRS Subcommittee on Plant Operations and Fire Protection will hold a..., October 6, 2010--8:30 a.m. until 12 p.m. The subcommittee will discuss the construction, inspection,...

  3. 76 FR 38212 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-29

    ... published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and... Operations and Fire Protection; Notice of Meeting The ACRS Subcommittee on Plant Operations and Fire... Region II to discuss the construction inspection program at the Vogtle site and discuss other items...

  4. 75 FR 44818 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-29

    ... Racks,'' NEDC- 33374P, ``Safety Analysis Report for Fuel Storage Racks Criticality Analysis for ESBWR... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... Subcommittee will discuss Chapters 2, 10, 12, 14, 15, 16, 18, 20, and 21 of the final Safety Evaluation...

  5. 76 FR 62866 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-11

    ..., (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web... Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on October 21, 2011, Room T-2B1, 11545 Rockville...

  6. 76 FR 68793 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-07

    ... published in the Federal Register on October 17, 2011, (76 FR 64127-64128). Detailed meeting agendas and... Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on November 30, 2011, Room T-2B1, 11545 Rockville...

  7. 77 FR 45699 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... ACRS meetings were published in the Federal Register on October 17, 2011, (76 FR 64126-64127). Detailed... and/or written comments should notify the Designated Federal Official (DFO), Christopher Brown (Telephone 301-415-7111 or Email: Christopher.Brown@nrc.gov ) five days prior to the meeting, if possible,...

  8. 75 FR 28824 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on APWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-24

    .... Detailed procedures for the conduct of and participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are... From the Federal Register Online via the Government Publishing Office NUCLEAR...

  9. 75 FR 57536 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and... Hydraulic Phenomena The ACRS Subcommittee on Thermal Hydraulic Phenomena will hold a meeting on October 18... 5 p.m. The Subcommittee will review the thermal-hydraulic research activities in the Office...

  10. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Bailey, Steven R; Bonow, Robert O; Chambers, Charles E; Chan, Paul S; Dehmer, Gregory J; Kirtane, Ajay J; Wann, L Samuel; Ward, R Parker

    2012-05-29

    The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22578925

  11. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology: Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2009-03-10

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  12. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization : a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Brindis, Ralph G; Beckman, Karen J; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Allen, Joseph M; Douglas, Pamela S; Hendel, Robert C; Peterson, Eric D

    2009-02-15

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  13. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2009-02-10

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  14. High-speed ACR/NEMA interface

    NASA Astrophysics Data System (ADS)

    Reijns, Gerard L.; Santilli, D.; Schellingerhout, G.; Jochem, A. J.; Ottes, Fenno P.; van Aken, I. W.

    1990-08-01

    The design and implementation of a standard high speed ACR-NEMA communications interface is described. The upper layers e.g. the Presentation layer, Session layer and part of the Transport/Network layer have been implemented in software. In order to reach the speed requirement of 8M byte/sec. the lower layers e.g. part of the Transport/Network layer and Data Link layer have been implemented in hardware. We have developed and built an interface for an IBM personal computer P5/2 model 50, working under the operating system OS/2. The PS/2, model 50 has been equipped with a fast micro-channel bus, which enables a large throughput. The operating systern OS/2 has a multitasking capability, which enables concurrent programming. In order to minimize the delays, we used this multitasking facility to create a number of parallel operating "threads". The Transport/Network layer functions have been implemented using a receive thread, two send threads and a device driver with three hardware registers. The time to transfer a packet by DMA, to initiate the DMA logic and to execute the required Kernal functions have each been measured and figures are shown. The Data Link layer provides for storage of two packets in two separate random access memories (RAM's). These two RAM's enable a pipelined operation, which minimizes the delay in the Data Link layer.

  15. 77 FR 36017 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-15

    ...; Cancellation of the June 19, 2012 ACRS Subcommittee Meeting The ACRS Subcommittee meeting on Digital I&C scheduled for June 19, 2012 has been cancelled. The notice of this meeting was previously published in the Federal Register on Monday, June 4, 2012, (77 FR 33003-33004). Information regarding this meeting can...

  16. 76 FR 78951 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-20

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and... October 17, 2011, (76 FR 64127- 64128). Information regarding topics to be discussed, changes to the... with security, please contact Mr. Theron Brown (Telephone (240) 888- 9835) to be escorted to...

  17. 76 FR 64123 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and... Register on October 21, 2010 (75 FR 65038-65039). Information regarding topics to be discussed, changes to... with security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting room....

  18. 77 FR 68160 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and..., (77 FR 64146- 64147). Information regarding changes to the agenda, whether the meeting has been... registering with security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting...

  19. 76 FR 64123 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant..., (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on the NRC Web..., MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835) to...

  20. 78 FR 59076 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR... were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting... Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  1. 77 FR 59677 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Planning and..., (76 FR 64126- 64127). Information regarding changes to the agenda, whether the meeting has been... registering with security, please contact Mr. Theron Brown (240-888-9835) to be escorted to the meeting...

  2. 77 FR 36582 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Plant License...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Plant License... October 17, 2011, (76 FR 64126- 64127). Detailed meeting agendas and meeting transcripts are available on..., Rockville, MD. After registering with security, please contact Mr. Theron Brown (Telephone 240-888-9835)...

  3. 75 FR 57537 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000 The...: September 15, 2010. Antonio Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor...

  4. 76 FR 44377 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). ] Detailed meeting... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on AP1000..., Technical Support Branch, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  5. 75 FR 52556 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-26

    ... October 14, 2009, (74 FR 58268-58269). ] Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on AP1000 The... a portion that may be closed to protect unclassified safeguards information or information that...

  6. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... of production flexibility contract acres or base acres protected by a Conservation Reserve...

  7. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... of production flexibility contract acres or base acres protected by a Conservation Reserve...

  8. Assessment of Low-Contrast Resolution for the ACR CT Accreditation Program: What is the Impact of Iterative Reconstruction?

    PubMed Central

    Kofler, James M.; Yu, Lifeng; Leng, Shuai; Zhang, Yi; Li, Zhoubo; Carter, Rickey E.; McCollough, Cynthia H.

    2015-01-01

    Objective To compare contrast-to-noise ratio (CNR) thresholds with visual assessment of low-contrast resolution (LCR) in filtered-backprojection (FBP) and iteratively-reconstructed (IR) CT images. Methods ACR CT accreditation phantom LCR images were acquired at CTDIvol levels of 8, 12, and 16 mGy using two scanner models and reconstructed using one FBP and two IR kernels. Acquisitions were repeated 100 times. Three board-certified medical physicists blindly reviewed the LCR-section images. Pass-percentage rates (PPRs) using previous and current ACR CT accreditation criteria were compared. Results Observer PPRs for FBP images were <32%. For IR images, 5/18 settings/dose/model configurations had PPRs >32% (maximum 76.3%). For CNR evaluation of FBP images, PPRs for 15 configurations were >70%. For IR images, all PPRs were ≥96%. Conclusions The CNR threshold used by the ACR CT accreditation program yields higher PPRs than visual assessment of LCR, potentially resulting in lower quality images passing the ACR CNR criteria. PMID:25853774

  9. Criteria for Developing Criteria Sets.

    ERIC Educational Resources Information Center

    Martin, James L.

    Criteria sets are a necessary step in the systematic development of evaluation in education. Evaluation results from the combination of criteria and evidence. There is a need to develop explicit tools for evaluating criteria, similar to those used in evaluating evidence. The formulation of such criteria depends on distinguishing between terms…

  10. 130. Julian Price Memorial Park. Fortyseven acre Julian Price Lake ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    130. Julian Price Memorial Park. Forty-seven acre Julian Price Lake created by an impoundment. Looking west. - Blue Ridge Parkway, Between Shenandoah National Park & Great Smoky Mountains, Asheville, Buncombe County, NC

  11. 6. View northeast of Ten Acre Lot with Joseph Fry ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. View northeast of Ten Acre Lot with Joseph Fry Farm complex (center) and Beehive House (right)in the background - Joseph Fry Farm Landscape, 2153 South County Trail Road (U.S. Route 2), East Greenwich, Kent County, RI

  12. 75 FR 61781 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed... obtained from the website cited above or by contacting the identified DFO. Moreover, in view of...

  13. 76 FR 4739 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-26

    ... Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are.... Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a...

  14. 76 FR 22935 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting.... Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor...

  15. 76 FR 11525 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on.... Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a...

  16. 77 FR 4838 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-31

    ... October 17, 2011, (76 FR 64127- 64128). Detailed meeting agendas and meeting transcripts are available on.... Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary...

  17. 76 FR 67232 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-31

    ... October 17, 2011, (76 FR 64126-64127). Detailed meeting agendas and meeting transcripts are available on.... Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor...

  18. 10 CFR 60.122 - Siting criteria.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Siting criteria. 60.122 Section 60.122 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Technical Criteria Siting Criteria § 60.122 Siting criteria. (a)(1) A geologic setting shall exhibit an appropriate combination of the...

  19. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Aderholt, Robert B. [R-AL-4

    2011-05-26

    09/30/2011 Became Public Law No: 112-33. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 10/4/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  20. Continuing Appropriations Resolution, 2015

    THOMAS, 113th Congress

    Rep. Rogers, Harold [R-KY-5

    2014-09-09

    09/19/2014 Became Public Law No: 113-164. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 12/11/2014. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  1. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Graves, Sam [R-MO-6

    2011-07-21

    10/05/2011 Became Public Law No: 112-36. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 11/18/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  2. Appropriate Educational Technology.

    ERIC Educational Resources Information Center

    Gregory, Ivan D.

    1982-01-01

    Identifies 16 issues considered significant in the planning of educational projects and offers to assist in the selection of the most appropriate media and in the design of software. Twenty references are listed. (LLS)

  3. Omnibus Appropriations Act, 2009

    THOMAS, 111th Congress

    Rep. Obey, David R. [D-WI-7

    2009-02-23

    03/11/2009 Became Public Law No: 111-8. (TXT | PDF) (All Actions) Notes: An explanatory statement was submitted by Mr. Obey, Chairman of the House Committee on Appropriations "as if it were a joint explanatory statement of a committee of conference." See the statement in the 2/23/2009 Congressional Record or in the House Appropriations committee print. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  4. ACRS elections can minimize taxes on oil and gas income

    SciTech Connect

    Bandy, D.

    1983-06-01

    The Accelerated Cost Recovery System (ACRS) is composed of elections which make either increases or decreases on oil and gas income possible. Current taxes can be elected to be reduced, but future taxes will be increased as a result of that decision. The various decisions that can be made on ACRS elections and the impact they will make on taxes are discussed, using an after-tax rate of return and showing the before- and after-tax returns when possible. Pertinent areas of discussion include full investment credit vs. full basis; equipment trade-in considerations; factors to be considered in the disposition of real estate; and the impact of alternative minimum tax on ACRS elections. 3 tables.

  5. Consolidated Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Culberson, John Abney [R-TX-7

    2011-05-31

    12/23/2011 Became Public Law No: 112-74. (TXT | PDF) (All Actions) Notes: The measure is the vehicle for making appropriations for most federal government operations for the remainder of FY2012. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  6. Continuing Appropriations Act, 2014

    THOMAS, 113th Congress

    Rep. Black, Diane [R-TN-6

    2013-07-22

    10/17/2013 Became Public Law No: 113-46. (TXT | PDF) (All Actions) Notes: The final version of the bill makes continuing appropriations through January 15, 2014, thus ending the government shutdown, and increases the debt limit through February 7, 2014. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  7. 24 CFR 1710.9 - Twenty acre lots.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Twenty acre lots. 1710.9 Section 1710.9 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR HOUSING-FEDERAL HOUSING COMMISSIONER, DEPARTMENT OF HOUSING AND...

  8. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) No later than April 1, 2009, owners on a farm may establish base acres for pulse crops. (1) Subject... pulse crops are equal to the sum of the following: (i) The 4-year average of the acreage planted or prevented planted to the pulse crops during each of the 1998 through 2001 crop years for harvest,...

  9. "Forty Acres and a Mule" as a Pedagogical Motif

    ERIC Educational Resources Information Center

    Burch, Kerry

    2008-01-01

    This essay revisits an iconic yet now languishing phrase in United States political culture--"Forty Acres and a Mule"--to clarify the meaning of freedom and to assess the contemporary meaning of its betrayal by the U.S. government immediately after the Civil War. Among the few citizens for whom the phrase still retains a semblance of…

  10. ACR Electrical Systems. Teacher Edition [and] Student Edition.

    ERIC Educational Resources Information Center

    Clemons, Mark

    This document contains a teacher's guide and student guide for a high school-level competency-based course in air conditioning and refrigeration (ACR) equipment electrical systems. Presented in the teacher's guide are the following: explanation of the instructional units' use; competency profile for recording students' performance of the tasks in…

  11. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) No later than April 1, 2009, owners on a farm may establish base acres for pulse crops. (1) Subject... Administrator. (c) Subject to paragraph (d) of this section, the total acreage of a pulse crop on the farm...) of this section results in a negative number, the pulse crop acreage on the farm for that crop...

  12. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...) No later than April 1, 2009, owners on a farm may establish base acres for pulse crops. (1) Subject... Administrator. (c) Subject to paragraph (d) of this section, the total acreage of a pulse crop on the farm...) of this section results in a negative number, the pulse crop acreage on the farm for that crop...

  13. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) No later than April 1, 2009, owners on a farm may establish base acres for pulse crops. (1) Subject... Administrator. (c) Subject to paragraph (d) of this section, the total acreage of a pulse crop on the farm...) of this section results in a negative number, the pulse crop acreage on the farm for that crop...

  14. Consolidated Appropriations Act, 2010

    THOMAS, 111th Congress

    Rep. Olver, John W. [D-MA-1

    2009-07-22

    12/16/2009 Became Public Law No: 111-117. (TXT | PDF) (All Actions) Notes: The conference report on the bill includes provisions for 6 of the 12 FY2010 appropriations: Transportation-HUD; Commerce-Justice-Science; Financial Services; Labor-HHS; Military Construction-VA; and State-Foreign Operations. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  15. 75 FR 28823 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-24

    ... ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR 58268- 58269). Detailed... oral statements and/or written comments should notify the Designated Federal Official (DFO), Peter Wen (Telephone 301-415-2832 or E-mail ( Peter.Wen@nrc.gov ) five days prior to the meeting, if possible, so...

  16. 75 FR 66401 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-28

    ...; Revision to October 21, 2010, ACRS Meeting Federal Register Notice The Federal Register Notice for the..., October 21, 2010, . All other items remain the same as previously published. Further information regarding...- 6279, E-mail: Weidong.Wang@nrc.gov between 7:30 a.m. and 5:15 p.m. (ET)). Dated: October 21,...

  17. 78 FR 8202 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY... and/or written comments should notify the Designated Federal Official (DFO), Girija Shukla...

  18. 76 FR 62867 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-11

    ... procedures for the conduct of and participation in ACRS meetings were published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and meeting transcripts are available on... From the Federal Register Online via the Government Publishing Office NUCLEAR...

  19. Significance of Breast Lesion Descriptors in the ACR BI-RADS MRI Lexicon

    PubMed Central

    Agrawal, Garima; Su, Min-Ying; Nalcioglu, Orhan; Feig, Stephen A.; Chen, Jeon-Hor

    2009-01-01

    In recent years, dynamic contrast enhanced MRI (DCE-MRI) has altered the clinical management for women with breast cancer. In March 2007, the American Cancer Society (ACS) issued a new guideline recommending annual MRI screening for high-risk women. This guideline is expected to substantially increase the number of women each year who receive breast MRI. The diagnosis of breast MRI involves the description of morphological and enhancement kinetics features. To standardize the communication language, the Breast Imaging-Reporting and Data System (BI-RADS) MRI lexicon was developed by the American College of Radiology (ACR). In this article, we will review various appearances of breast lesions on MRI using the standardized terms of ACR BI-RADS MRI lexicon. The purpose is to familiarize all medical professionals with the breast MRI lexicon, since the use of this imaging modality is rapidly growing in the field of breast disease. Using this common language, a comprehensive analysis of both morphological and kinetic features used in image interpretation will help radiologists and other clinicians to communicate more clearly and consistently. This may in turn help physicians and patients to jointly select an appropriate management protocol for each patient’s clinical situation. PMID:19197974

  20. Appropriate technology for birth.

    PubMed

    1985-08-24

    In April 1985, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) sponsored an interdisciplinary conference on appropriate technology for birth. A lengthy list of recommendations, reprinted in this article, was unanimously adopted by the conferees. Among the considerations addressed by the recommendations are a woman's right to exercise control over conditions of labor and delivery; the importance of communication between women, their families, and health personnel; and the need to make judicious use of technologies such as fetal monitoring. A network of evaluation groups to assess new technologies, sponsored by WHO and PAHO, is advocated. PMID:2863457

  1. 78 FR 2694 - Meeting of the ACRS Subcommittee on Planning and Procedures; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ..., (77 FR 64146-64147). Information regarding changes to the agenda, whether the meeting has been... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and... Reactor Safeguards. BILLING CODE 7590-01-P...

  2. 76 FR 57082 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-15

    ..., Metallurgy & Reactor Fuels Revision to September 21, 2011, ACRS Meeting; Federal Register Notice The Federal Register Notice for the ACRS Subcommittee Meeting on Materials, Metallurgy and Reactor Fuels is...

  3. 76 FR 9835 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-22

    ... Instrumentation & Control (DI&C); Revision to February 23, 2011, ACRS Meeting Federal Register Notice The Federal Register Notice for the ACRS Subcommittee Meeting on Digital Instrumentation & Control (DI&C) scheduled...

  4. Two chip ACR-NEMA datalink/physical layer implementation

    NASA Astrophysics Data System (ADS)

    DeJarnette, Wayne T.

    1990-08-01

    A high performance ACR-NEMA computer interface board for the IBM PC/AT bus will be described. The interface board (AT/NSIF) implements the transport/network thru physical layers of the R-NEW standard. The interface board also supplies a session layer mapping function. The session layer mapping function, the transport/network layer protocol and the datalink layer protocol are implented via an on board microprocessor and resident firmware. The interface board makes use of a pair of gate arrays to implement the datalink frame checksum calculation and the physical layer protocol. The two gate array datalink/physical layer implementation will be described. One gate array interfaces the ACR-NEMA EIA-485 transceivers to high speed buffer memory. This gate array, the Datalink/Physical Layer Pipeline Processor (DLPP), is responsible for the ACR-NEMA physical layer word transfer protocol as well as the physical layer parity calculation. The DLPP also handles the datalink layer checksum calculation in real time. The second gate array, the Datalink/Physical Layer Controller (DLC), contains control and status registers for controlling and monitoring the DLPP. The PLC is also responsible for managing the CR-NEM physical layer interface arbitration. Performance measurements for the Datalink/Physical Layer Pipeline Processor will be detailed. AT/PASIF board level point to point communication performance measurements will be described.

  5. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the ACRS. The...

  6. 76 FR 40406 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Plant Operations...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Plant Operations and Fire Protection; Revision to an ACRS Subcommittee Meeting Federal Register Notice The Federal Register Notice for the ACRS Subcommittee Meeting...

  7. Comparison of the American-European Consensus Group Sjögren's syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterized sicca cohort

    PubMed Central

    Rasmussen, Astrid; Ice, John A.; Li, He; Grundahl, Kiely; Kelly, Jennifer A.; Radfar, Lida; Stone, Donald U.; Hefner, Kimberly S.; Anaya, Juan-Manuel; Rohrer, Michael; Gopalakrishnan, Rajaram; Houston, Glen D.; Lewis, David M.; Chodosh, James; Harley, John B.; Hughes, Pamela; Maier-Moore, Jacen S.; Montgomery, Courtney G.; Rhodus, Nelson L.; Farris, A. Darise; Segal, Barbara M.; Jonsson, Roland; Lessard, Christopher J.; Scofield, R. Hal; Moser Sivils, Kathy L.

    2013-01-01

    Objective To compare the performance of the American-European Consensus Group (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome in a well-characterized sicca cohort, given ongoing efforts to resolve discrepancies and weaknesses in the systems. Methods In a multidisciplinary clinic for the evaluation of sicca, we assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR criteria in 646 participants. Global gene expression profiles were compared in a subset of 180 participants. Results Application of the AECG and ACR criteria resulted in classification of 279 and 268 participants with SS, respectively. Both criteria were met by 244 participants (81%). In 26 of the 35 AECG+/ACR- participants, the minor salivary gland biopsy focal score was ≥1 (74%), while 9 had positive anti-Ro/La (26%). There were 24 AECG-/ACR+ who met ACR criteria mainly due to differences in the scoring of corneal staining. All patients with SS, regardless of classification, had similar gene expression profiles, which were distinct from the healthy controls. Conclusion The two sets of classification criteria yield concordant results in the majority of cases and gene expression profiling suggests that patients meeting either set of criteria are more similar to other SS participants than to healthy controls. Thus, there is no clear evidence for increased value of the new ACR criteria over the old AECG criteria from the clinical or biological perspective. It is our contention, supported by this report, that improvements in diagnostic acumen will require a more fundamental understanding of the pathogenic mechanisms than is at present available. PMID:23968620

  8. Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions.

    PubMed

    Jeong, Hae Woong; Her, Minyoung; Bae, Jong Seok; Kim, Seong-Kyu; Lee, Sung Won; Kim, Ho Kyun; Kim, Dongyook; Park, Nayoung; Chung, Won Tae; Lee, Sang Yeob; Choe, Jung-Yoon; Kim, In Joo

    2015-05-01

    The purpose of this study was to identify the characteristic magnetic resonance imaging (MRI) findings in neuropsychiatric systemic lupus erythematosus (NPSLE) and to investigate the association between MRI findings and neuropsychiatric manifestations in SLE. Brain MRIs with a diagnosis of SLE from 2002 to 2013 from three tertiary university hospitals were screened. All clinical manifestations evaluated by brain MRI were retrospectively reviewed. If the clinical manifestations were compatible with the 1999 NPSLE American College of Rheumatology (ACR) nomenclature and case definitions, the brain MRIs were assessed for the presence of white matter hyperintensities, gray matter hyperintensities, parenchymal defects, atrophy, enhancement, and abnormalities in diffusion-weighted images (DWI). The number, size, and location of each lesion were evaluated. The neuropsychiatric manifestation of each brain MRI was classified according to the 1999 ACR NPSLE case definitions. The associations between MRI findings and NPSLE manifestations were examined. In total, 219 brain MRIs with a diagnosis of SLE were screened, and 133 brain MRIs met the inclusion criteria for NPSLE. The most common MRI abnormality was white matter hyperintensities, which were observed in 76 MRIs (57.1 %). Gray matter hyperintensities were observed in 41 MRIs (30.8 %). Parenchymal defects were found in 31 MRIs (23.3 %), and atrophy was detected in 20 MRIs (15.0 %). Patients who had seizures were more associated with gray matter hyperintensities than patients with other neuropsychiatric manifestations. Patients with cerebrovascular disease were more associated with gray matter hyperintensity, parenchymal defects, and abnormal DWI than patients with other neuropsychiatric manifestations. In addition to white matter hyperintensities, which were previously known as SLE findings, we also noted the presence of gray matter hyperintensities, parenchymal defects, and abnormal DWI in a substantial portion of SLE

  9. Criteria for software modularization

    NASA Technical Reports Server (NTRS)

    Card, David N.; Page, Gerald T.; Mcgarry, Frank E.

    1985-01-01

    A central issue in programming practice involves determining the appropriate size and information content of a software module. This study attempted to determine the effectiveness of two widely used criteria for software modularization, strength and size, in reducing fault rate and development cost. Data from 453 FORTRAN modules developed by professional programmers were analyzed. The results indicated that module strength is a good criterion with respect to fault rate, whereas arbitrary module size limitations inhibit programmer productivity. This analysis is a first step toward defining empirically based standards for software modularization.

  10. Criteria for Behçet's disease with reflections on all disease criteria.

    PubMed

    Yazici, Hasan; Yazici, Yusuf

    2014-01-01

    With no specific histologic, laboratory or imaging features the diagnosis/classification of Behçet's Disease (BD) remains clinical. As such, disease criteria are needed. The International Study Group Criteria set is the most widely used. It has some limitations, especially in telling BD from Crohn's disease. On the other hand the main issue, as it also applies to many of the other criteria sets in rheumatology, is our lack of appreciation of a list of misconceptions--some examples of which are unluckily also found in the 2010 ACR/EULAR RA Criteria set--about diagnostic/classification criteria making and their implementation. 1. The view that classification and diagnostic criteria should be different is ill advised in that the cerebral/arithmetic basis of both are the same. 2. The default promise of diagnostic criteria to come once we formulate a classification criteria set is an extension of the previous misconception. 3.Taking pains to avoid circularity in criteria making is unwarranted since the essence of criteria making is circular. In addition we fail to exploit the utility of the disease criteria in ruling out, rather than ruling in, the diseases we seek. Finally we also fail to appreciate the paramount importance of the Bayesian prior (the pretest) probability in formulating and implementing these disease criteria. To formulate criteria tailored to subspecialties, as well as giving the often forgotten family history more importance in our criteria sets are some ways to improve the prior probability on which our diagnostic/classification decisions will be based. We first have to reconcile with ourselves that probabilities are very important in our practice and research. Moreover that reconciliation must also be shared with the public, which includes our patients. PMID:24461382

  11. Substrate-dependent dynamics of the multidrug efflux transporter AcrB of Escherichia coli.

    PubMed

    Yamamoto, Kentaro; Tamai, Rei; Yamazaki, Megumi; Inaba, Takehiko; Sowa, Yoshiyuki; Kawagishi, Ikuro

    2016-01-01

    The resistance-nodulation-cell division (RND)-type xenobiotic efflux system plays a major role in the multidrug resistance of gram-negative bacteria. The only constitutively expressed RND system of Escherichia coli consists of the inner membrane transporter AcrB, the membrane fusion protein AcrA, and the outer membrane channel TolC. The latter two components are shared with another RND-type transporter AcrD, whose expression is induced by environmental stimuli. Here, we demonstrate how RND-type ternary complexes, which span two membranes and the cell wall, form in vivo. Total internal reflection fluorescence (TIRF) microscopy revealed that most fluorescent foci formed by AcrB fused to green fluorescent protein (GFP) were stationary in the presence of TolC but showed lateral displacements when tolC was deleted. The fraction of stationary AcrB-GFP foci decreased with increasing levels of AcrD. We propose that the AcrB-containing complex becomes unstable upon the induction of AcrD, which presumably replaces AcrB, a process we call "transporter exchange." This instability is suppressed by AcrB-specific substrates, suggesting that the ternary complex is stabilised when it is in action. These results suggest that the assembly of the RND-type efflux system is dynamically regulated in response to external stimuli, shedding new light on the adaptive antibiotic resistance of bacteria. PMID:26916090

  12. Substrate-dependent dynamics of the multidrug efflux transporter AcrB of Escherichia coli

    PubMed Central

    Yamamoto, Kentaro; Tamai, Rei; Yamazaki, Megumi; Inaba, Takehiko; Sowa, Yoshiyuki; Kawagishi, Ikuro

    2016-01-01

    The resistance-nodulation-cell division (RND)-type xenobiotic efflux system plays a major role in the multidrug resistance of gram-negative bacteria. The only constitutively expressed RND system of Escherichia coli consists of the inner membrane transporter AcrB, the membrane fusion protein AcrA, and the outer membrane channel TolC. The latter two components are shared with another RND-type transporter AcrD, whose expression is induced by environmental stimuli. Here, we demonstrate how RND-type ternary complexes, which span two membranes and the cell wall, form in vivo. Total internal reflection fluorescence (TIRF) microscopy revealed that most fluorescent foci formed by AcrB fused to green fluorescent protein (GFP) were stationary in the presence of TolC but showed lateral displacements when tolC was deleted. The fraction of stationary AcrB-GFP foci decreased with increasing levels of AcrD. We propose that the AcrB-containing complex becomes unstable upon the induction of AcrD, which presumably replaces AcrB, a process we call “transporter exchange.” This instability is suppressed by AcrB-specific substrates, suggesting that the ternary complex is stabilised when it is in action. These results suggest that the assembly of the RND-type efflux system is dynamically regulated in response to external stimuli, shedding new light on the adaptive antibiotic resistance of bacteria. PMID:26916090

  13. The ACR BI-RADS® Experience: Learning From History

    PubMed Central

    Burnside, Elizabeth S.; Sickles, Edward A.; Bassett, Lawrence W.; Rubin, Daniel L.; Lee, Carol H.; Ikeda, Debra M.; Mendelson, Ellen B.; Wilcox, Pamela A.; Butler, Priscilla F.; D’Orsi, Carl J.

    2011-01-01

    The Breast Imaging Reporting and Data System® (BI-RADS®) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future. PMID:19945040

  14. CLUSTERING CRITERIA AND MULTIVARIATE NORMAL MIXTURES

    EPA Science Inventory

    New clustering criteria for use when a mixture of multivariate normal distributions is an appropriate model are presented. They are derived from maximum likelihood and Bayesian approaches corresponding to different assumptions about the covariance matrices of the mixture componen...

  15. The active commuting route environment scale (ACRES): development and evaluation

    PubMed Central

    2010-01-01

    Background Route environments can be a potentially important factor in influencing people's behaviours in relation to active commuting. To better understand these possible relationships, assessments of route environments are needed. We therefore developed a scale; the Active Commuting Route Environment Scale (ACRES), for the assessment of bicyclists' and pedestrians' perceptions of their commuting route environments. Here we will report on the development and the results of validity and reliability assessments thereof. Methods Active commuters (n = 54) were recruited when they bicycled in Stockholm, Sweden. Traffic planning and environmental experts from the Municipality of Stockholm were assembled to form an expert panel (n = 24). The active commuters responded to the scale on two occasions, and the expert panel responded to it once. To test criterion-related validity, differences in ratings of the inner urban and suburban environments of Greater Stockholm were compared between the experts and the commuters. Furthermore, four items were compared with existing objective measures. Test-retest reproducibility was assessed with three types of analysis: order effect, typical error and intraclass correlation. Results There was a concordance in sizes and directions of differences in ratings of inner urban and suburban environments between the experts and the commuters. Furthermore, both groups' ratings were in line with existing objectively measured differences between the two environmental settings. Order effects between test and retest were observed in 6 of 36 items. The typical errors ranged from 0.93 to 2.54, and the intraclass correlation coefficients ranged from 'moderate' (0.42) to 'almost perfect' (0.87). Conclusions The ACRES was characterized by considerable criterion-related validity and reasonable test-retest reproducibility. PMID:20609250

  16. Substrate path in the AcrB multidrug efflux pump of Escherichia coli

    PubMed Central

    Husain, Fasahath; Nikaido, Hiroshi

    2010-01-01

    A major tripartite multidrug efflux pump of Escherichia coli, AcrAB-TolC, confers resistance to a wide variety of compounds. The drug molecule is captured by AcrB probably from the periplasm or the periplasm/inner membrane interface, and is passed through AcrB and then TolC to the medium. Currently there exist numerous crystallographic and mutation data concerning the regions of AcrB and its homologs that may interact with substrates. Starting with these data, we devised fluorescence assays in whole cells to determine the entire substrate path through AcrB. We tested 48 residues in AcrB along the predicted substrate path and 25 gave positive results, based on the covalent labeling of cysteine residues by a lipophilic dye-maleimide and the blocking of Nile Red efflux by covalent labeling with bulky maleimide reagents. These residues are all located in the periplasmic domain, in regions we designate as the lower part of the large external cleft, the cleft itself, the crystallographically defined binding pocket, and the gate between the pocket and the funnel. Our observations suggest that the substrate is captured in the lower cleft region of AcrB, then transported through the binding pocket, the gate, and finally to the AcrB funnel that connects AcrB to TolC. PMID:20804453

  17. Launch Commit Criteria Monitoring Agent

    NASA Technical Reports Server (NTRS)

    Semmel, Glenn S.; Davis, Steven R.; Leucht, Kurt W.; Rowe, Dan A.; Kelly, Andrew O.; Boeloeni, Ladislau

    2005-01-01

    The Spaceport Processing Systems Branch at NASA Kennedy Space Center has developed and deployed a software agent to monitor the Space Shuttle's ground processing telemetry stream. The application, the Launch Commit Criteria Monitoring Agent, increases situational awareness for system and hardware engineers during Shuttle launch countdown. The agent provides autonomous monitoring of the telemetry stream, automatically alerts system engineers when predefined criteria have been met, identifies limit warnings and violations of launch commit criteria, aids Shuttle engineers through troubleshooting procedures, and provides additional insight to verify appropriate troubleshooting of problems by contractors. The agent has successfully detected launch commit criteria warnings and violations on a simulated playback data stream. Efficiency and safety are improved through increased automation.

  18. DAPcentrism: Challenging Developmentally Appropriate Practice.

    ERIC Educational Resources Information Center

    Fleer, Marilyn, Ed.

    This book examines the implications of existing learning theories for early childhood education, with a special emphasis on Developmentally Appropriate Practice (DAP). Chapter 1, "Challenging Developmentally Appropriate Practice: An Introduction (Marilyn Fleer), presents the debate and summarizes the remaining chapters. Chapter 2, "Does Cognition…

  19. Proliferation Resistance Evaluation of ACR-1000 Fuel with Minor Actinides

    SciTech Connect

    Gray S. Chang

    2008-09-01

    The Global Nuclear Energy Partnership (GNEP) program is to significantly advance the science and technology of nuclear energy systems and to enhance the spent fuel proliferation resistance. It consists of both innovative nuclear reactors and innovative research in separation and transmutation. The merits of nuclear energy are high-density energy, with low environmental impacts (i.e. almost zero greenhouse gas emission). Planned efforts involve near-term and intermediate-term improvements in fuel utilization and recycling in current light water reactors (LWRs) as well as the longer-term development of new nuclear energy systems that offer much improved fuel utilization and proliferation resistance, along with continued advances in operational safety. For future advanced nuclear systems, minor actinides (MA) are viewed more as a resource to be recycled, and transmuted to less hazardous and possibly more useful forms, rather than simply disposed of as a waste stream in an expensive repository facility. MAs can play a much larger part in the design of advanced systems and fuel cycles, not only as additional sources of useful energy, but also as direct contributors to the reactivity control of the systems into which they are incorporated. In this work, an Advanced CANDU Reactor (ACR) fuel unit lattice cell model with 43 UO2 fuel rods will be used to investigate the effectiveness of a Minor Actinide Reduction Approach (MARA) for enhancing proliferation resistance and improving the fuel cycle performance. The main MARA objective is to increase the 238Pu / Pu isotope ratio by using the transuranic nuclides (237Np and 241Am) in the high burnup fuel and thereby increase the proliferation resistance even for a very low fuel burnup. As a result, MARA is a very effective approach to enhance the proliferation resistance for the on power refueling ACR system nuclear fuel. The MA transmutation characteristics at different MA loadings were compared and their impact on neutronics

  20. Health-Related Quality of Life and Appropriateness of Cholecystectomy

    PubMed Central

    Quintana, José Ma; Cabriada, Jose; Aróstegui, Inmaculada; Oribe, Victor; Perdigo, Luis; Varona, Mercedes; Bilbao, Amaia

    2005-01-01

    Ojbective: To evaluate the relationship among appropriateness of the use of cholecystectomy and outcomes. Summary Background Data: The use of cholecystectomy varies widely across regions and countries. Explicit appropriateness criteria may help identify suitable candidates for this commonly performed procedure. This study evaluates the relationship among appropriateness of the use of cholecystectomy and outcomes. Methods: Prospective observational study in 6 public hospitals in Spain of all consecutive patients on waiting lists to undergo cholecystectomy for nonmalignant disease. Explicit appropriateness criteria for the use of cholecystectomy were developed by a panel of experts using the RAND appropriateness methodology and applied to recruited patients. Patients were asked to complete 2 questionnaires that measure health-related quality of life—the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)—before the intervention and 3 months after it. Results: Patients judged as being appropriate candidates for cholecystectomy, using the panel's explicit appropriateness criteria, had greater improvements in the bodily pain, vitality, and social function domains of the SF-36 than those judged to be inappropriate candidates. They also demonstrated improvements in the GIQLI's physical impairment domain. Interventions judged as inappropriate were performed primarily among patients without symptoms of cholelithiasis. Those asymptomatic had a lower improvement in the bodily pain, social functioning, and physical summary scale of the SF-36 and in the symptomatology, physical impairment, and total score domains of the GIQLI. Conclusions: These results suggest a direct relationship between the application of explicit appropriateness criteria and better outcomes, as measured by health-related quality of life. They also indicate that patients without symptoms are not good candidates for cholecystectomy. PMID:15621998

  1. Effectiveness of urban stormwater control measures in a 100-acre test site

    EPA Science Inventory

    Kansas City, Missouri chose a test area (100 acres) and a control area (80 acres) to test the effectiveness of urban stormwater control (SCM) deployment in conjunction with the USEPA, University of Alabama, University of Missouri-Kansas City and TetraTech. Both the test and cont...

  2. 42 CFR 417.594 - Computation of adjusted community rate (ACR).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Computation of adjusted community rate (ACR). 417... community rate (ACR). (a) Basic rule. Each HMO or CMP must compute its basic rate as follows: (1) Compute an... must compute its initial rate using either of the following systems: (i) A community rating system...

  3. 42 CFR 417.594 - Computation of adjusted community rate (ACR).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Computation of adjusted community rate (ACR). 417... community rate (ACR). (a) Basic rule. Each HMO or CMP must compute its basic rate as follows: (1) Compute an... must compute its initial rate using either of the following systems: (i) A community rating system...

  4. 42 CFR 417.594 - Computation of adjusted community rate (ACR).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Computation of adjusted community rate (ACR). 417... adjusted community rate (ACR). (a) Basic rule. Each HMO or CMP must compute its basic rate as follows: (1... community rating system as defined in § 417.104(b); or (ii) A system, approved by CMS, under which the...

  5. 42 CFR 417.594 - Computation of adjusted community rate (ACR).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Computation of adjusted community rate (ACR). 417... adjusted community rate (ACR). (a) Basic rule. Each HMO or CMP must compute its basic rate as follows: (1... community rating system as defined in § 417.104(b); or (ii) A system, approved by CMS, under which the...

  6. 42 CFR 417.594 - Computation of adjusted community rate (ACR).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Computation of adjusted community rate (ACR). 417... adjusted community rate (ACR). (a) Basic rule. Each HMO or CMP must compute its basic rate as follows: (1... community rating system as defined in § 417.104(b); or (ii) A system, approved by CMS, under which the...

  7. 10 CFR 52.53 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.53 Section 52.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  8. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application for an early...

  9. 10 CFR 52.141 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.141 Section 52.141 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  10. 10 CFR 52.141 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.141 Section 52.141 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  11. 10 CFR 52.53 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.53 Section 52.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  12. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application for an early...

  13. 10 CFR 52.53 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.53 Section 52.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  14. 10 CFR 52.53 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.53 Section 52.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  15. 10 CFR 52.141 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.141 Section 52.141 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  16. 75 FR 7632 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-22

    ... October 14, 2009 (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling Water Reactor (ABWR) The ACRS Subcommittee on ABWR will hold a meeting on March 2, 2010, at...

  17. 10 CFR 52.53 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.53 Section 52.53 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  18. 10 CFR 52.141 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.141 Section 52.141 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  19. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  20. 10 CFR 52.141 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.141 Section 52.141 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS... Committee on Reactor Safeguards (ACRS). The Commission shall refer a copy of the application to the...

  1. 75 FR 13611 - Meeting of the ACRS Subcommittee on Reliability and PRA; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-22

    ... published in the Federal Register on October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability... would result in major inconvenience. Dated: March 15, 2010. Antonio F. Dias, Chief, Reactor...

  2. 75 FR 10840 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... October 14, 2009, (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on March...

  3. 75 FR 7634 - Advisory Committee on Reactor Safeguards (ACRS); Planning and Procedures Subcommittee Meeting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-22

    .... Dated: February 12, 2010. Antonio F. Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Planning and Procedures Subcommittee Meeting... participation in ACRS meetings were published in the Federal Register on October 14, 2009 (74 FR...

  4. 75 FR 1830 - Advisory Committee on Reactor Safeguards (ACRS), Planning and Procedures Subcommittee Meeting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-13

    .... Dated: January 7, 2010. Antonio Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Planning and Procedures Subcommittee Meeting... participation in ACRS meetings were published in the Federal Register on October 14, 2009, (74 FR...

  5. 76 FR 76442 - Advisory Committee On Reactor Safeguards Meeting of The ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards Meeting of The ACRS Subcommittee on Materials, Metallurgy... Notice for the ACRS Subcommittee Meeting on Materials, Metallurgy & Reactor Fuels scheduled to be held...

  6. 78 FR 8202 - Meeting of the Joint ACRS Subcommittees on Thermal Hydraulic Phenomena and Materials, Metallurgy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... ACRS meetings were published in the Federal Register on October 18, 2012, (77 FR 64146- 64147... Hydraulic Phenomena and Materials, Metallurgy and Reactor Fuels; Notice of Meeting The Joint ACRS Subcommittees on Thermal Hydraulic Phenomena and Materials, Metallurgy and Reactor Fuels will hold a meeting...

  7. Is it time for a dedicated pediatric MRI ACR accreditation program?

    PubMed

    Serai, Suraj D; Jones, Blaise V; Podberesky, Daniel J; Coley, Brian

    2013-04-01

    Participation in ACR accreditation programs has become an essential practice for adult and pediatric imaging centers across the country. The responsibility for these ACR programs is vested in the Commission on Quality and Safety, 1 of 7 operational commissions in the ACR. The MRI Accreditation Program evaluates the qualifications of personnel, quality control programs, MR safety policies, and image quality specific to MRI. Currently, the ACR MRI Accreditation Program is designed primarily to evaluate adult MRI practices, which are in many ways not applicable to pediatric applications and facilities. In this article, the authors describe the difficulties faced during the ACR MRI Accreditation Program at a dedicated children's hospital and offer suggested changes for the process. PMID:23245436

  8. In vitro drug sensitivity of Plasmodium falciparum in Acre, Brazil.

    PubMed Central

    Kremsner, P. G.; Zotter, G. M.; Feldmeier, H.; Graninger, W.; Kollaritsch, M.; Wiedermann, G.; Rocha, R. M.; Wernsdorfer, W. H.

    1989-01-01

    In Acre, the westernmost state of Brazil in the Amazon region, the sensitivity of Plasmodium falciparum to chloroquine, amodiaquine, mefloquine, quinine and sulfadoxine/pyrimethamine was determined in vitro by the Rieckmann microtechnique. The study was performed between January and June 1987; the in vitro parasite responses to all antimalarial drugs were determined according to the recommendations of WHO. Of 83 isolates of P. falciparum, all were sensitive to mefloquine and of 87 isolates of P. falciparum, 84 (97%) were sensitive to quinine. The EC50 for mefloquine was 0.27 mumol/l and for quinine 4.60 mumol/l. In contrast, 65 of 89 (73%) and 70 of 83 (84%) isolates were resistant to amodiaquine and chloroquine, respectively; 11 isolates even grew at 6.4 mumol chloroquine/l. The EC50 for amodiaquine was 0.34 mumol/l and for chloroquine 0.73 mumol/l. Sulfadoxine/pyrimethamine resistance was seen in 23 of 25 (92%) cases. These data clearly indicate that in the western part of the Amazon region the 4-aminoquinolines, as well as sulfadoxine/pyrimethamine, can no longer be recommended for the treatment of P. falciparum infections. PMID:2670298

  9. [Clinical and epidemiological characteristics of snakebites in Rio Branco, Acre].

    PubMed

    Moreno, Edna; Queiroz-Andrade, Marcony; Lira-da-Silva, Rejâne Maria; Tavares-Neto, José

    2005-01-01

    This study aimed to determine the clinical epidemiological profile of the snake bites attended at the reference hospital of Acre. One hundred-forty four patients were studied prospectively, from January to December 2002. One hundred-thirteen (78.5%) cases were classified as accidents by venomous snakes. The genera Bothrops, Lachesis and Micrurus were responsible, respectively, for 75.7%, 2.1% e 0.7% cases. The accidents predominated in males (78.5%), rural workers (51.4%) and between 10 and 29 years old (43.8%). The distribution according to the severity of poisoning by genera Bothrops was: moderate (48.6%), mild (31.2%) or severe (20.2%). Two cases of Bothrops accident did not receive serum therapy. However, the antivenom was administered in twenty-three patients without envenoming. In conclusion, the results obtained were different of the observed by another authors with respect to the severity of accidents and suitable treatment. PMID:15717089

  10. Further Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-02-28

    03/02/2011 Became Public Law No: 112-4. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 3/18/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  11. Additional Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-03-11

    03/18/2011 Became Public Law No: 112-6. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 4/8/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  12. Appropriate Technology--A Selected, Annotated Bibliography No. 8.

    ERIC Educational Resources Information Center

    Andree, Carolyn

    Presented is an annotated bibliography of "appropriate technology" (AT) publications. The bibliography is divided into the following sections. Philosophy and overview section includes works describing the interrelationship of technology with other facets of development; place of technology in international relations; criteria for…

  13. CDROM User Interface Evaluation: The Appropriateness of GUIs.

    ERIC Educational Resources Information Center

    Bosch, Victoria Manglano; Hancock-Beaulieu, Micheline

    1995-01-01

    Assesses the appropriateness of GUIs (graphical user interfaces), more specifically Windows-based interfaces for CD-ROM. An evaluation model is described that was developed to carry out an expert evaluation of the interfaces of seven CD-ROM products. Results are discussed in light of HCI (human-computer interaction) usability criteria and design…

  14. Pseudoatomic Structure of the Tripartite Multidrug Efflux Pump AcrAB-TolC Reveals the Intermeshing Cogwheel-like Interaction between AcrA and TolC.

    PubMed

    Jeong, Hyeongseop; Kim, Jin-Sik; Song, Saemee; Shigematsu, Hideki; Yokoyama, Takeshi; Hyun, Jaekyung; Ha, Nam-Chul

    2016-02-01

    The resistance-nodulation-division type tripartite pump AcrAB-TolC and its homologs are responsible for multidrug resistance in Gram-negative bacteria by expelling a wide variety of toxic substrates. The three essential components, AcrA, AcrB, and TolC, must function in concert with each respective binding partner within the complex. In this study, we report an 8.2-Å resolution cryo-electron microscopy (cryo-EM) 3D reconstruction of the complex that consists of an AcrAB fusion protein and a chimeric TolC protein. The pseudoatomic structure derived from the cryo-EM reconstruction clearly demonstrates a model only compatible with the adaptor bridging mechanism, wherein the funnel-like AcrA hexamer forms an intermeshing cogwheel-like interaction with the α-barrel tip region of TolC. These observations provide a structural milestone for understanding multidrug resistance in pathogenic Gram-negative bacteria, and may also lead to the design of new antibacterial drugs. PMID:26777412

  15. Update of ACR guidelines for osteoarthritis: role of the coxibs.

    PubMed

    Schnitzer, Thomas J

    2002-04-01

    The American College of Rheumatology (ACR) recently provided an update to the guidelines published in 1995 on the management of osteoarthritis (OA) of the knee and hip. Members of the Ad Hoc Committee on OA Guidelines followed an evidence-based medicine approach to revise the guidelines by reviewing an extensive literature search of the Cochrane and Medline databases and published abstracts, and discussing evidence with expert rheumatologists. The goal of the guidelines is to provide recommendations to control patients' OA pain, improve function and health-related quality of life, and avoid therapeutic toxicity. As in the original guidelines, nonpharmacologic interventions involving patient education and physical measures are recommended following initial diagnosis of OA. The pharmacologic algorithm was updated to include currently available therapeutic agents. Acetaminophen remains first-line therapy because of its cost, efficacy, and safety profiles. Cyclooxygenase-2-selective inhibitors (coxibs) have been included as an alternative to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at risk for upper gastrointestinal adverse events. Tramadol is an available alternative for patients who have a contraindication to coxibs or nonselective NSAIDs or for those who have not responded to previous oral therapy. Intra-articular injections or topical therapy may be used as monotherapy, or as an adjunct to oral analgesia. Surgical treatment of OA remains a last resort for patients who have failed to respond to nonpharmacologic and pharmacologic treatment approaches, and have progressive limitation in their activities of daily living. Several therapies for the prevention or treatment of OA are currently under investigation, including nutritional supplements, such as glucosamine and chondroitin, disease-modifying OA drugs, and devices, such as acupuncture and electromagnetic therapy. It is anticipated that the guidelines for the management of OA will

  16. "Free and Appropriate" in Jeopardy.

    ERIC Educational Resources Information Center

    Pieper, Elizabeth

    1981-01-01

    Issues involved in third party payment for related services given to handicapped students are discussed. It is asserted that coercing parents to use third party payment is an abrogration of the right to a free appropriate education as specified in P.L. 94-142, the Education for All Handicapped Children Act. (CL)

  17. Cultural Backgrounds and Textual Appropriation

    ERIC Educational Resources Information Center

    Shi, Ling

    2006-01-01

    This study examines interviews with 46 undergraduates to explore if participants with differing language and cultural backgrounds view plagiarism or textual appropriation primarily as a) a language problem because of a lack of words of one's own, or b) a cultural challenge as a result of either some first language (L1) cultural training to…

  18. Community Colleges and Appropriate Technology.

    ERIC Educational Resources Information Center

    American Association of Community and Junior Colleges, Washington, DC.

    A roundtable on Appropriate Technology (AT) was sponsored by the American Association of Community and Junior Colleges (AACJC) and supported by the National Science Foundation (NSF) as a result of a mandate from Congress to develop an AT program. The roundtable report first discusses the role of the NSF in including community colleges in the…

  19. Disaster Relief Appropriations Act, 2013

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-02-11

    12/30/2012 Message on Senate action sent to the House. (All Actions) Notes: This bill was for a time the Senate legislative vehicle for Hurricane Sandy supplemental appropriations. Tracker: This bill has the status Passed SenateHere are the steps for Status of Legislation:

  20. Appropriate selection of GTR therapy.

    PubMed

    Fugazzotto, P A

    1999-01-01

    The appropriate application of guided tissue regeneration (GTR) therapy demands both diagnostic and technical acumen. This article discusses the presurgical considerations that must be evaluated before surgical entry and treatment. A diagnostic system for the evaluation of maxillary molar furcation involvements also is presented. PMID:11360323

  1. Test Anxiety: Age Appropriate Interventions

    ERIC Educational Resources Information Center

    Ross, David B.; Driscoll, Richard

    2006-01-01

    The presentation covers information on test anxiety reduction strategies from over thirty years of experience with clients of a variety of ages. Dr. Ross is from the College of Lake County. Dr. Driscoll is a private practitioner and Director of the American Test Anxieties Association. The purpose is to address age appropriate test anxiety…

  2. Rowley, Centennial, and Appropriate Education.

    ERIC Educational Resources Information Center

    Boomer, Lyman W.

    1989-01-01

    The paper discusses the impact of two legal cases. In "Board versus Rowley," the Supreme Court established a three-part standard for appropriate education of students with disabilities. In "Centennial versus Commonwealth," the Pennsylvania Supreme Court held that gifted students merit an Individualized Education Program and adherence to due…

  3. 75 FR 38564 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Plant Operations...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... published in the Federal Register on October 14, 2009 (74 FR 58268-58269). Detailed meeting agendas and... and Fire Protection The ACRS Subcommittee on Plant Operations and Fire Protection will hold a...

  4. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Desert-Land Entries Within a Reclamation Project § 2524.7 Disposal of lands in excess of 160 acres....

  5. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Desert-Land Entries Within a Reclamation Project § 2524.7 Disposal of lands in excess of 160 acres....

  6. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Desert-Land Entries Within a Reclamation Project § 2524.7 Disposal of lands in excess of 160 acres....

  7. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Desert-Land Entries Within a Reclamation Project § 2524.7 Disposal of lands in excess of 160 acres....

  8. 75 FR 7634 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the Subcommittee on Power Uprates...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-22

    ... October 14, 2009 (74 FR 58268-58269). Detailed meeting agendas and meeting transcripts are available on... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the Subcommittee on Power Uprates... Safeguards. BILLING CODE 7590-01-P...

  9. Association between ACR1 gene product expression and cardiomyopathy in children

    PubMed Central

    Wang, Yan; Niu, Ling; He, Xiuhua; Xue, Ying; Ling, Nan; Wang, Zhenzhou; An, Xinjiang

    2016-01-01

    Cardiomyopathy is a heterogeneous heart disease. Although morbidity of pediatric cardiomyopathy has been on the increase, effective treatments have not been identified. The aim of the study was to examine the expression of ACR1 gene products in association with cardiomyopathy in children. In total, 73 patients and 76 healthy subjects were enrolled in the study, from April, 2013 to April, 2015. The relative expression of ACR1 mRNA and protein were quantified in all cases, using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), ELISA and western blot analysis. Immunohistochemistry was used to stain cardiac tissue samples to reveal differences between the patients and the control group. The results showed that the level of ACR1 mRNA by RT-qPCR was not different between the two study groups. However, ELISA and western blot analysis showed a significant difference, with patients expressing lower levels of ACR1. Additionally, immunohistochemistry revealed the levels of ACR1 were reduced in patients as the time course of disease increased. Thus, there is an association between the inhibition of ACR1 expression and the development of the disease. These findings are useful in the elucidation of the pathogenesis of pediatric cardiomyopathy, a severe disease with few effective treatment options available. PMID:27588091

  10. Substrate binding accelerates the conformational transitions and substrate dissociation in multidrug efflux transporter AcrB

    PubMed Central

    Wang, Beibei; Weng, Jingwei; Wang, Wenning

    2015-01-01

    The tripartite efflux pump assembly AcrAB-TolC is the major multidrug resistance transporter in E. coli. The inner membrane transporter AcrB is a homotrimer, energized by the proton movement down the transmembrane electrochemical gradient. The asymmetric crystal structures of AcrB with three monomers in distinct conformational states [access (A), binding (B) and extrusion (E)] support a functional rotating mechanism, in which each monomer of AcrB cycles among the three states in a concerted way. However, the relationship between the conformational changes during functional rotation and drug translocation has not been totally understood. Here, we explored the conformational changes of the AcrB homotrimer during the ABE to BEA transition in different substrate-binding states using targeted MD simulations. It was found that the dissociation of substrate from the distal binding pocket of B monomer is closely related to the concerted conformational changes in the translocation pathway, especially the side chain reorientation of Phe628 and Tyr327. A second substrate binding at the proximal binding pocket of A monomer evidently accelerates the conformational transitions as well as substrate dissociation in B monomer. The acceleration effect of the multi-substrate binding mode provides a molecular explanation for the positive cooperativity observed in the kinetic studies of substrate efflux and deepens our understanding of the functional rotating mechanism of AcrB. PMID:25918513

  11. Using the ACR CT accreditation phantom for routine image quality assurance on both CT and CBCT imaging systems in a radiotherapy environment.

    PubMed

    Hobson, Maritza A; Soisson, Emilie T; Davis, Stephen D; Parker, William

    2014-01-01

    Image-guided radiation therapy using cone-beam computed tomography (CBCT) is becoming routine practice in modern radiation therapy. The purpose of this work was to develop an imaging QA program for CT and CBCT units in our department, based on the American College of Radiology (ACR) CT accreditation phantom. The phantom has four testing modules, permitting one to test CT number accuracy, slice width, low contrast resolution, image uniformity, in-plane distance accuracy, and high-contrast resolution reproducibly with suggested window/levels for image analysis. Additional tests for contrast-to-noise ratio (CNR) and noise were added using the polyethylene and acrylic plugs. Baseline values were obtained from CT simulator images acquired on a Phillips Brilliance Big Bore CT simulator and CBCT images acquired on three Varian CBCTs for the imaging protocols most used clinically. Images were then acquired quarterly over a period of two years. Images were exported via DICOM and analyzed manually using OsiriX. Baseline values were used to ensure that image quality remained consistent quarterly, and baselines were reset at any major maintenance or recalibration. Analysis of CT simulator images showed that image quality was within ACR guidelines for all tested scanning protocols. All three CBCT systems were unable to distinguish the low-contrast resolution plugs and had the same high-contrast resolution over all imaging protocols. Analysis of CBCT results over time determined a range of values that could be used to establish quantitative tolerance levels for image quality deterioration. While appropriate for the helical CT, the ACR phantom and guidelines could be modified to be more useful in evaluating CBCT systems. In addition, the observed values for the CT simulator were well within ACR tolerances. PMID:25207412

  12. Increased expression of the multidrug efflux genes acrAB occurs during slow growth of Escherichia coli.

    PubMed

    Rand, Jonathan D; Danby, Simon G; Greenway, David L A; England, Reg R

    2002-01-22

    Intrinsic antimicrobial resistance of Escherichia coli is elicited by the gene products of the multidrug efflux acrAB-tolC operon. In this paper, we have shown that acrAB is regulated as a function of the growth rate of E. coli during growth in batch and chemostat culture. In chemostat culture, expression of acrAB is inversely related to growth rate irrespective of the limiting nutrient. The level of expression of acrAB is greater under glucose limitation compared with either iron or nitrogen limitation. Increase in expression of acrAB confers a greater resistance to ciprofloxacin, and the implications for a clinical situation are discussed. Slow growth rate regulation of acrAB transcription does not require the presence of the stationary-phase sigma factor. A putative gearbox consensus sequence was identified at the -10 region of the acrAB promoter. PMID:11886757

  13. Three-Quarters of Persons in the US Population Reporting a Clinical Diagnosis of Fibromyalgia Do Not Satisfy Fibromyalgia Criteria: The 2012 National Health Interview Survey

    PubMed Central

    Walitt, Brian; Katz, Robert S.; Bergman, Martin J.; Wolfe, Frederick

    2016-01-01

    Objectives Although fibromyalgia criteria have been in effect for decades, little is known about how the fibromyalgia diagnosis is applied and understood by clinicians and patients. We used the National Health Interview Survey (NHIS) to determine the prevalence of self-reported clinician diagnosed fibromyalgia and then compared demographics, symptoms, disability and medical utilization measures of persons with a clinical diagnosis of fibromyalgia that did not meet diagnostic criteria (false-positive or prior [F/P] fibromyalgia) to persons with and without criteria-positive fibromyalgia. Methods The National Health Interview Survey (NHIS) collected information about both clinical diagnosis and symptoms of fibromyalgia that was appropriately weighted to represent 225,726,257 US adults. Surrogate NHIS diagnostic criteria for fibromyalgia were developed based on the level of polysymptomatic distress (PSD) as characterized in the 2011 modified American College of Rheumatology criteria (ACR) for fibromyalgia. Persons with F/P fibromyalgia were compared with persons who do not have fibromyalgia and those meeting surrogate NHIS fibromyalgia criteria. Results Of the 1.78% of persons reporting a clinical diagnosis, 73.5% did not meet NHIS fibromyalgia criteria. The prevalence of F/P fibromyalgia is 1.3%. F/P fibromyalgia is associated with a mild degree of polysymptomatic distress (NHIS PSD score 6.2) and characterized by frequent but not widespread pain and insomnia. Measures of work disability and medical utilization in F/P fibromyalgia were equal to that seen with NHIS criteria positive fibromyalgia and were 6-7x greater in F/P fibromyalgia than in non-fibromyalgia persons. F/P fibromyalgia was best predicted by being female (Odds Ratio [OR] 8.81), married (OR 3.27), and white (OR 1.96). In contrast, being a white, married woman was only modestly predictive of NHIS (criteria positive) fibromyalgia (OR 2.1). Conclusions The majority of clinically diagnosed fibromyalgia

  14. Toward new criteria for systemic lupus erythematosus-a standpoint.

    PubMed

    Aringer, M; Dörner, T; Leuchten, N; Johnson, S R

    2016-07-01

    While clearly different in their aims and means, classification and diagnosis both try to accurately label the disease patients are suffering from. For systemic lupus erythematosus (SLE), this is complicated by the multi-organ nature of the disease and by our incomplete understanding of its pathophysiology. Hallmarks of SLE are the presence of antinuclear antibodies (ANA), and multiple immune-mediated organ symptoms that are largely independent. In an attempt to overcome limitations of the current sets of SLE classification criteria, a new four-phase approach is being developed, which is jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). This review attempts to delineate the performance of the current sets of criteria, the reasons for the decision for classification, and not diagnostic, criteria, and to provide a background of the current approach taken. PMID:27252256

  15. Applicability of ACR breast dosimetry methodology to a digital mammography system

    SciTech Connect

    Tomon, John J.; Johnson, Thomas E.; Swenson, Kristin N.; Schauer, David A.

    2006-03-15

    Determination of mean glandular dose (MGD) to breast tissue is an essential aspect of mammography equipment evaluations and exposure controls. The American College of Radiology (ACR) Quality Control Manual outlines the procedure for MGD determination in screen-film mammography based upon conversions of entrance skin exposures (ESEs) measured with an ionization chamber (IC). The development of digital mammography has increased with the demand for improved object resolution and tissue contrast. This change in image receptor from screen-film to a solid-state detector has led to questions about the applicability of the ACR MGD methodology to digital mammography. This research has validated the applicability of the ACR MGD methodology to digital mammography in the GE digital mammography system Senographe 2000D[reg]. MGD was determined using light output measurements from thermoluminescent dosimeters (MGD{sub TL}), exposure measurements from an IC (MGD{sub IC}) and conversion factors from the ACR Mammography Quality Control Manual. MGD{sub TL} and MGD{sub IC} data indicate that there is a statistically significant difference between the two measurements with the Senographe 2000D[reg]. However, the applicability of the ACR's methodology was validated by calculating MGD at various depths in a 50/50 breast phantom. Additionally, the results of backscatter measurements from the image receptors of both mammography modalities indicate there is a difference (all P values <0.001) in the radiation backscattered from each image receptor.

  16. Appropriation and dementia in India.

    PubMed

    Brijnath, Bianca; Manderson, Lenore

    2011-12-01

    Biomedical technologies like MRI scans offer a way for carers and people with dementia to 'see' pathology, as a means to reorient their perceptions of the body and functionality. Through interpretive and syncretic processes, the MRI and the diagnosis of dementia facilitate the incorporation of the clinical category 'dementia' into social understandings of illness and care in India. Complex shifts occur as families and providers move from socio-cultural explanations of disruption to bio-social etiologies of the disease 'dementia' and then to socio-ecological frameworks of causality. Both the biomedicalisation of illness and the localisation of illness occur as the clinical category 'dementia' is folded into local understandings of illness and care. Through elucidating how the dialectic between biomedical and local knowledge is operationalized, we offer insights into how dementia is absorbed and appropriated into Indian cultural contexts. PMID:21837538

  17. Nutrient Criteria Research

    EPA Science Inventory

    EPA has developed methodologies for deriving nutrient criteria, default criteria for the variety of waters and eco-regions found in the U.S., and a strategy for implementing the criteria including guidance on the use and development of biocriteria. Whereas preliminary research ha...

  18. 22 CFR 223.11 - Appropriate action.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Appropriate action. 223.11 Section 223.11...-EMPLOYMENT RESTRICTIONS § 223.11 Appropriate action. The Administrator may take appropriate action in the... action....

  19. 76 FR 70365 - Prevailing Rate Systems; Redefinition of the Austin, TX and Waco, TX, Appropriated Fund Federal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-14

    ... the area of application of the Waco wage area. Based on an analysis of the regulatory criteria for... criteria. Based on this analysis, we believe Brazos County is appropriately defined to the Waco wage area... wage area over the Austin wage area. All other criteria are indeterminate. Based on this analysis,...

  20. Structures of Gate Loop Variants of the AcrB Drug Efflux Pump Bound by Erythromycin Substrate

    PubMed Central

    Ababou, Abdessamad; Koronakis, Vassilis

    2016-01-01

    Gram-negative bacteria such as E. coli use tripartite efflux pumps such as AcrAB-TolC to expel antibiotics and noxious compounds. A key feature of the inner membrane transporter component, AcrB, is a short stretch of residues known as the gate/switch loop that divides the proximal and distal substrate binding pockets. Amino acid substitutions of the gate loop are known to decrease antibiotic resistance conferred by AcrB. Here we present two new AcrB gate loop variants, the first stripped of its bulky side chains, and a second in which the gate loop is removed entirely. By determining the crystal structures of the variant AcrB proteins in the presence and absence of erythromycin and assessing their ability to confer erythromycin tolerance, we demonstrate that the gate loop is important for AcrB export activity but is not required for erythromycin binding. PMID:27403665

  1. Furfural and hydroxymethylfurfural tolerance in Escherichia coli ΔacrR regulatory mutants.

    PubMed

    Luhe, Annette Lin; Lim, Chan Yuen; Gerken, Henri; Wu, Jinchuan; Zhao, Hua

    2015-01-01

    The presence of the highly toxic furfural and hydroxymethylfurfural (HMF) in the hydrolysate of lignocellulosic biomass prompted the investigation of the Escherichia coli ΔacrR regulatory mutant for higher tolerance to these compounds, to facilitate the production of biofuels and biochemicals, and further biocatalytic conversions. In comparison with the parental strain, the regulatory mutant with the upregulated efflux pump AcrAB-TolC produced moderately better growth and higher tolerance to concentrations of furfural and HMF between 1 and 2 g L(-1) . PMID:24716991

  2. Criteria for substantiating claims.

    PubMed

    Aggett, Peter J

    2007-01-01

    Claims are used to support public health advocacy and marketing. Their evidence base is variable. Claims are made on (i) nutrient content, (ii) comparative merits, (iii) health benefits, and (iv) medical benefits. Experience with therapeutic agents has aided the development of recommendations for the substantiation of health claims for foods and food components, with which dietary supplements would be included. An EU Concerted Activity, Functional Food Science in Europe, suggested that such claims should be based on the general outcomes of 'enhanced function' and 'reduced risk of disease'. A further EU Concerted Activity, The Process for the Assessment of Scientific Support for Claims on Foods, proposed that the evidence base should provide: a characterization of the food or food component to which the claimed effect is attributed; human data, primarily from intervention studies that represent the target populations for the claim; a dose-response relationship: evidence of allowing for confounders including lifestyle, consumption patterns, background diet and food matrix; an appropriate duration for the study; a measure of compliance; and have adequate statistical power to test the hypothesis. When ideal endpoints are not easily accessible for measurement, validated and quality assured markers of the intermediate or final outcomes could be used, as long as their relationship is well characterized. Overall, the totality and coherence of published and unpublished evidence should be considered. Assessments for substantiation need expert judgement, weighting of the strength of the claim, and intelligent use of the criteria applied on an individual basis with respect both to gaps in knowledge and to any need for new knowledge and data. PMID:17913223

  3. 23 CFR 636.202 - When are two-phase design-build selection procedures appropriate?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false When are two-phase design-build selection procedures... When are two-phase design-build selection procedures appropriate? You may consider the following criteria in deciding whether two-phase selection procedures are appropriate. A negative response...

  4. Rater Behaviour When Judging Language Learners' Pragmatic Appropriateness in Extended Discourse

    ERIC Educational Resources Information Center

    Sydorenko, Tetyana; Maynard, Carson; Guntly, Erin

    2014-01-01

    The criteria by which raters judge pragmatic appropriateness of language learners' speech acts are underexamined, especially when raters evaluate extended discourse. To shed more light on this process, the present study investigated what factors are salient to raters when scoring pragmatic appropriateness of extended request sequences, and which…

  5. 76 FR 9694 - Prevailing Rate Systems; Redefinition of the Northeastern Arizona and Colorado Appropriated Fund...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-22

    ... application. Based on our analysis of the regulatory criteria for defining appropriated fund FWS wage areas... Arizona wage area. Based on this analysis, we recommend that Montrose County be redefined to the... Northeastern Arizona and Colorado Appropriated Fund Federal Wage System Wage Areas AGENCY: U.S. Office...

  6. 75 FR 70616 - Prevailing Rate Systems; Redefinition of the Madison, WI, and Southwestern Wisconsin Appropriated...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-18

    ... application. Based on our analysis of the regulatory criteria for defining appropriated fund FWS wage areas... area. Based on this analysis, we recommend that Waushara County be redefined to the Madison wage area... Madison, WI, and Southwestern Wisconsin Appropriated Fund Federal Wage System Wage Areas AGENCY:...

  7. 76 FR 31885 - Prevailing Rate Systems; Redefinition of the Northern Mississippi and Memphis, TN, Appropriated...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... analysis of the regulatory criteria for defining appropriated fund FWS wage areas, we find that Panola... analysis, we recommend that Panola County be redefined to the Memphis wage area. The Federal Prevailing... Memphis, TN, Appropriated Fund Federal Wage System Wage Areas AGENCY: U.S. Office of Personnel...

  8. 7 CFR 3430.63 - Expiring appropriations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Expiring appropriations. 3430.63 Section 3430.63... appropriations. (a) CSREES awards supported with agency appropriations. Most CSREES awards are supported with annual appropriations. On September 30th of the 5th fiscal year after the period of availability...

  9. 14 CFR 170.23 - LORAN-C establishment criteria.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (CONTINUED) NAVIGATIONAL FACILITIES ESTABLISHMENT AND DISCONTINUANCE CRITERIA FOR AIR TRAFFIC CONTROL... all approach obstacles in accordance with FAA marking and lighting provisions. (5) Appropriate weather... for which there is a demonstrated operational or air traffic control requirement....

  10. 14 CFR 170.23 - LORAN-C establishment criteria.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (CONTINUED) NAVIGATIONAL FACILITIES ESTABLISHMENT AND DISCONTINUANCE CRITERIA FOR AIR TRAFFIC CONTROL... all approach obstacles in accordance with FAA marking and lighting provisions. (5) Appropriate weather... for which there is a demonstrated operational or air traffic control requirement....

  11. 14 CFR 170.23 - LORAN-C establishment criteria.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... (CONTINUED) NAVIGATIONAL FACILITIES ESTABLISHMENT AND DISCONTINUANCE CRITERIA FOR AIR TRAFFIC CONTROL... all approach obstacles in accordance with FAA marking and lighting provisions. (5) Appropriate weather... for which there is a demonstrated operational or air traffic control requirement....

  12. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method.

    PubMed

    Chopra, Vineet; Flanders, Scott A; Saint, Sanjay; Woller, Scott C; O'Grady, Naomi P; Safdar, Nasia; Trerotola, Scott O; Saran, Rajiv; Moureau, Nancy; Wiseman, Stephen; Pittiruti, Mauro; Akl, Elie A; Lee, Agnes Y; Courey, Anthony; Swaminathan, Lakshmi; LeDonne, Jack; Becker, Carol; Krein, Sarah L; Bernstein, Steven J

    2015-09-15

    Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients. PMID:26369828

  13. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Base acres and Conservation Reserve Program. 1412.23 Section 1412.23 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE CROP REVENUE...

  14. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Base acres and Conservation Reserve Program. 1412.23 Section 1412.23 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE CROP REVENUE...

  15. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Base acres and Conservation Reserve Program. 1412.23 Section 1412.23 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE CROP REVENUE...

  16. SUBSURFACE DESIGN SUPPORT LOW THERMAL LOAD REPOSITORY (25 MTU/ACRE)

    SciTech Connect

    T.M. Lahnalampi

    1999-05-14

    The objective of this document is to present a comparison between the Viability Assessment Design Layout and a 25 MTU/acre conceptual repository design. The scope of this analysis is comparing the linear dimensions and the quantities of the major design elements, for example, emplacement drifts, perimeter mains, exhaust mains, performance confirmation drifts, connecting ramps and vertical development.

  17. 76 FR 80410 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-23

    ... Requirements for Shipment and Receipt of Radioactive Material.'' The Subcommittee will hear presentations by... and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on January 18, 2012, Room T-2B3, 11545 Rockville Pike, Rockville,...

  18. Putting the Pieces Together: Using Jane Smiley's "A Thousand Acres" in Sociology of Families.

    ERIC Educational Resources Information Center

    Hall, Kelley J.

    2000-01-01

    Addresses the use of fiction to teach undergraduate students about sociological theories and concepts. Discusses how "A Thousand Acres" (Jane Smiley) was used in a sociology of families course. Includes descriptions of the plot and themes in the book and the group work and paper assigned in conjunction with Smiley's novel. (CMK)

  19. Incest, Incorporation, and "King Lear" in Jane Smiley's "A Thousand Acres."

    ERIC Educational Resources Information Center

    Leslie, Marina

    1998-01-01

    Suggests that Jane Smiley's "A Thousand Acres" is a faithful and a "profoundly subversive" revision of Shakespeare's "King Lear." Argues that the terms in which the novel have been most frequently praised, no less than the case made for banning it, raise important questions about the relationship between the novel's secret and the source of…

  20. 75 FR 47621 - Final Environmental Impact Statement for the North Fork Rancheria's Proposed 305-Acre Trust...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-06

    ... proposed action in the Federal Register on October 27, 2004 (69 FR 62721). The BIA held a public scoping... Availability for the Draft EIS (DEIS) was published in the Federal Register on February 15, 2008 (73 FR 8898...-Acre Trust Acquisition and Hotel/Casino Project, Madera County, CA AGENCY: Bureau of Indian...

  1. 43 CFR 3216.19 - May I transfer record title interest for less than 640 acres?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false May I transfer record title interest for less than 640 acres? 3216.19 Section 3216.19 Public Lands: Interior Regulations Relating to Public...) GEOTHERMAL RESOURCE LEASING Transfers § 3216.19 May I transfer record title interest for less than 640...

  2. 43 CFR 3216.19 - May I transfer record title interest for less than 640 acres?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false May I transfer record title interest for less than 640 acres? 3216.19 Section 3216.19 Public Lands: Interior Regulations Relating to Public...) GEOTHERMAL RESOURCE LEASING Transfers § 3216.19 May I transfer record title interest for less than 640...

  3. 43 CFR 3216.19 - May I transfer record title interest for less than 640 acres?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false May I transfer record title interest for less than 640 acres? 3216.19 Section 3216.19 Public Lands: Interior Regulations Relating to Public...) GEOTHERMAL RESOURCE LEASING Transfers § 3216.19 May I transfer record title interest for less than 640...

  4. 43 CFR 3216.19 - May I transfer record title interest for less than 640 acres?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false May I transfer record title interest for less than 640 acres? 3216.19 Section 3216.19 Public Lands: Interior Regulations Relating to Public...) GEOTHERMAL RESOURCE LEASING Transfers § 3216.19 May I transfer record title interest for less than 640...

  5. 75 FR 7633 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the Subcommittee on Plant Operations...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-22

    ...: February 12, 2010. Antonio F. Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the Subcommittee on Plant Operations... October 14, 2009 (74 FR 58268-58269). ] Detailed meeting agendas and meeting transcripts are available...

  6. Biofilm formation ability of Salmonella enterica serovar Typhimurium acrAB mutants.

    PubMed

    Schlisselberg, Dov B; Kler, Edna; Kisluk, Guy; Shachar, Dina; Yaron, Sima

    2015-10-01

    Recent studies offer contradictory findings about the role of multidrug efflux pumps in bacterial biofilm development. Thus, the aim of this study was to investigate the involvement of the AcrAB efflux pump in biofilm formation by investigating the ability of AcrB and AcrAB null mutants of Salmonella enterica serovar Typhimurium to produce biofilms. Three models were used to compare the ability of S. Typhimurium wild-type and its mutants to form biofilms: formation of biofilm on polystyrene surfaces; production of biofilm (mat model) on the air/liquid interface; and expression of curli and cellulose on Congo red-supplemented agar plates. All three investigated genotypes formed biofilms with similar characteristics. However, upon exposure to chloramphenicol, formation of biofilms on solid surfaces as well as the production of curli were either reduced or were delayed more significantly in both mutants, whilst there was no visible effect on pellicle formation. It can be concluded that when no selective pressure is applied, S. Typhimurium is able to produce biofilms even when the AcrAB efflux pumps are inactivated, implying that the use of efflux pump inhibitors to prevent biofilm formation is not a general solution and that combined treatments might be more efficient. Other factors that affect the ability to produce biofilms depending on efflux pump activity are yet to be identified. PMID:26260191

  7. 7 CFR 1412.41 - Direct and counter-cyclical program contract or ACRE program contract.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Provisions for Covered Commodities and Peanuts 2008 through 2012 § 1412.41 Direct and counter-cyclical... respect to fiscal years 2010 through 2012 payments, CCC will annually allow offers for a DCP or ACRE... 2012 fiscal year contracts. (ii) Except as may otherwise be provided in statute for 2008, enrollment...

  8. 7 CFR 1412.41 - Direct and counter-cyclical program contract or ACRE program contract.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Provisions for Covered Commodities and Peanuts 2008 Through 2012 § 1412.41 Direct and counter-cyclical... respect to fiscal years 2010 through 2012 payments, CCC will annually allow offers for a DCP or ACRE... 2012 fiscal year contracts. (ii) Except as may otherwise be provided in statute for 2008, enrollment...

  9. 76 FR 61118 - Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... published in the Federal Register on October 21, 2010, (75 FR 65038-65039). Detailed meeting agendas and... Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR... Flint North building, 11555 Rockville Pike, Rockville, MD. After registering with security,...

  10. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  11. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  12. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  13. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  14. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  15. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  16. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  17. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  18. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  19. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  20. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  1. Proposed Evaluation Criteria for Screening Programs for the Elderly.

    ERIC Educational Resources Information Center

    Rogers, John; And Others

    1986-01-01

    Contends that generally accepted criteria for screening asymptomatic individuals are not appropriate for the elderly due to the prevalence of symptoms and chronic problems in the elderly and the importance of tertiary prevention. Proposes evaluation criteria that reflect the goals of screening elderly individuals. (Author/ABB)

  2. AIR QUALITY CRITERIA FOR PARTICULATE MATTER (Final Report, Oct 2004)

    EPA Science Inventory

    EPA has completed the process of updating and revising, where appropriate, its Air Quality Criteria for Particulate Matter (PM) as issued in 1996 (usually referred to as the Criteria Document). Sections 108 and 109 of the Clean Air Act require that EPA carry out a periodic revi...

  3. 47 CFR 101.1333 - Interference protection criteria.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... protection criteria. (a) Frequency coordination. All EA licensees are required to coordinate their frequency... 47 Telecommunication 5 2011-10-01 2011-10-01 false Interference protection criteria. 101.1333... appropriate coordination agreements between the United States and Canada and the United States and...

  4. Trends and Evaluative Criteria of Informational Books for Children.

    ERIC Educational Resources Information Center

    Dowd, Frances Smardo

    1990-01-01

    Describes six trends and five evaluative criteria of children's nonfiction books and suggests four additional criteria for activity books. Topics discussed include humor, unusual formats, graphics and illustrations, accuracy and authenticity, content and perspective, and organization. Specific titles appropriate for kindergarten through sixth…

  5. Multidimensional Adaptive Testing with Optimal Design Criteria for Item Selection

    ERIC Educational Resources Information Center

    Mulder, Joris; van der Linden, Wim J.

    2009-01-01

    Several criteria from the optimal design literature are examined for use with item selection in multidimensional adaptive testing. In particular, it is examined what criteria are appropriate for adaptive testing in which all abilities are intentional, some should be considered as a nuisance, or the interest is in the testing of a composite of the…

  6. Experimental evolution and gene knockout studies reveal AcrA-mediated isobutanol tolerance in Ralstonia eutropha.

    PubMed

    Bernardi, Amanda C; Gai, Claudia S; Lu, Jingnan; Sinskey, Anthony J; Brigham, Christopher J

    2016-07-01

    Isobutanol (IBT) has attracted much attention from researchers as a next generation drop-in biofuel. Ralstonia eutropha is a gram-negative bacterium which naturally produces polyhydroxybutyrate (PHB), and has been reported to produce IBT after metabolic engineering. Similar to other microbes, R. eutropha experiences toxicity from branched-chain alcohols and is unable to grow in the presence of IBT concentrations higher than 0.5% (v v(-1)). Such low tolerance greatly limits the ability of R. eutropha to grow and produce IBT. In order to study toxicity to the cells, IBT-tolerant strains were developed by experimental evolution, revealing that two genes, previously described as being related to IBT tolerance in Escherichia coli (acrA and acrA6), also presented mutations in R. eutropha evolved strains. The effect on the physiology of the cells of in-frame deletions of each of these genes was assessed in wild type and engineered IBT-producing strains in an attempt to reproduce a tolerant phenotype. The mutant strains' ability to tolerate, consume, and produce IBT were also analyzed. Although deletions of acrA6 and acrA did not significantly improve R. eutropha growth in the presence of IBT, these deletions improved cell survival in the presence of high concentrations of IBT in the extracellular milieu. Moreover, an in-frame acrA deletion in an engineered IBT-producing R. eutropha enhanced the strain's ability to produce IBT, which could potentially be associated with enhanced survival at high IBT concentrations. PMID:26811221

  7. Forest Fires in Southwestern Amazonia During 2005: Extent and Distribution in Eastern Acre State, Brazil

    NASA Astrophysics Data System (ADS)

    Brown, I.; Moulard, E. M.; Nakamura, J.; Schroeder, W.; Maldonado, M.; Vasconcelos, S. S.; Selhorst, D.

    2007-05-01

    The extended drought in western Amazonia during 2005 provided the conditions for wild fires that spread in old- growth rain forests and cleared areas of the contiguous areas of Madre de Dios, Peru, Acre, Brazil, and Pando, Bolivia, collectively known as the MAP Region. The greatest extent of the wild fires occurred in eastern Acre State with 60,000 km2 of diverse land uses that range from intensely occupied colonization areas, large cattle ranches, extractive and biological reserves and indigenous areas. At the request of the Public Ministry of Acre and other government agencies we analyzed Landsat 5 and CBERS 2 imagery for forests with canopies affected by fires, using visual interpretation and manual digitalization of polygons. Accuracy assessment was done with 180 aerial photos. The total area of forest with canopies affected by fires was 267,000 ha, roughly five times recent annual deforestation rates for Acre State. Omission and commission errors were 28% and 2%, respectively. Burn scars in non-forest areas were determined using ASTER and CBERS 2 imagery via supervised classification. Total open area with burn scars was 203,000 ha. The total of open area and forests affected by fires exceeded 470,000 ha due to three factors: (1) some images used did not include the last weeks of burning; (2) ground fires in forests that did not affect the canopy and therefore were not detected; and (3) concern of the interpreters to avoid commission errors. Of the twelve municipalities of eastern Acre, most affected were Acrelandia, Placido de Castro, Epitaciolandia with >31%, >19% and >17% of the municipality affected, respectively). The largest impact, >114,000 ha, occurred in the Rio Branco Municipality. Similar patterns of burning occurred in Pando and in Madre de Dios. The environmental, social and economic disaster that these fires produced may be a harbinger of future impacts in southwestern Amazonia if current climate predictions prove to be correct.

  8. Comparison of Irrigation Water Use Estimates Calculated from Remotely Sensed Irrigated Acres and State Reported Irrigated Acres in the Lake Altus Drainage Basin, Oklahoma and Texas, 2000 Growing Season

    USGS Publications Warehouse

    Masoner, J.R.; Mladinich, C.S.; Konduris, A.M.; Smith, S. Jerrod

    2003-01-01

    Increased demand for water in the Lake Altus drainage basin requires more accurate estimates of water use for irrigation. The U.S. Geological Survey, in cooperation with the U.S. Bureau of Reclamation, is investigating new techniques to improve water-use estimates for irrigation purposes in the Lake Altus drainage basin. Empirical estimates of reference evapotranspiration, crop evapotranspiration, and crop irrigation water requirements for nine major crops were calculated from September 1999 to October 2000 using a solar radiation-based evapotranspiration model. Estimates of irrigation water use were calculated using remotely sensed irrigated crop acres derived from Landsat 7 Enhanced Thematic Mapper Plus imagery and were compared with irrigation water-use estimates calculated from irrigated crop acres reported by the Oklahoma Water Resources Board and the Texas Water Development Board for the 2000 growing season. The techniques presented will help manage water resources in the Lake Altus drainage basin and may be transferable to other areas with similar water management needs. Irrigation water use calculated from the remotely sensed irrigated acres was estimated at 154,920 acre-feet; whereas, irrigation water use calculated from state reported irrigated crop acres was 196,026 acre-feet, a 23 percent difference. The greatest difference in irrigation water use was in Carson County, Texas. Irrigation water use for Carson County, Texas, calculated from the remotely sensed irrigated acres was 58,555 acrefeet; whereas, irrigation water use calculated from state reported irrigated acres was 138,180 acre-feet, an 81 percent difference. The second greatest difference in irrigation water use occurred in Beckham County, Oklahoma. Differences between the two irrigation water use estimates are due to the differences of irrigated crop acres derived from the mapping process and those reported by the Oklahoma Water Resources Board and Texas Water Development Board.

  9. Impact of generational differences on the future of radiology: proceedings of the 11th annual ACR Forum.

    PubMed

    Krishnaraj, Arun; Weinreb, Jeffrey C; Ellenbogen, Paul H; Patti, John A; Hillman, Bruce J

    2012-02-01

    The 2011 ACR Forum focused on the impact of generational differences on the future of radiology, seeking to inform ACR leadership and members on how best to address the influence of the new integrated workforce on the specialty of radiology and on individual practices. PMID:22305696

  10. 77 FR 9707 - Advisory Committee on Reactor Safeguards Meeting of the ACRS Subcommittee on Thermal-Hydraulics...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-17

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards Meeting of the ACRS Subcommittee on Thermal-Hydraulics... for the ACRS Subcommittee meeting on Thermal-Hydraulics Phenomena scheduled to be held on February...

  11. WATER QUALITY CRITERIA DOCUMENTS

    EPA Science Inventory

    Background

    Water quality standards and criteria are the foundation for a wide range of programs under the Clean Water Act. Specifically, under section 304(a)(1) of the Clean Water Act it requires EPA to develop criteria for water quality that accurately re...

  12. Plutonium storage criteria

    SciTech Connect

    Chung, D.; Ascanio, X.

    1996-05-01

    The Department of Energy has issued a technical standard for long-term (>50 years) storage and will soon issue a criteria document for interim (<20 years) storage of plutonium materials. The long-term technical standard, {open_quotes}Criteria for Safe Storage of Plutonium Metals and Oxides,{close_quotes} addresses the requirements for storing metals and oxides with greater than 50 wt % plutonium. It calls for a standardized package that meets both off-site transportation requirements, as well as remote handling requirements from future storage facilities. The interim criteria document, {open_quotes}Criteria for Interim Safe Storage of Plutonium-Bearing Solid Materials{close_quotes}, addresses requirements for storing materials with less than 50 wt% plutonium. The interim criteria document assumes the materials will be stored on existing sites, and existing facilities and equipment will be used for repackaging to improve the margin of safety.

  13. Study of helicopterroll control effectiveness criteria

    NASA Technical Reports Server (NTRS)

    Heffley, Robert K.; Bourne, Simon M.; Curtiss, Howard C., Jr.; Hindson, William S.; Hess, Ronald A.

    1986-01-01

    A study of helicopter roll control effectiveness based on closed-loop task performance measurement and modeling is presented. Roll control critieria are based on task margin, the excess of vehicle task performance capability over the pilot's task performance demand. Appropriate helicopter roll axis dynamic models are defined for use with analytic models for task performance. Both near-earth and up-and-away large-amplitude maneuvering phases are considered. The results of in-flight and moving-base simulation measurements are presented to support the roll control effectiveness criteria offered. This Volume contains the theoretical analysis, simulation results and criteria development.

  14. 22 CFR 223.11 - Appropriate action.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Appropriate action. 223.11 Section 223.11 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATIVE ENFORCEMENT PROCEDURES OF POST-EMPLOYMENT RESTRICTIONS § 223.11 Appropriate action. The Administrator may take appropriate action in...

  15. 50 CFR 34.8 - Appropriations authorized.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Appropriations authorized. 34.8 Section 34... (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM REFUGE REVENUE SHARING WITH COUNTIES § 34.8 Appropriations authorized. The Act authorizes appropriations to the fund for any fiscal year when the aggregate amount...

  16. Fire protection design criteria

    SciTech Connect

    1997-03-01

    This Standard provides supplemental fire protection guidance applicable to the design and construction of DOE facilities and site features (such as water distribution systems) that are also provided for fire protection. It is intended to be used in conjunction with the applicable building code, national Fire Protection Association Codes and Standards, and any other applicable DOE construction criteria. This Standard, along with other delineated criteria, constitutes the basic criteria for satisfying DOE fire and life safety objectives for the design and construction or renovation of DOE facilities.

  17. Expression of the AcrAB Components of the AcrAB-TolC Multidrug Efflux Pump of Yersinia enterocolitica Is Subject to Dual Regulation by OmpR

    PubMed Central

    Raczkowska, Adrianna; Trzos, Joanna; Lewandowska, Olga; Nieckarz, Marta; Brzostek, Katarzyna

    2015-01-01

    OmpR is a transcriptional regulator implicated in the control of various cellular processes and functions in Enterobacteriaceae. This study was undertaken to identify genes comprising the OmpR regulon in the human gastrointestinal pathogen Yersinia enterocolitica. Derivatives of an ompR-negative strain with random transposon insertions creating transcriptional fusions with the reporter gene lacZ were isolated. These were supplied with the wild-type ompR allele in trans and then screened for OmpR-dependent changes in β-galactosidase activity. Using this strategy, five insertions in genes/operons positively regulated by OmpR and two insertions in genes negatively regulated by this protein were identified. Genetic analysis of one of these fusion strains revealed that the gene acrR, encoding transcriptional repressor AcrR is negatively regulated by OmpR. Differential analysis of membrane proteins by SDS-PAGE followed by mass spectrometry identified the protein AcrB, a component of the AcrAB-TolC multidrug efflux pump, as being positively regulated by OmpR. Analysis of the activity of the acrR and acrAB promoters using gfp fusions confirmed their OmpR-dependent repression and activation, respectively. The identification of putative OmpR-binding sites and electrophoretic mobility shift assays confirmed that this regulator binds specifically to both promoter regions with different affinity. Examination of the activity of the acrR and acrAB promoters after the exposure of cells to different chemicals showed that bile salts can act as an OmpR-independent inducer. Taken together, our findings suggest that OmpR positively controls the expression of the AcrAB-TolC efflux pump involved in the adaptive response of Y. enterocolitica O:9 to different chemical stressors, thus conferring an advantage in particular ecological niches. PMID:25893523

  18. Expression of the AcrAB Components of the AcrAB-TolC Multidrug Efflux Pump of Yersinia enterocolitica Is Subject to Dual Regulation by OmpR.

    PubMed

    Raczkowska, Adrianna; Trzos, Joanna; Lewandowska, Olga; Nieckarz, Marta; Brzostek, Katarzyna

    2015-01-01

    OmpR is a transcriptional regulator implicated in the control of various cellular processes and functions in Enterobacteriaceae. This study was undertaken to identify genes comprising the OmpR regulon in the human gastrointestinal pathogen Yersinia enterocolitica. Derivatives of an ompR-negative strain with random transposon insertions creating transcriptional fusions with the reporter gene lacZ were isolated. These were supplied with the wild-type ompR allele in trans and then screened for OmpR-dependent changes in β-galactosidase activity. Using this strategy, five insertions in genes/operons positively regulated by OmpR and two insertions in genes negatively regulated by this protein were identified. Genetic analysis of one of these fusion strains revealed that the gene acrR, encoding transcriptional repressor AcrR is negatively regulated by OmpR. Differential analysis of membrane proteins by SDS-PAGE followed by mass spectrometry identified the protein AcrB, a component of the AcrAB-TolC multidrug efflux pump, as being positively regulated by OmpR. Analysis of the activity of the acrR and acrAB promoters using gfp fusions confirmed their OmpR-dependent repression and activation, respectively. The identification of putative OmpR-binding sites and electrophoretic mobility shift assays confirmed that this regulator binds specifically to both promoter regions with different affinity. Examination of the activity of the acrR and acrAB promoters after the exposure of cells to different chemicals showed that bile salts can act as an OmpR-independent inducer. Taken together, our findings suggest that OmpR positively controls the expression of the AcrAB-TolC efflux pump involved in the adaptive response of Y. enterocolitica O:9 to different chemical stressors, thus conferring an advantage in particular ecological niches. PMID:25893523

  19. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... service or employment site must not normally exceed 2 hours, not including the transporting of a child to and from a child care facility, unless a longer commuting distance or time is generally accepted in... community standards. (4) When child care is required, the care must meet the standards normally required...

  20. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... service or employment site must not normally exceed 2 hours, not including the transporting of a child to and from a child care facility, unless a longer commuting distance or time is generally accepted in... community standards. (4) When child care is required, the care must meet the standards normally required...

  1. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... service or employment site must not normally exceed 2 hours, not including the transporting of a child to and from a child care facility, unless a longer commuting distance or time is generally accepted in... community standards. (4) When child care is required, the care must meet the standards normally required...

  2. SU-E-J-27: Appropriateness Criteria for Deformable Image Registration and Dose Propagation

    SciTech Connect

    Papanikolaou, P; Tuohy, Rachel; Mavroidis, P; Eng, T; Gutierrez, A; Stathakis, S

    2014-06-01

    Purpose: Several commercial software packages have been recently released that allow the user to apply deformable registration algorithms (DRA) for image fusion and dose propagation. Although the idea of anatomically tracking the daily patient dose in the context of adaptive radiotherapy or merely adding the dose from prior treatment to the current one is very intuitive, the accuracy and applicability of such algorithms needs to be investigated as it remains somewhat subjective. In our study, we used true anatomical data where we introduced changes in the density, volume and location of segmented structures to test the DRA for its sensitivity and accuracy. Methods: The CT scan of a prostate patient was selected for this study. The CT images were first segmented to define structure such as the PTV, bladder, rectum, intestines and pelvic bone anatomy. To perform our study, we introduced anatomical changes in the reference patient image set in three different ways: (i) we kept the segmented volumes constant and changed the density of rectum and bladder in increments of 5% (ii) we changed the volume of rectum and bladder in increments of 5% and (iii) we kept the segmented volumes constant but changed their location by moving their COM in increments of 3mm. Using the Velocity software, we evaluated the accuracy of the DRA for each incremental change in all three scenarios. Results: The DRA performs reasonably well when the differential density difference against the background is more than 5%. For the volume change study, the DRA results became unreliable for relative volume changes greater than 10%. Finally for the location study, the DRA performance was acceptable for shifts below 9mm. Conclusion: Site specific and patient specific QA for DRA is an important step to evaluate such algorithms prior to their use for dose propagation.

  3. Eligibility Criteria for Language Impairment: Is the Low End of Normal Always Appropriate?

    ERIC Educational Resources Information Center

    Spaulding, Tammie J.; Plante, Elena; Farinella, Kimberly A.

    2006-01-01

    Purpose: The assumption that children with language impairment will receive low scores on standardized tests, and therefore that low scores will accurately identify these children, is examined through a review of data in the manuals of tests that are intended for use in identifying such children. Method: Data from 43 commercially available tests…

  4. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and from a child care facility, unless a longer commuting distance or time is generally accepted in... community standards. (4) When child care is required, the care must meet the standards normally required by... safety standards. (6) Assignments must not be made which are discriminatory in terms of age, sex,...

  5. ACR white paper on teleradiology practice: a report from the Task Force on Teleradiology Practice.

    PubMed

    Silva, Ezequiel; Breslau, Jonathan; Barr, Robert M; Liebscher, Lawrence A; Bohl, Michael; Hoffman, Thomas; Boland, Giles W L; Sherry, Cynthia; Kim, Woojin; Shah, Samir S; Tilkin, Mike

    2013-08-01

    Teleradiology services are now embedded into the workflow of many radiology practices in the United States, driven largely by an expanding corporate model of services. This has brought opportunities and challenges to both providers and recipients of teleradiology services and has heightened the need to create best-practice guidelines for teleradiology to ensure patient primacy. To this end, the ACR Task Force on Teleradiology Practice has created this white paper to update the prior ACR communication on teleradiology and discuss the current and possible future state of teleradiology in the United States. This white paper proposes comprehensive best-practice guidelines for the practice of teleradiology, with recommendations offered regarding future actions. PMID:23684535

  6. [Cancer mortality trends in Rio Branco, Acre State, Brazil, 1980-2006].

    PubMed

    Nakashima, Juliano de Pádua; Koifman, Sérgio; Koifman, Rosalina Jorge

    2011-06-01

    Time trends in cancer incidence and mortality in the Western Amazon remain unknown. This study explored age-standardized cancer mortality rates according to anatomical site in Rio Branco, Acre State, Brazil, by constructing linear regression time trend models. Cancer mortality showed an increasing but inconstant trend in men and stability in women. At the end of the time series, the highest cancer rates among women were for the cervix, lung, liver and intrahepatic biliary tract, stomach, and breast. Among men, the highest rates were for cancer of the lung, prostate, liver and intra-hepatic biliary tract, stomach, and esophagus. The study showed an increasing mortality time trend for cancer of the prostate, breast, and lung and declining mortality rates for cervical cancer in women, lung cancer in men, and stomach cancer in both sexes. The high mortality rate from liver cancer merits attention, considering the high hepatitis B and C infection rates in the State of Acre. PMID:21710013

  7. The future of imaging screening: proceedings of the Fourth Annual ACR FORUM.

    PubMed

    Hillman, Bruce J; Amis, E Stephen; Weinreb, Jeffrey C; Neiman, Harvey L

    2005-01-01

    The FORUM is an ACR planning activity focused on a specific topic deemed to be of long-range importance to the college. A select panel of multidisciplinary experts met in 2004 to consider the ramifications of imaging screening from diverse perspectives. Considerations included the nature of screening for disease, its technological issues, and biases associated with the perceived success of screening; potential technologies and target diseases; business and economics; insurance coverage; ethics and the law; how imaging screening could be paired with nonimaging screening; and how the lay public perceives screening. The FORUM participants considered how imaging screening might develop over the next 5 to 10 years and made recommendations to the ACR on actions it might take to benefit both the specialty and patients. PMID:17411759

  8. Using the ACR/NEMA standard with TCP/IP and Ethernet

    NASA Astrophysics Data System (ADS)

    Chimiak, William J.; Williams, Rodney C.

    1991-07-01

    There is a need for a consolidated picture archival and communications system (PACS) in hospitals. At the Bowman Gray School of Medicine of Wake Forest University (BGSM), the authors are enhancing the ACR/NEMA Version 2 protocol using UNIX sockets and TCP/IP to greatly improve connectivity. Initially, nuclear medicine studies using gamma cameras are to be sent to PACS. The ACR/NEMA Version 2 protocol provides the functionality of the upper three layers of the open system interconnection (OSI) model in this implementation. The images, imaging equipment information, and patient information are then sent in ACR/NEMA format to a software socket. From there it is handed to the TCP/IP protocol, which provides the transport and network service. TCP/IP, in turn, uses the services of IEEE 802.3 (Ethernet) to complete the connectivity. The advantage of this implementation is threefold: (1) Only one I/O port is consumed by numerous nuclear medicine cameras, instead of a physical port for each camera. (2) Standard protocols are used which maximize interoperability with ACR/NEMA compliant PACSs. (3) The use of sockets allows a migration path to the transport and networking services of OSIs TP4 and connectionless network service as well as the high-performance protocol being considered by the American National Standards Institute (ANSI) and the International Standards Organization (ISO) -- the Xpress Transfer Protocol (XTP). The use of sockets also gives access to ANSI's Fiber Distributed Data Interface (FDDI) as well as other high-speed network standards.

  9. The Challenges from Extreme Climate Events for Sustainable Development in Amazonia: the Acre State Experience

    NASA Astrophysics Data System (ADS)

    Araújo, M. D. N. M.

    2015-12-01

    In the past ten years Acre State, located in Brazil´s southwestern Amazonia, has confronted sequential and severe extreme events in the form of droughts and floods. In particular, the droughts and forest fires of 2005 and 2010, the 2012 flood within Acre, the 2014 flood of the Madeira River which isolated Acre for two months from southern Brazil, and the most severe flooding throughout the state in 2015 shook the resilience of Acrean society. The accumulated costs of these events since 2005 have exceeded 300 million dollars. For the last 17 years, successive state administrations have been implementing a socio-environmental model of development that strives to link sustainable economic production with environmental conservation, particularly for small communities. In this context, extreme climate events have interfered significantly with this model, increasing the risks of failure. The impacts caused by these events on development in the state have been exacerbated by: a) limitations in monitoring; b) extreme events outside of Acre territory (Madeira River Flood) affecting transportation systems; c) absence of reliable information for decision-making; and d) bureaucratic and judicial impediments. Our experience in these events have led to the following needs for scientific input to reduce the risk of disasters: 1) better monitoring and forecasting of deforestation, fires, and hydro-meteorological variables; 2) ways to increase risk perception in communities; 3) approaches to involve more effectively local and regional populations in the response to disasters; 4) more accurate measurements of the economic and social damages caused by these disasters. We must improve adaptation to and mitigation of current and future extreme climate events and implement a robust civil defense, adequate to these new challenges.

  10. Improving olefin tolerance and production in E. coli using native and evolved AcrB

    DOE PAGESBeta

    Mingardon, Florence; Clement, Camille; Hirano, Kathleen; Nhan, Melissa; Luning, Eric G.; Chanal, Angelique; Mukhopadhyay, Aindrila

    2015-01-20

    Microorganisms can be engineered for the production of chemicals utilized in the polymer industry. However many such target compounds inhibit microbial growth and might correspondingly limit production levels. Here, we focus on compounds that are precursors to bioplastics, specifically styrene and representative alpha-olefins; 1-hexene, 1-octene, and 1-nonene. We evaluated the role of the Escherichia coli efflux pump, AcrAB-TolC, in enhancing tolerance towards these olefin compounds. AcrAB-TolC is involved in the tolerance towards all four compounds in E. coli. Both styrene and 1-hexene are highly toxic to E. coli. Styrene is a model plastics precursor with an established route for productionmore » in E. coli (McKenna and Nielsen, 2011). Though our data indicates that AcrAB-TolC is important for its optimal production, we observed a strong negative selection against the production of styrene in E. coli. Thus we used 1-hexene as a model compound to implement a directed evolution strategy to further improve the tolerance phenotype towards this alpha-olefin. We focused on optimization of AcrB, the inner membrane domain known to be responsible for substrate binding, and found several mutations (A279T, Q584R, F617L, L822P, F927S, and F1033Y) that resulted in improved tolerance. Several of these mutations could also be combined in a synergistic manner. Our study shows efflux pumps to be an important mechanism in host engineering for olefins, and one that can be further improved using strategies such as directed evolution, to increase tolerance and potentially production.« less

  11. Colonoscopy appropriateness: Really needed or a waste of time?

    PubMed Central

    Gimeno-García, Antonio Z; Quintero, Enrique

    2015-01-01

    Technical and quality improvements in colonoscopy along with the widespread implementation of population screening programs and the development of open-access units have resulted in an exponential increase in colonoscopy demands, forcing endoscopy units to bear an excessive burden of work. The American Society for Gastrointestinal Endoscopy appropriateness guideline and the European panel appropriateness of gastrointestinal endoscopy guideline have appeared as potential solutions to tackle this problem and to increase detection rates of relevant lesions. Inappropriate indications based on either guideline are as high as 30%. Strategies based on these clinical criteria or other systems may be used to reduce inappropriate indications, thus decreasing waiting lists for outpatient colonoscopy, saving costs, prioritizing colonoscopy referrals and subsequently decreasing interval times from diagnosis to treatment. Despite the potential role of appropriateness guidelines, they have not been widely adopted partly due to fear of missing significant lesions detected in inappropriate indications. We review the main appropriateness and prioritising systems, their usefulness for detecting relevant lesions, as well as interventions based on those systems and cost-effectiveness. PMID:25685265

  12. Regulation of the AcrAB multidrug efflux pump in Salmonella enterica serovar Typhimurium in response to indole and paraquat.

    PubMed

    Nikaido, Eiji; Shirosaka, Ikue; Yamaguchi, Akihito; Nishino, Kunihiko

    2011-03-01

    Salmonella enterica serovar Typhimurium has at least nine multidrug efflux pumps. Among these, AcrAB is constitutively expressed and is the most efficient, playing a role in both drug resistance and virulence. The acrAB locus is induced by indole, Escherichia coli-conditioned medium, and bile salts. This induction is dependent on RamA through the binding sequence in the upstream region of acrA that binds RamA. In the present study, we made a detailed investigation of the ramA and acrAB induction mechanisms in Salmonella in response to indole, a biological oxidant for bacteria. We found that acrAB and ramA induction in response to indole is dependent on RamR. However, the cysteine residues of RamR do not play a role in the induction of ramA in response to indole, and the oxidative effect of indole is therefore not related to ramA induction via RamR. Furthermore, we showed that paraquat, a superoxide generator, induces acrAB but not ramA. We further discovered that the mechanism of acrAB induction in response to paraquat is dependent on SoxS. The data indicate that there are at least two independent induction pathways for acrAB in response to extracellular signals such as indole and paraquat. We propose that Salmonella utilizes these regulators for acrAB induction in response to extracellular signals in order to adapt itself to environmental conditions. PMID:21148208

  13. Molecular basis for inhibition of AcrB multidrug efflux pump by novel and powerful pyranopyridine derivatives.

    PubMed

    Sjuts, Hanno; Vargiu, Attilio V; Kwasny, Steven M; Nguyen, Son T; Kim, Hong-Suk; Ding, Xiaoyuan; Ornik, Alina R; Ruggerone, Paolo; Bowlin, Terry L; Nikaido, Hiroshi; Pos, Klaas M; Opperman, Timothy J

    2016-03-29

    TheEscherichia coliAcrAB-TolC efflux pump is the archetype of the resistance nodulation cell division (RND) exporters from Gram-negative bacteria. Overexpression of RND-type efflux pumps is a major factor in multidrug resistance (MDR), which makes these pumps important antibacterial drug discovery targets. We have recently developed novel pyranopyridine-based inhibitors of AcrB, which are orders of magnitude more powerful than the previously known inhibitors. However, further development of such inhibitors has been hindered by the lack of structural information for rational drug design. Although only the soluble, periplasmic part of AcrB binds and exports the ligands, the presence of the membrane-embedded domain in AcrB and its polyspecific binding behavior have made cocrystallization with drugs challenging. To overcome this obstacle, we have engineered and produced a soluble version of AcrB [AcrB periplasmic domain (AcrBper)], which is highly congruent in structure with the periplasmic part of the full-length protein, and is capable of binding substrates and potent inhibitors. Here, we describe the molecular basis for pyranopyridine-based inhibition of AcrB using a combination of cellular, X-ray crystallographic, and molecular dynamics (MD) simulations studies. The pyranopyridines bind within a phenylalanine-rich cage that branches from the deep binding pocket of AcrB, where they form extensive hydrophobic interactions. Moreover, the increasing potency of improved inhibitors correlates with the formation of a delicate protein- and water-mediated hydrogen bond network. These detailed insights provide a molecular platform for the development of novel combinational therapies using efflux pump inhibitors for combating multidrug resistant Gram-negative pathogens. PMID:26976576

  14. Discos de acresção em sistemas Be-X

    NASA Astrophysics Data System (ADS)

    Lopes de Oliveira, R.; Janot-Pacheco, E.

    2003-08-01

    Alguns fenômenos de outbursts em Be-X sugerem a existência, mesmo que temporária, de um disco de acresção quando da passagem do objeto compacto pelo periastro orbital. Neste trabalho avaliamos a possibilidade de formação do disco de acresção em sistemas Be+estrela de neutrons e Be+anã branca, e a influência da excentricidade orbital na ocorrência deste fenômeno. Utilizamos a expressão analítica para o momento angular específico da matéria constituinte de um meio em expansão lenta, como é o caso do disco circunstelar das estrelas Be, proposta por Wang(1981), sob a condição básica de que o raio de circularização deva ser maior do que o raio de Alfvén. Concluímos que existe um limite para o período orbital do sistema acima do qual não é possível a formação do disco de acresção, e que este valor aumenta para sistemas com excentricidade orbital maior.

  15. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer

    SciTech Connect

    Rosenthal, Seth A.; Bittner, Nathan H.J.; Demanes, D. Jeffrey; Goldsmith, Brian J.; Horwitz, Eric M.; Ibbott, Geoffrey S.; Lee, W. Robert; Nag, Subir; Suh, W. Warren; Potters, Louis

    2011-02-01

    Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachtherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program.

  16. Evapotranspiration Cover for the 92-Acre Area Retired Mixed Waste Pits:Interim CQA Report

    SciTech Connect

    The Delphi Groupe, Inc., and J. A. Cesare and Associates, Inc.

    2011-06-20

    This Interim Construction Quality Assurance (CQA) Report is for the 92-Acre Evapotranspiration Cover, Area 5 Waste Management Division (WMD) Retired Mixed Waste Pits, Nevada National Security Site, Nevada for the period of January 20, 2011 to May 12, 2011. This Interim Construction Quality Assurance (CQA) Report is for the 92-Acre Evapotranspiration Cover, Area 5 Waste Management Division (WMD) Retired Mixed Waste Pits, Nevada National Security Site, Nevada for the period of January 20, 2011 to May 12, 2011. Construction was approved by the Nevada Division of Environmental Protection (NDEP) under the Approval of Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) for Corrective Action Unit (CAU) 111: Area 5 WMD Retired Mixed Waste Pits, Nevada National Security Site, Nevada, on January 6, 2011, pursuant to Subpart XII.8a of the Federal Facility Agreement and Consent Order. The project is located in Area 5 of the Radioactive Waste Management Complex (RWMC) at the Nevada National Security Site (NNSS), formerly known as the Nevada Test Site, located in southern Nevada, approximately 65 miles northwest of Las Vegas, Nevada, in Nye County. The project site, in Area 5, is located in a topographically closed basin approximately 14 additional miles north of Mercury Nevada, in the north-central part of Frenchman Flat. The Area 5 RWMS uses engineered shallow-land burial cells to dispose of packaged waste. The 92-Acre Area encompasses the southern portion of the Area 5 RWMS, which has been designated for the first final closure operations. This area contains 13 Greater Confinement Disposal (GCD) boreholes, 16 narrow trenches, and 9 broader pits. With the exception of two active pits (P03 and P06), all trenches and pits in the 92-Acre Area had operational covers approximately 2.4 meters thick, at a minimum, in most areas when this project began. The units within the 92-Acre Area are grouped into the following six informal categories based on physical location

  17. 77 FR 74697 - Meeting of the ACRS, Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... published in the Federal Register on October 18, 2012, (77 FR 64146- 64147). Detailed meeting agendas and.... Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor...

  18. Lung donor selection criteria

    PubMed Central

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward

    2014-01-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  19. Lung donor selection criteria.

    PubMed

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward; van Berkel, Victor

    2014-08-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  20. Tests Appropriate for Use with American Indians.

    ERIC Educational Resources Information Center

    Educational Testing Service, Princeton, NJ. Test Collection.

    The annotated bibliography describes 13 standardized tests appropriate for use with American Indians from preschool through high school levels, furnishing authors, copyright date, appropriate age level, physical format (microfiche), and publisher. A separate listing provides names, addresses, and telephone numbers of 33 major U.S. publishers of…

  1. Using Appropriate Tools Strategically for Instruction

    ERIC Educational Resources Information Center

    Sherman, Milan; Cayton, Charity

    2015-01-01

    Students' ability to use appropriate tools strategically is an important skill of mathematically proficient students (SMP 5, CCSSI 2010, p. 7). A parallel practice for teachers is using appropriate tools strategically for mathematics instruction. An important element of this practice is that the use of technology depends on the goals of…

  2. Technology: Appropriate for What? And for Whom?

    ERIC Educational Resources Information Center

    Black, Maggie, Ed.

    1983-01-01

    Included in this issue of UNICEF News are several brief articles focusing on the theme of appropriate technology. Topics discussed include (1) the improvement of family life through the scientific application of appropriate technology; (2) UNICEF and the household fuels crisis; (3) the workload of African women; (4) ways energy, food, health, and…

  3. Appropriate information: new products and services.

    PubMed

    Avriel, D; Aronson, B; Bertrand, I

    1993-01-01

    Effective health information services require action on three major levels: identifying and acquiring appropriate resources; applying appropriate methodologies for management of information and its communication; and stimulating local initiatives and applications. WHO's Programme of Library and Health Literature Services proposes its methodologies and products for creating and improving effective information services to health workers. PMID:8185798

  4. 2011 Education Appropriations Guide. Issue Brief

    ERIC Educational Resources Information Center

    Delisle, Jason; Cohen, Jennifer

    2011-01-01

    Congress completed the fiscal year 2011 appropriations process on April 14th, 2011, finalizing annual funding for nearly all federal education programs through September 30, 2011 at $68.3 billion, up $4.2 billion from the prior year. Making sense of the federal education budget and the appropriations process can be a frustrating task for education…

  5. 2012 Education Appropriations Guide. Issue Brief

    ERIC Educational Resources Information Center

    Delisle, Jason; Cohen, Jennifer

    2012-01-01

    Congress completed the fiscal year 2012 appropriations process on December 17th, 2011, finalizing annual funding for federal education programs through September 30, 2012 at $68.1 billion, down $233 million from the prior year. It is the first year since 2007 that Congress did not increase total appropriations for education programs. This issue…

  6. 7 CFR 457.9 - Appropriation contingency.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Appropriation contingency. 457.9 Section 457.9 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.9 Appropriation...

  7. Ghost-Story Telling: Keeping It Appropriate.

    ERIC Educational Resources Information Center

    Weintraub, Jeff

    1996-01-01

    Guidelines for telling ghost stories at camp involve considering children's fears at different ages, telling age appropriate stories, determining appropriate times for telling ghost stories, and minimizing fear when a child becomes frightened by a ghost story. Includes tips on the selection, preparation, and presentation of ghost stories. (LP)

  8. Molecular Mechanism of MBX2319 Inhibition of Escherichia coli AcrB Multidrug Efflux Pump and Comparison with Other Inhibitors

    PubMed Central

    Vargiu, Attilio V.; Ruggerone, Paolo; Opperman, Timothy J.; Nguyen, Son T.

    2014-01-01

    Efflux pumps of the resistance nodulation division (RND) superfamily, such as AcrB, make a major contribution to multidrug resistance in Gram-negative bacteria. The development of inhibitors of the RND pumps would improve the efficacy of current and next-generation antibiotics. To date, however, only one inhibitor has been cocrystallized with AcrB. Thus, in silico structure-based analysis is essential for elucidating the interaction between other inhibitors and the efflux pumps. In this work, we used computer docking and molecular dynamics simulations to study the interaction between AcrB and the compound MBX2319, a novel pyranopyridine efflux pump inhibitor with potent activity against RND efflux pumps of Enterobacteriaceae species, as well as other known inhibitors (D13-9001, 1-[1-naphthylmethyl]-piperazine, and phenylalanylarginine-β-naphthylamide) and the binding of doxorubicin to the efflux-defective F610A variant of AcrB. We also analyzed the binding of a substrate, minocycline, for comparison. Our results show that MBX2319 binds very tightly to the lower part of the distal pocket in the B protomer of AcrB, strongly interacting with the phenylalanines lining the hydrophobic trap, where the hydrophobic portion of D13-9001 was found to bind by X-ray crystallography. Additionally, MBX2319 binds to AcrB in a manner that is similar to the way in which doxorubicin binds to the F610A variant of AcrB. In contrast, 1-(1-naphthylmethyl)-piperazine and phenylalanylarginine-β-naphthylamide appear to bind to somewhat different areas of the distal pocket in the B protomer of AcrB than does MBX2319. However, all inhibitors (except D13-9001) appear to distort the structure of the distal pocket, impairing the proper binding of substrates. PMID:25114133

  9. PP2A-3 interacts with ACR4 and regulates formative cell division in the Arabidopsis root

    PubMed Central

    Yue, Kun; Sandal, Priyanka; Williams, Elisabeth L.; Murphy, Evan; Stes, Elisabeth; Nikonorova, Natalia; Ramakrishna, Priya; Czyzewicz, Nathan; Montero-Morales, Laura; Kumpf, Robert; Lin, Zhefeng; van de Cotte, Brigitte; Iqbal, Mudassar; Van Bel, Michiel; Van De Slijke, Eveline; Meyer, Matthew R.; Gadeyne, Astrid; Zipfel, Cyril; De Jaeger, Geert; Van Montagu, Marc; Van Damme, Daniël; Gevaert, Kris; Rao, A. Gururaj; Beeckman, Tom; De Smet, Ive

    2016-01-01

    In plants, the generation of new cell types and tissues depends on coordinated and oriented formative cell divisions. The plasma membrane-localized receptor kinase ARABIDOPSIS CRINKLY 4 (ACR4) is part of a mechanism controlling formative cell divisions in the Arabidopsis root. Despite its important role in plant development, very little is known about the molecular mechanism with which ACR4 is affiliated and its network of interactions. Here, we used various complementary proteomic approaches to identify ACR4-interacting protein candidates that are likely regulators of formative cell divisions and that could pave the way to unraveling the molecular basis behind ACR4-mediated signaling. We identified PROTEIN PHOSPHATASE 2A-3 (PP2A-3), a catalytic subunit of PP2A holoenzymes, as a previously unidentified regulator of formative cell divisions and as one of the first described substrates of ACR4. Our in vitro data argue for the existence of a tight posttranslational regulation in the associated biochemical network through reciprocal regulation between ACR4 and PP2A-3 at the phosphorylation level. PMID:26792519

  10. PP2A-3 interacts with ACR4 and regulates formative cell division in the Arabidopsis root.

    PubMed

    Yue, Kun; Sandal, Priyanka; Williams, Elisabeth L; Murphy, Evan; Stes, Elisabeth; Nikonorova, Natalia; Ramakrishna, Priya; Czyzewicz, Nathan; Montero-Morales, Laura; Kumpf, Robert; Lin, Zhefeng; van de Cotte, Brigitte; Iqbal, Mudassar; Van Bel, Michiel; Van De Slijke, Eveline; Meyer, Matthew R; Gadeyne, Astrid; Zipfel, Cyril; De Jaeger, Geert; Van Montagu, Marc; Van Damme, Daniël; Gevaert, Kris; Rao, A Gururaj; Beeckman, Tom; De Smet, Ive

    2016-02-01

    In plants, the generation of new cell types and tissues depends on coordinated and oriented formative cell divisions. The plasma membrane-localized receptor kinase ARABIDOPSIS CRINKLY 4 (ACR4) is part of a mechanism controlling formative cell divisions in the Arabidopsis root. Despite its important role in plant development, very little is known about the molecular mechanism with which ACR4 is affiliated and its network of interactions. Here, we used various complementary proteomic approaches to identify ACR4-interacting protein candidates that are likely regulators of formative cell divisions and that could pave the way to unraveling the molecular basis behind ACR4-mediated signaling. We identified PROTEIN PHOSPHATASE 2A-3 (PP2A-3), a catalytic subunit of PP2A holoenzymes, as a previously unidentified regulator of formative cell divisions and as one of the first described substrates of ACR4. Our in vitro data argue for the existence of a tight posttranslational regulation in the associated biochemical network through reciprocal regulation between ACR4 and PP2A-3 at the phosphorylation level. PMID:26792519

  11. Photovoltaic system criteria documents. Volume 2: Quality assurance criteria for photovoltaic applications

    NASA Technical Reports Server (NTRS)

    Koenig, John C.; Billitti, Joseph W.; Tallon, John M.

    1979-01-01

    Quality assurance criteria are described for manufacturers and installers of solar photovoltaic tests and applications. Quality oriented activities are outlined to be pursued by the contractor/subcontractor to assure the physical and operational quality of equipment produced is included. In the broad sense, guidelines are provided for establishing a QA organization if none exists. Mainly, criteria is provided to be considered in any PV quality assurance plan selected as appropriate by the responsible Field Center. A framework is established for a systematic approach to ensure that photovoltaic tests and applications are constructed in a timely and cost effective manner.

  12. Revisiting Bioaccumulation Criteria

    EPA Science Inventory

    The objective of workgroup 5 was to revisit the B(ioaccumulation) criteria that are currently being used to identify POPs under the Stockholm Convention and PBTs under CEPA, TSCA, REACh and other programs. Despite the lack of a recognized definition for a B substance, we defined ...

  13. Laboratory Equipment Criteria.

    ERIC Educational Resources Information Center

    State Univ. Construction Fund, Albany, NY.

    Requirements for planning, designing, constructing and installing laboratory furniture are given in conjunction with establishing facility criteria for housing laboratory equipment. Furniture and equipment described include--(1) center tables, (2) reagent racks, (3) laboratory benches and their mechanical fixtures, (4) sink and work counters, (5)…

  14. Graphite criteria peer review

    SciTech Connect

    1986-09-01

    This report documents a review of the stress criteria proposed for the graphite components of the modular high temperature gas-cooled reactor (MHTGR) core. The review was conducted by a panel of six independent consultants, chosen for their expertise over a range of relevant disciplines.

  15. CRITERIA FOR COUNSELOR PERFORMANCE.

    ERIC Educational Resources Information Center

    MILLER, LEONARD A.; MUTHARD, JOHN E.

    THIS RESEARCH CONCERNS THE RELATIONSHIPS AMONG REHABILITATION COUNSELOR PERFORMANCE CRITERIA CURRENTLY BEING USED OR READILY AVAILABLE TO STATE VOCATIONAL REHABILITATION AGENCIES. THE 143 COUNSELORS STUDIED CAME FROM MIDDLE-SIZED AGENCIES IN SIX STATES AND, SINCE COWORKER RATINGS WERE REQUIRED, THE SAMPLE WAS LIMITED TO COUNSELORS WORKING WITH TWO…

  16. Correlation between AcrB trimer association affinity and efflux activity.

    PubMed

    Ye, Cui; Wang, Zhaoshuai; Lu, Wei; Zhong, Meng; Chai, Qian; Wei, Yinan

    2014-06-17

    The majority of membrane proteins function as oligomers. However, it remains largely unclear how the oligomer stability of protein complexes correlates with their function. Understanding the relationship between oligomer stability and activity is essential to protein research and to virtually all cellular processes that depend on the function of protein complexes. Proteins make lasting or transient interactions as they perform their functions. Obligate oligomeric proteins exist and function exclusively at a specific oligomeric state. Although oligomerization is clearly critical for such proteins to function, a direct correlation between oligomer affinity and biological activity has not yet been reported. Here, we used an obligate trimeric membrane transporter protein, AcrB, as a model to investigate the correlation between its relative trimer affinity and efflux activity. AcrB is a component of the major multidrug efflux system in Escherichia coli. We created six AcrB constructs with mutations at the transmembrane intersubunit interface, and we determined their activities using both a drug susceptibility assay and an ethidium bromide accumulation assay. The relative trimer affinities of these mutants in detergent micelles were obtained using blue native polyacrylamide gel electrophoresis. A correlation between the relative trimer affinity and substrate efflux activity was observed, in which a threshold trimer stability was required to maintain efflux activity. The trimer affinity of the wild-type protein was approximately 3 kcal/mol more stable than the threshold value. Once the threshold was reached, an additional increase of stability in the range observed had no observable effect on protein activity. PMID:24854514

  17. Structure of the AcrAB-TolC multidrug efflux pump

    PubMed Central

    Du, Dijun; Wang, Zhao; James, Nathan R.; Voss, Jarrod E.; Klimont, Ewa; Ohene-Agyei, Thelma; Venter, Henrietta; Chiu, Wah; Luisi, Ben F.

    2015-01-01

    The capacity of numerous bacterial species to tolerate antibiotics and other toxic compounds arises in part from the activity of energy-dependent transporters. In Gram-negative bacteria, many of these transporters form multicomponent ‘pumps’ that span both inner and outer membranes and are driven energetically by a primary or secondary transporter component1-7. A model system for such a pump is the acridine resistance complex of Escherichia coli1. This pump assembly comprises the outer-membrane channel TolC, the secondary transporter AcrB located in the inner membrane, and the periplasmic AcrA, which bridges these two integral membrane proteins. The AcrAB-TolC efflux pump is able to vectorially transport a diverse array of compounds with little chemical similarity, and accordingly confers resistance to a broad spectrum of antibiotics. Homologous complexes are found in many Gram-negative species, including pathogens of animals and plants. Crystal structures are available for the individual pump components2-7 and these have provided insights into substrate recognition, energy coupling and the transduction of conformational changes associated with the transport process. How the subunits are organised in the pump, their stoichiometry and the details of their interactions are not known and are under debate. In this manuscript, we present the pseudoatomic structure of a complete multidrug efflux pump in complex with a modulatory protein partner8. The model defines the quaternary organization of the pump, identifies key domain interactions, and suggests a cooperative process for channel assembly and opening. These findings illuminate the basis for drug resistance in numerous pathogenic bacterial species. PMID:24747401

  18. Characterization of a Novel Pyranopyridine Inhibitor of the AcrAB Efflux Pump of Escherichia coli

    PubMed Central

    Kwasny, Steven M.; Kim, Hong-Suk; Nguyen, Son T.; Houseweart, Chad; D'Souza, Sanjay; Walker, Graham C.; Peet, Norton P.; Nikaido, Hiroshi; Bowlin, Terry L.

    2014-01-01

    Members of the resistance-nodulation-division (RND) family of efflux pumps, such as AcrAB-TolC of Escherichia coli, play major roles in multidrug resistance (MDR) in Gram-negative bacteria. A strategy for combating MDR is to develop efflux pump inhibitors (EPIs) for use in combination with an antibacterial agent. Here, we describe MBX2319, a novel pyranopyridine EPI with potent activity against RND efflux pumps of the Enterobacteriaceae. MBX2319 decreased the MICs of ciprofloxacin (CIP), levofloxacin, and piperacillin versus E. coli AB1157 by 2-, 4-, and 8-fold, respectively, but did not exhibit antibacterial activity alone and was not active against AcrAB-TolC-deficient strains. MBX2319 (3.13 μM) in combination with 0.016 μg/ml CIP (minimally bactericidal) decreased the viability (CFU/ml) of E. coli AB1157 by 10,000-fold after 4 h of exposure, in comparison with 0.016 μg/ml CIP alone. In contrast, phenyl-arginine-β-naphthylamide (PAβN), a known EPI, did not increase the bactericidal activity of 0.016 μg/ml CIP at concentrations as high as 100 μM. MBX2319 increased intracellular accumulation of the fluorescent dye Hoechst 33342 in wild-type but not AcrAB-TolC-deficient strains and did not perturb the transmembrane proton gradient. MBX2319 was broadly active against Enterobacteriaceae species and Pseudomonas aeruginosa. MBX2319 is a potent EPI with possible utility as an adjunctive therapeutic agent for the treatment of infections caused by Gram-negative pathogens. PMID:24247144

  19. Structure of the AcrAB-TolC multidrug efflux pump.

    PubMed

    Du, Dijun; Wang, Zhao; James, Nathan R; Voss, Jarrod E; Klimont, Ewa; Ohene-Agyei, Thelma; Venter, Henrietta; Chiu, Wah; Luisi, Ben F

    2014-05-22

    The capacity of numerous bacterial species to tolerate antibiotics and other toxic compounds arises in part from the activity of energy-dependent transporters. In Gram-negative bacteria, many of these transporters form multicomponent 'pumps' that span both inner and outer membranes and are driven energetically by a primary or secondary transporter component. A model system for such a pump is the acridine resistance complex of Escherichia coli. This pump assembly comprises the outer-membrane channel TolC, the secondary transporter AcrB located in the inner membrane, and the periplasmic AcrA, which bridges these two integral membrane proteins. The AcrAB-TolC efflux pump is able to transport vectorially a diverse array of compounds with little chemical similarity, thus conferring resistance to a broad spectrum of antibiotics. Homologous complexes are found in many Gram-negative species, including in animal and plant pathogens. Crystal structures are available for the individual components of the pump and have provided insights into substrate recognition, energy coupling and the transduction of conformational changes associated with the transport process. However, how the subunits are organized in the pump, their stoichiometry and the details of their interactions are not known. Here we present the pseudo-atomic structure of a complete multidrug efflux pump in complex with a modulatory protein partner from E. coli. The model defines the quaternary organization of the pump, identifies key domain interactions, and suggests a cooperative process for channel assembly and opening. These findings illuminate the basis for drug resistance in numerous pathogenic bacterial species. PMID:24747401

  20. Description of Trichophoromyia ruifreitasi, a new phlebotomine species (Diptera, Psychodidae) from Acre State, Brazilian Amazon

    PubMed Central

    de Oliveira, Arley Faria José; Teles, Carolina Bioni Garcia; Medeiros, Jansen Fernandes; Camargo, Luís Marcelo Aranha; Pessoa, Felipe Arley Costa

    2015-01-01

    Abstract Trichophoromyia ruifreitasi sp. n. is described as a new species of sand fly from the genus Trichophoromyia Barretto. This description is supported with illustrations and photographs that detail the morphological characteristics of male specimens collected in the municipality of Assis Brasil, Acre State, Brazilian Amazon. This species is similar to Trichophoromyia auraensis (Mangabeira), but the two species can be easily differentiated by the distribution of setae on their parameres, and by the presence of a dorsal lobe in the parameres of the new species. PMID:26487825

  1. Comparison of European (ESR) and American (ACR) white papers on teleradiology: patient primacy is paramount.

    PubMed

    Ranschaert, Erik R; Boland, Giles W; Duerinckx, Andre J; Barneveld Binkhuysen, Frits H

    2015-02-01

    The ACR and European Society of Radiology white papers on teleradiology propose best practice guidelines for teleradiology, with each body focusing on its respective local situation, market, and legal regulations. The organizations have common viewpoints, the most important being patient primacy, maintenance of quality, and the "supplementary" position of teleradiology to local services. The major differences between the white papers are related mainly to the market situation, the use of teleradiology, teleradiologist credentialing and certification, the principles of "international" teleradiology, and the need to obtain "informed consent" from patients. The authors describe these similarities and differences by highlighting the background and context of teleradiology in Europe and the United States. PMID:25652303

  2. Characterization of AcrD, a Resistance-Nodulation-Cell Division-type multidrug efflux pump from the fire blight pathogen Erwinia amylovora

    PubMed Central

    2014-01-01

    Background Multidrug efflux pumps are membrane translocases that have the ability to extrude a variety of structurally unrelated compounds from the cell. AcrD, a resistance-nodulation-cell division (RND) transporter, was shown to be involved in efflux of highly hydrophilic aminoglycosides and a limited number of amphiphilic compounds in E. coli. Here, a homologue of AcrD in the plant pathogen and causal agent of fire blight disease Erwinia amylovora was identified. Results The substrate specificity of AcrD was studied by overexpression of the corresponding gene from a high-copy plasmid in E. amylovora Ea1189-3, which is hypersensitive to many drugs due to a deficiency of the major multidrug pump AcrB. AcrD mediated resistance to several amphiphilic compounds including clotrimazole and luteolin, two compounds hitherto not described as substrates of AcrD in enterobacteria. However, AcrD was not able to expel aminoglycosides. An acrD mutant exhibited full virulence on apple rootstock and immature pear fruits. RT-PCR analysis revealed an induction of acrD expression in infected apple tissue but not on pear fruits. Moreover, a direct binding of BaeR, the response regulator of the two-component regulatory system BaeSR, to the acrD promoter was observed as has already been shown in other enterobacteria. Conclusions AcrD from E. amylovora is involved in resistance to a limited number of amphiphilic compounds, but in contrast to AcrD of E. coli, it is not involved in resistance to aminoglycosides. The expression of acrD was up-regulated by addition of the substrates deoxycholate, naringenin, tetracycline and zinc. AcrD appears to be regulated by the BaeSR two-component system, an envelope stress signal transduction pathway. PMID:24443882

  3. Further Additional Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-04-04

    04/09/2011 Became Public Law No: 112-8. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 4/15/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  4. Consolidated and Further Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Kingston, Jack [R-GA-1

    2011-06-03

    11/18/2011 Became Public Law No: 112-55. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 12/16/2011. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  5. An Appropriate Education. 1998 AVERA President's Address.

    ERIC Educational Resources Information Center

    Stitt-Gohdes, Wanda

    1999-01-01

    Suggests that public schools have failed to ensure an appropriate education for all students. Urges the provision of meaningful, cohesive educational experiences for all, rather than labeling or tracking into college prep/vocational education. (SK)

  6. Operating Budget Appropriation and Supporting Technical Data for the Illinois Public Community College System, Fiscal Year 2002.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    This document provides detailed tables of the operating budget appropriation for the Illinois public community college system for fiscal year 2002. This document reflects final audited data and revised decision criteria affecting the appropriation for the community college system. Figures detailed in this report include basic instruction resource…

  7. Chautauqua notebook: appropriate technology on radio

    SciTech Connect

    Renz, B.

    1981-01-01

    Experiences in establishing and maintaining a regional call-in information-exchange radio show (Chautauqua) on energy conservation, appropriate technology, renewable energy sources, and self-reliance are discussed. Information is presented on: appropriate technology; the Chautauquaa concept; topics discussed; research performed; guests; interviewing tips; types of listeners; program features; where to find help; promotion and publicity; the technical and engineering aspects; the budget and funding; and station policies. (MCW)

  8. Myalgic encephalomyelitis: International Consensus Criteria

    PubMed Central

    Carruthers, B M; van de Sande, M I; De Meirleir, K L; Klimas, N G; Broderick, G; Mitchell, T; Staines, D; Powles, A C P; Speight, N; Vallings, R; Bateman, L; Baumgarten-Austrheim, B; Bell, D S; Carlo-Stella, N; Chia, J; Darragh, A; Jo, D; Lewis, D; Light, A R; Marshall-Gradisbik, S; Mena, I; Mikovits, J A; Miwa, K; Murovska, M; Pall, M L; Stevens, S

    2011-01-01

    , Japan; A. Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia; Department of Biochemistry & Basic Medical Sciences, Washington State University, Portland, OR; Department of Sports Sciences, University of the Pacific, Stockton, CA USA). Myalgic encephalomyelitis: International Consensus Criteria (Review). J Intern Med 2011; 270: 327–338. The label ‘chronic fatigue syndrome’ (CFS) has persisted for many years because of the lack of knowledge of the aetiological agents and the disease process. In view of more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology, it is more appropriate and correct to use the term ‘myalgic encephalomyelitis’ (ME) because it indicates an underlying pathophysiology. It is also consistent with the neurological classification of ME in the World Health Organization’s International Classification of Diseases (ICD G93.3). Consequently, an International Consensus Panel consisting of clinicians, researchers, teaching faculty and an independent patient advocate was formed with the purpose of developing criteria based on current knowledge. Thirteen countries and a wide range of specialties were represented. Collectively, members have approximately 400 years of both clinical and teaching experience, authored hundreds of peer-reviewed publications, diagnosed or treated approximately 50 000 patients with ME, and several members coauthored previous criteria. The expertise and experience of the panel members as well as PubMed and other medical sources were utilized in a progression of suggestions/drafts/reviews/revisions. The authors, free of any sponsoring organization, achieved 100% consensus through a Delphi-type process. The scope of this paper is limited to criteria of ME and their application. Accordingly, the criteria reflect the complex symptomatology. Operational notes enhance clarity and specificity by providing guidance in the

  9. Individualized Education Program and Appropriate Placement in the Least Restrictive Environment. Technical Assistance Document.

    ERIC Educational Resources Information Center

    Arizona State Dept. of Education, Phoenix. Div. of Special Education.

    This document, designed to support Arizona's special education state plan, establishes minimum standards for Individualized Education Programs (IEPs), provides a measurement tool for determining compliance with federal and state requirements, and establishes criteria for determining appropriate placement in the least restrictive environment. The…

  10. Do Picture Books about Starting Kindergarten Portray the Kindergarten Experience in Developmentally Appropriate Ways?

    ERIC Educational Resources Information Center

    Phillips, Eva C.; Sturm, Brian W.

    2013-01-01

    This study examines the illustrations and the texts of thirteen picture books for young children on the topic of preparing for and starting kindergarten to assess whether, and to what extent, they depict forty-nine criteria for developmentally appropriate kindergarten practice. Results show that the books vary in quality and coverage, but they are…

  11. Preparing Books for Children from Birth to Age Six: The Approach of Appropriateness for the Child

    ERIC Educational Resources Information Center

    Çer, Ekran

    2016-01-01

    Children's books must primarily be appropriate for children so that they could be a significant stimulus in children's lives. In other words, it is essential that the concepts child reality, literary criteria and artist sensitivity be reflected in books in order to create children's books. From birth to age 6, the fact that children's books are…

  12. 23 CFR 636.202 - When are two-phase design-build selection procedures appropriate?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ENGINEERING AND TRAFFIC OPERATIONS DESIGN-BUILD CONTRACTING Selection Procedures, Award Criteria § 636.202 When are two-phase design-build selection procedures appropriate? You may consider the following... 23 Highways 1 2011-04-01 2011-04-01 false When are two-phase design-build selection...

  13. Unified nonclassicality criteria

    NASA Astrophysics Data System (ADS)

    Ryl, S.; Sperling, J.; Agudelo, E.; Mraz, M.; Köhnke, S.; Hage, B.; Vogel, W.

    2015-07-01

    In this work we generalize the Bochner criterion addressing the characteristic function, i.e., the Fourier transform, of the Glauber-Sudarshan phase-space function. For this purpose we extend the Bochner theorem by including derivatives of the characteristic function. The resulting necessary and sufficient nonclassicality criteria unify previously known moment-based criteria with those based on the characteristic function. For applications of the generalized nonclassicality probes, we provide direct sampling formulas for balanced homodyne detection. A squeezed vacuum state is experimentally realized and characterized with our method. This complete framework—theoretical unification, sampling approach, and experimental implementation—presents an efficient toolbox to characterize quantum states of light for applications in quantum technology.

  14. The 2014 ACR annual meeting: a bird's eye view of autoimmunity in 2015.

    PubMed

    Selmi, Carlo; Cantarini, Luca; Kivity, Shaye; Dagaan, Amir; Shovman, Ora; Zandman-Goddard, Gisele; Perricone, Carlo; Amital, Howard; Toubi, Elias; Shoenfeld, Yehuda

    2015-07-01

    Our understanding of the mechanisms leading to rheumatic diseases is growing at unprecedented pace thanks to the worldwide network of clinical and translational researchers who gather at major scientific meetings to share their progresses. Further, these meetings allow the contamination of unrelated research areas and thus the spreading of ideas, hypotheses, and research tools. The annual meeting of the American College of Rheumatology (ACR) serves this purpose by allowing thousands of rheumatologists, immunologists, health care professionals, and basic scientists to attend the same sessions and present their work. The 2014 ACR meeting was held in Boston, MA, and was attended by over 16,000 participants who had the opportunity to directly witness the presentation of over 3000 abstracts. As such is the case, a full attendance of all update opportunities was not feasible. To fill this gap we arbitrarily selected the abstracts the appeared most interesting in a few fields of interest and we herein discuss the presented data and their further implications. In particular, we were intrigued by research advances in biomarkers for rheumatic diseases, and by advances on Sjögren syndrome, neuropsychiatric systemic lupus erythematosus, fibromyalgia, and B cell mechanisms. While we are well aware of the numerous blind spots that are expected in this type of article, we submit that this is far from a comprehensive overview and refer to the abstract book for a more complete analysis of the presented abstracts. PMID:25801806

  15. New platyrrhine monkeys from the Solimões Formation (late Miocene, Acre State, Brazil).

    PubMed

    Kay, Richard F; Cozzuol, Mario Alberto

    2006-06-01

    We report here a new fossil primate from the late Miocene of Brazil. The material consists of a lower first molar and a maxilla with P3-4. The fossils were collected in the Solimões Formation at the locality of Patos, upper Acre River, Acre State, Brazil. The locality is assigned to the Huayquerian South American Land Mammal Age based on faunal content (late Miocene; dated to between 9 and 6 Ma). The new material is the oldest known occurrence of fossil primates in Brazil and is recognized as a new genus and species, Solimoea acrensis. Solimoea is the oldest known member of the ateline subfamily, which includes the living genera Ateles, Lagothrix, and Brachyteles. By analogy with the molar structures and diets of extant platyrrhines, Solimoea primarily had a diet of fruit, perhaps similar to that of the spider monkey, Ateles. Two other primate teeth described previously from the same formation in Bolivia document the occurrence of alouattines and cebines. One of those specimens is a late Miocene representative of the middle Miocene Colombian genus Stirtonia. The other represents one of the largest known platyrrhine primates, for which is erected a new primate genus, Acrecebus fraileyi. PMID:16530809

  16. Demystifying "oxi" cocaine: Chemical profiling analysis of a "new Brazilian drug" from Acre State.

    PubMed

    da Silva Junior, Ronaldo C; Gomes, Cezar S; Goulart Júnior, Saulo S; Almeida, Fernanda V; Grobério, Tatiane S; Braga, Jez W B; Zacca, Jorge J; Vieira, Maurício L; Botelho, Elvio D; Maldaner, Adriano O

    2012-09-10

    Recent information from various sources suggests that a new illicit drug, called "oxi", is being spread across Brazil. It would be used in the smoked form and it would look like to crack cocaine: usually small yellowish or light brown stones. As fully released in the media, "oxi" would differ from crack cocaine in the sense that crack would contain carbonate or bicarbonate salts whereas "oxi" would include the addition of calcium oxide and kerosene (or gasoline). In this context, this work presents a chemical profiling comparative study between "oxi" street samples seized by the Civil Police of the State of Acre (CP/AC) and samples associated with both international and interstate drug trafficking seized by the Brazilian Federal Police in Acre (FP/AC). The outcome of this work assisted Brazilian authorities to stop inaccurate and alarmist releases on this issue. It may be of good use by the forensic community in order to better understand matters in their efforts to guide local law enforcement agencies in case such claims reach the international illicit market. PMID:22571827

  17. PML diagnostic criteria

    PubMed Central

    Aksamit, Allen J.; Clifford, David B.; Davis, Larry; Koralnik, Igor J.; Sejvar, James J.; Bartt, Russell; Major, Eugene O.; Nath, Avindra

    2013-01-01

    Objective: To establish criteria for the diagnosis of progressive multifocal leukoencephalopathy (PML). Methods: We reviewed available literature to identify various diagnostic criteria employed. Several search strategies employing the terms “progressive multifocal leukoencephalopathy” with or without “JC virus” were performed with PubMed, SCOPUS, and EMBASE search engines. The articles were reviewed by a committee of individuals with expertise in the disorder in order to determine the most useful applicable criteria. Results: A consensus statement was developed employing clinical, imaging, pathologic, and virologic evidence in support of the diagnosis of PML. Two separate pathways, histopathologic and clinical, for PML diagnosis are proposed. Diagnostic classification includes certain, probable, possible, and not PML. Conclusion: Definitive diagnosis of PML requires neuropathologic demonstration of the typical histopathologic triad (demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei) coupled with the techniques to show the presence of JC virus. The presence of clinical and imaging manifestations consistent with the diagnosis and not better explained by other disorders coupled with the demonstration of JC virus by PCR in CSF is also considered diagnostic. Algorithms for establishing the diagnosis have been recommended. PMID:23568998

  18. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria.

    PubMed

    Dubois, Bruno; Feldman, Howard H; Jacova, Claudia; Hampel, Harald; Molinuevo, José Luis; Blennow, Kaj; DeKosky, Steven T; Gauthier, Serge; Selkoe, Dennis; Bateman, Randall; Cappa, Stefano; Crutch, Sebastian; Engelborghs, Sebastiaan; Frisoni, Giovanni B; Fox, Nick C; Galasko, Douglas; Habert, Marie-Odile; Jicha, Gregory A; Nordberg, Agneta; Pasquier, Florence; Rabinovici, Gil; Robert, Philippe; Rowe, Christopher; Salloway, Stephen; Sarazin, Marie; Epelbaum, Stéphane; de Souza, Leonardo C; Vellas, Bruno; Visser, Pieter J; Schneider, Lon; Stern, Yaakov; Scheltens, Philip; Cummings, Jeffrey L

    2014-06-01

    In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD. PMID:24849862

  19. Appropriate assessment of plans in England

    SciTech Connect

    Therivel, Riki

    2009-07-15

    'Appropriate assessment' of plans and projects is required under the European Habitats Directive. It assesses whether a plan or project, 'in combination', could affect the 'integrity' of sites of international nature conservation importance in Europe. It is very precautionary: plans or projects that could affect site integrity may not be adopted unless a series of stringent requirements-testing of alternatives, proof of overriding need, and provision of compensation-are met. Appropriate assessment of plans began to be carried out in England in early 2006. Since then, various guidance documents have been published, but there is still considerable debate about just what methodology should be used, how to test impacts on site 'integrity', what avoidance and mitigation measures are adequate, who should be responsible for these measures etc., and even about what the process should be called. The first legal challenges based on appropriate assessment of plans are emerging. Appropriate assessments are showing that many English plans could affect European sites, either directly through land take, or indirectly by, for instance, reducing water levels or increasing recreational disturbance. The question now is how to respond to the clash between people's aspirations for new homes and economic growth, and wildlife conservation. This article discusses the legal requirements and emerging guidance on appropriate assessment of plans in England, how it relates to strategic environmental assessment, the current status of these assessments, and emerging issues.

  20. Simulated microgravity affects ciprofloxacin susceptibility and expression of acrAB-tolC genes in E. coli ATCC25922.

    PubMed

    Xu, Bingxin; Li, Chenglin; Zheng, Yanhua; Si, Shaoyan; Shi, Yuhua; Huang, Yuling; Zhang, Jianzhong; Cui, Yan; Cui, Yimin

    2015-01-01

    As a representative fluoroquinolone antibacterial, ciprofloxacin is frequently used to treat infections caused by bacteria such as E. coli. It is much meaningful to explore ciprofloxacin susceptibility and investigate a possible mechanism of drug susceptibility changes in E. coli ATCC25922 exposed to the environmental stress of simulated microgravity. The subculture of E. coli lasted for 7 days under simulated microgravity conditions (SMG) and normal microgravity (NG) conditions. On the 8th day, the cultures were divided into three groups: (1) NG group (continuous NG cultures); (2) SMG group (continuous SMG cultures); (3) SMCNG group (simulated microgravity change into normal gravity cultures). Ciprofloxacin (a final concentration of 0.125 μg/ml) sensitivity and expression of acrAB-tolC genes were detected in E. coli cells. The count and percentage of viable cells in the SMG cultures bacteria exposed to ciprofloxacin were higher than that in NG cultures and reduced to the levels of NG group when they were subcultivated from SMG to NG. The expressions of efflux pump genes (acrA, acrB and tolC) were upregulated in SMG culture and downregulated to the levels of NG group when they were subcultivated from SMG to NG. Susceptibility to ciprofloxacin and expression of acrAB-tolC genes in E. coli could be reversibly affected by SMG conditions. Over expression of efflux pump genes acrAB-tolC perhaps played an important role in decreased CIP susceptibility under SMG. PMID:26339360